HomeMy WebLinkAbout277 OGLE ST - Building Permits�. i
CITY OF COSTA MESA
BUILDING DIYISION
77 FAIR DRIVE, COSTq MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER: BC07-00004
PERMIT TYPE: B COMBO
Sub Type: RES_ALT
JOB ADDRESS: 277 OGLE ST CM ".
APN: 42522207
Zoning: , ,
STATUS: ISSUED
DATE ISSUED: 08/23/2007
ISSUED BY:
Suite/Unit: -
Vicinity: Primary Occ:
Const Type: V-N ,..' So: FT' 2040 ' Valuation:. $50,000.00
SCOPE OF WORK: CONVERT TRIpLEX TO 3 CONDOMINIUMS. UNITS A, B AND C.
INSTALL 35FIXTURES, 200UTLETS, 10SWITCHES 3SUBPANELS AND 3SERVICES (100AMP) , 3FAU, 3COFFEE CONNECT,
3DISHWASHERS, 3GASREPIPE, 3LANDSCAPE IRRIGATION, 3LAUNDRY TUBS, 1PRESSURE REGULATOR, 3SHOWERS,
3KITCHEN SINKS, 3WASFI BASINS, SWATER CLOSETS, 3WATER HEATERS, 3WATER REPIPE, 3WATER SERVICES.
PA-06-49
OWNER: SAYWITZ, JEF.FREY _
BEACH,CA
Phone:
APPLICANT: JOE PAMCINO
Phone: 949-264�819
CONTRACTOR:
Phone:
Cell:
ARCHITECT: ROBERT STERN ARCHITECT -- -
ENGINEER:
COMBINTATION PERMIT FEE SUMMARY
Building Plan Check: $418.76
Building Fees: $644.25
Electrical Fees: $272.45
Mechanical Fees: $68.50
Plumbing Fees: $420.70
SMIP Residential: $5.00
SMIP Commercial: $0.00
TOTAL FEES: $1,829.66
"RMer to fee recNpts ior all fces paiU fa proJect
Address: SUITE 100
City/StatelLip: 4740 VON KARMAN AVE
Address:
CitylState/zZip: - ..
Address: Unit:
City/State:�� � ..
License No.C18885
Lice�� w+- .
License No.
' Unit: NEWPORT
Unit: :
2ipCode
PHONE:714S562656
PHONE:
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenLS 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 fnal approval will result in the expiration of this permit.
CODE1. INSiECTIONTYPE DATE INTITIAlS CODEI INSPECTIONTVPE DRTE INTITIA�S
ifit6 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Elecirical
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 0uiltlinglOccupancy Y _ ��� V
!.
WORKERS' COMPENSATION DECLARA710N:
I hereby aKrm under penalry of perjury one of the following tleclarations:
C] I have and will main[ain a certificate of consent to self-Insure for workers'
�bmpensation, as provided for by section 3700 ot Ihe La6or Cotle, for the
p@Aormance ot the wurk !or which lhis permit is issued.
p I have and will maintain wvrkers' compensation insurance, as required by
sCclion 3700 of the La6or Code, for the pedortnance of the vrork for which this
p0rtnit is issued. My vrorkers' compensation Insurance cartier and policy
number are:
Carrier:
(iNs sectpn neetl mt Oe rompetetl d(he pemul a valueC at one nunOreO ba'Wrsl5100) wless )
Policy Number:
❑ I certiFy Ihat in the pedomnance of the work (or which"this pertnit is
issued, I shall not employ any person in any manner so as to become subject
to Ihe workers' compensation laws of Califomia, antl agree that if I should
become subject to the workers' compensadon provisions o! Section 3700 of
the Labor Code, I shall forthwith wmpty with these provisions.
AppGfanl'S 5i9riaWre Dale
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNL4WFUL AND SHALL SUBJECT AN EMPIOVER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNORED THOUSAND DOLLAF2S
(S100,000), IN ADDfTIpN TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR.CODE, INTEREST, AND
A770RNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby a�rm [hat I am licensed under provisions o( Chapter 9(commencing
with Section 7000) of Division 3 of Ihe Business and Professions Code. and
my license is in tull force antl eKect.
Lic. # Class #
GontracmYs SignaWre Da�e
CONSTRUCTION LENDING AGENCY:
❑ I hereby affum that there is a construction lending agency for the
pedortnance of the v.vrk fa wfiich this pertnit is issued. (Sec. 3097, Gvil Code).
Lentler's Name:
Lender's Atldress:
SB�aWre Oa�e
OWNER-BUILDER DFCLARATIONS:
� hereby aKrm that under penalty of perjury that I am EXEMPT FROM iHE
CONTRACTORS LICENSE LAW (or [he follovring reason (Sec. 7031.5,
8usiness and Professions Cotle: Any ciry or counry which requires a permit to
conslmct, alter, improve, demolish, or repair any strucNre, prior to its
issuance, also requires the applicant (or such permit to fite a signed statement
that he or she is licensetl pursuant to [he provisions of the Contractors
4icense Law (Chapler g(commencing with Section 7000) of Division 3 of Ihe
6usiness and Professions Code) or that he or she is exempt therefrom and
the basis fpr ihe allegetl exemption. A�y violation of Section 7031.5 by any
applicant for a permit subjec[s the applicant to a civil penalty of not more lhan
flve hundred dollars ($500).�:
❑ I, as ovmer o( the property, or my employees with wages as their sole
Compensation, WILL DO THE WORK, and Ihe structure is not intended or
oHered for sale (Sec. 7044, Business and Professions Code: The Contractors
license Law does not apply to an owner of property who builtls or improves
�hereon, and who does such work himself or herself or through his or her own
employees, provided itiat such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of
Completioq the owner-builder will have lhe burden of proving Ihal he or she
did no[ build or improve for purpose of sale.).
[] I, as ovmer ol the propeRy, am EXC�USIVELY CONTRAC7ING WI7H
IICENSED CONTRACTORS to construct the project (Sec. 7044, Business and
Professions Code: The cont2ctors License Law dces not appty to an owner of
property who builds or improves thereon, and who contracts for such project with
a caitractor(s) license pursuant to the Convactors License Lav.s.).
❑ I am exempt under sec. �
9usiness antl Professions Cotle for this reason:
305]<6 (J/O])
1
Owner ID venfied by drive .se. ❑ Yes ❑ Nd " '
Driver's License No. Expires:
Verifcation of Ownership by (lype of document, i.e. - property tax bill or deed):
'DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 hereby certAy Ihat no excavation frve (5) or more (eet in depth into wfiich a
person is reQuired to descentl. will be matle in connectio� with woM autlronzed
by this pertnit, and that no building sWcWre, scaffdding, falsework, a tlemolilbn
or tlismanlling thereof, will be more lhan thirty-six (36) feet �igh. (Chap. 32, Grp
2, Ari 2, Sec. 341, Title 8, Califomia Atlminist2live Code).
❑ As ovmer•builder, I will not employ anyone to do work which would
require a permit from Ihe Division of Industrial Safery, as noted above, unless
such person has a pertnit lo do such work (rom the division.
Applitanl'S SignaWre Dale
Oivision of Industrial Safety Permit Number:
HAZARDOUS MATERIAIS AND EMISSIONS CERTIFICATION:
1. Will the appliwnt or present or future building occupant need to file antl
certi(y a Business Plan for emergency response to release or lhreatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 ot the Califomia Health and Safery Code requires, with some
exceptions, ihat a Business Plan be filed with [he Costa Mesa Fire
Departmenl hy every business which has at any one time during a reported
year a quantiry of �azartlous matenals equal lo or greater than a weight of
500 pounds, or a volume ot 55 gallons, or 200 cubic feet of compressed gas
at stantlard temperature and pressure).
2. Does or will the appliwnt or preseM or fuWre building occupant need to file
a regisVation fortn lor acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the Calilomia Heallh and Safely Cotle, with some
eaceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one lime has on hand a quanlity of acutely
hazardous matenals 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 ro
prepare an RMPP (Risk Managemenl and Prevention Program for acutely
hazardous materials)? ❑ Ves ❑ No
(Seclion 25534 of the Califomia Health and Safery Coae provides that the
Costa Mesa Fire Department may require the preparation, certifcation and
fling with ihe Fire Department of an RMPP by businesses which are required
to regis[er acutey hazardous materials with the Fire Department.
4. If an RMPP is presently requiretl, has Section 25534 of the Califomia
Health antl Safety Cotle been fully complied with? ❑ Yas ❑ No
5. Does or wil7 the applicant or present or (uture boiiding occupant require !or
the work which is the subject of this application a permit for such conswction
or modifcation from Ihe SoWh Coast Air Qualiry Management Distnct or fiom
any other air pollution control distnct or agency7 ❑ Yes ❑ No
(Sectbn 65850,2 of the Califomia Govemment Code requires that the requested
information be fumishetl on applications (or non-residenlial building permits).
6. Will any part of the (aciliry to be constructed under Ihis permit he vnthin
1000 teet from lhe outer Oountlanes ot a schoolT ❑ Yes ❑ No
(If "yes", the faciliry must meet Ihe requirement of Sec�ions 25534 and 42303
of the California Health and Safery Code).
7. If a permit from the South Coast Air Quality Management District or other
air poNution control district or agency is required for the work which is lhe
su6jecl ot Ihis application, have all of the disclosures prescribetl by Califomia
Health antl Sa(ery Cotle Seclion 42303 been made? ❑ Yes ❑ No
8. pt'yes", aqach certi�cate of compliance from the appropriate air pollution
conlrol oKcer).
CERTIFICATE OF COMPLIANCE: I certify that under penalry of perjury the
inlormation given above is correcL I agree lo comply wilh all state laws and
ciry ortlinances regartlinq Haiardous Materials and Emissions. •
Signalure
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalry of perjury that I have read this application and state that
the information given is correct. 1 agree to comply vnth all state laws and city
ordinances relating to builtling construction, and authorize representatives of
the City of Costa Mesa to enter upon the above-descnbed property (or
inspection purposes. I agree not to occupy or allow occupancy o! any building
authonzed by this permit until final inspection.
Sgnawre ol Legal Owner(5)
Antllw Aut�aizeE AOdiwm Dale
�.
O M
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:
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*e� �^.
PERMIT TYPE
Sub Type:
, ; •
CITY OF COSTA MESA
BUILD/NG D/V/S/ON
77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • Hv+w.ci.costa-mesa.ca.us
FOR INSPECTIONS CAIL: (714) 754-5626
B COMBO
RES ALT
�oB ,nDDRess: 277 OGLE ST CM
APN: 425222W
Vicinity:
Const Type: V-N
PERMIT NUMBER: BC07-00004
STATUS: ISSUED
DATE ISSUED: OS/23/2007
- ISSUED BY:
SuitelUnit:
Zoning: , ,
. Primary Occ: �
SQ. FT: 2040
SCOPE OF WORK: CONVERT,TRIPLEX TO 3 CONDOMINIUMS. UNITS A, B AND C.
PA-06-49
OWNER: SAYWITZ, JEFFREY � Address: SUITE 100
BEACH,CA
Phone: Ciry/S�ate(Zip: 4740 VON KARMAN AVE
APPLICANT: JOE P�.AICINO
Phone: 949-254-5819
CONTRACTOR:
Phone:
Cell:
ARCHITECT: ROBERT STERN ARCHITECT
ENGINEER: -
Address:
City/Slale/zZip:
Address: Unit
Ciry/State:
License No.C16865 �
License No. � ��
COMBINTATION PE_RMIT FEE SU_MMARY
Building Plan Check: 5418.76
Building Fees: 5644.25
Electrical Fees: 50.00
Mechanical Fees: � � $0.00
Plumbing Fees: � $0.00
SMIP Residential: $5.00
SMIP Commercial: $0.00
TOTAL FEES: $1,068.01
"Refer ro fee receipts for all tees paid for prqoct
License No.
a
Valuation
$50,000.00
Unit: NEWPORT
Unit: :
ZipCode
.� PHONE714-556-2656
PHONE:
NOTICE: The work autho�ized by this permit shall comply with all applicable handicap access requirements under Califomia 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 authonzed under this permit to be wnsidered legal, such work must comply with all applicable codes, and all
required inspections and flnal approval musl be obtained. Failure to obtain inspections and final approval will result in the expiration o( this permit.
90�EN INSPELTIONTYPE ORTE IN111W� CODEN INSPECTIONTYPE DRTE INR71AL5
1676 Fixed System Final FirB Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electncal
201 Final BIocWRetaining Wall 212 Final Fire Prevenlion
202 Final Factory Fire PIacG 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
�NORKERS' COMPENSATION DECLARATION:
I hereby aKrm under penalty o! perjury one of the (ollowing decla2tions:
Q I have and will maintain a certificate o( consent to sel4lnsure for wprkers'
cOmpensation, as provided tor by section 3700 of Ihe-Labor Code, for the
pedormance o( the work (or which this permit is issuetl.
❑ 1 have and wiil maintain workers' compensation insurance, as required by
section 3700 of Ihe lahor Code, (a Ihe performance of the Hork (w vfiich this
pNrtnil is issuetl. My workers' compensation Insurance carrier and policy
n4mber are:
Carrier:
(T�is sedqn neetl rrof 6e comdetM /lhe pemW u✓dlued af ine �untlttd abtlars (E100) mbss.)
POlicy Number:
❑ I certify that in the pedormance of the work !or vfiich this pertnit is
issued, I shall nol employ any person in any manner so as to become subject
to the workers' compensation laws ot California, and agree that i! I should
become subject to the workers' compensation provisions of Section 3700 0(
�he La6or Cotle, I shall forthwith comply with lhese provisions.
AOO�iwnYs Signalure
NIARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNfAWFUL AND SHALL SUBJEC7 AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLAF2S
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND
A7TORNEY'S FEES.
LICENSED CONTRACTORS DECIARATION:
I hereby affirm that I am licensetl untler provisions of Chapier 9(commencing
with Section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force and effect.
l.ic. # Class #
GpnVacler's Sie�lure pare
CONSTRUCTION LENDING AGENCY:
C] I hereby affum that there is a constructbn lendinq agency for the
performance of the work ta which this permit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lentler's Address:
S�9natpre Da�e
OWNER-BUILDER DECLARATIONS:
i hereby aRrm that under penalty of perjury thal I am EXEMPT FROM THE
CONTRACTORS tICENSE LAW for [he following reason (Sec. 7037.5,
Business antl Professions Cotle: Any city or county which requires a permit to
cnnswct, alter, improve, dem01i5h, or repair any slruclure, pdor to its
issuance, a150 requires the applicant for such permit ro fle a signed statement
�hat he or she is licensed pursuant ro the provisions of the Conlraclors
Li�ense Law (Chapter 9(commencing with Section 7000) ot Division 3 0( the
Business antl Professions Code) or Ihat he or she is exempt therefrom and
�he basis for the allegetl exemption. Any violalion o( Section 7031.5 by any
applicant for a permit subjects the applicant to a civil penalry of not more than
(ve hundred tlollars ($500).):
� I, as owner of the property, or my employees vrith vrages as their sole
compensation, WILL DO 7HE WORK, and the structure is not intended or
oHered for sale (Sec. 7044, Business and Professions Cotle: The Conlractors
License Law dces not apply to an owner of property who 6udds o� improves
�hereon, and who does such work himself or herself or through his or her own
employees, provided that such improvements are not intended or offered (or
sale. If, however, the �building or improvement is so10 within one year of
completion, the owner-builder will have the burden of proving thal he or she
did not build or improve for purpose o! sale.).
[] I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS lo conswct the project (Sec. 7044, Business and
Professbns Code: The contractors License Law dces not apply to an ovmer of
property who builds or improves ihereon, antl who contracts for such prqect with
a contractor�s) license pureuant to the Contractors license Lavrs.).
[] I am exempt under sec. -
Business antl Professions CoOe for thfs reason:
�� �� _
-�
Ovmer ID verified by drive .se, ❑ Yes ❑ No � '
Dnver's�icenseNo. / pves: �� 0 7
Verification of Ownership by (type of documenC i.�perty taz bill or tleetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certAy that no excavation frve (5) or more feel in depth into which a
pereon is required to tlescend, will be made in connectbn wiih vrork authonzed
by this permit, and that no building sWcture, scaffdding, falsewnrk, a Cemolitbn
or di5man0ing thereof, will be more [han lhirty-six (36) feet high. (Chap. 32, Grp
2, Art 2, Sec. 341, Ttle 8, Califomia Administrative Cotle).
❑ As owner-builder, I will not employ anyone to do work which woultl
require a permi[ from tha Division of IndusMal Safety, as noted above, unless
such person has a permit to do such work from the division.
Applicanl's SignaWre
Divisfon of Indusirial Sa(ety Pertnit Number. _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future building occupant need to fle antl
certify a Business Plan for emergency response to release or threatened
release of a hazardous material4 ❑ Yes 0 No
(Section 25505 ot 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 aoy one time during a repotled
year a quantity of hazardous matenals equal to or greater than a weight ot
500 pounds, or a volume of 55 gallons, or 200 cubic leet o( compressed gas
at standard temperature and pressure).
2. Does or will the applicant or p�eseN or fuWre building occupant neetl ro file
a registralion lorm for acUtety hazartlous matenals? ❑ Yes ❑ No
(Section 25533 of the Califomia Heallh and Safety Code, wiN some
exceplions, requires registration with Ihe Cosla Mesa Fire Department by
each business which at any one time has on hand a quantity of acu[ely
hazardous materials equal to or greater tl�an a wei9ht of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet o( compressed gas at standard
temperature and pressure).
3. Does or wiil the applicant or present or future builtling occupant need to
prepare an RMPP (Risk Management and Prevention Program for acuiely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of lhe Califomia Health and Safery Cotle provides that the
Costa Mesa Fire Department may require the preparation, certification and
fling vrilh the Fire Department of an RMPP by businesses which are required
lo register acutely hazartlous materials with the Fire Department.
4. If an RMPP is presently requiretl, has Section 25534 of the Califomia
Health and Sa(ety Code been fully complied vriN? � Yes ❑ No
5. Does or will the applicant or present or fuWre building occupant require for
the vrork which is fhe subjecl of [hi5 applicaGon a permit (or SUGh COnSimCliOn
or modifGatiOn from the South Coast Air �ualiry Managemen� Distric[ or from
any other air pollution control district or agency? ❑ Ves � No
(Sectbn fi58502 of the Califomia Govemment Code requires Ihat the requested
in(ormation be (umished on applications !a rron-residential buiiding pertnits).
6. Will any part ot Ihe (acility to be construcled under this permit be vnt�in
1000 feet from the outer bountlaries of a school? ❑ Yes ❑ No
Qf "yes", Ihe faciliry must meet the requirement o( Seclions 25534 and 42303
of �he Caiifornia Health and Safery Code�.
7. If a permit from the South Coast Air Qualiry Management DisMct or other
air polWtion coNrol district or agency is required for the vrork which is the
subject ol this application, have all of the disclosures prescribed by Califomia
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. Qf yes", attach certificate of compliance Irom the appropriate air pollution
control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
information given above�is correcL I agree to comply vnth ali state laws and
ciry ordinances regarding Hazardous Materials antl Emissions.
SignaWre oa�e
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury lhat I have read this application and state that
the information given is wrrect. I agree to comply with all state laws and city
ordinances relating to building construction, and auihorize represenWtives of
[he City o( Costa Mesa ro enter upon the above-described property for
inspectibn purposes. I agree not ro occupy or allow occupancy of any building
authonzed by this permit until final inspection.
' 23'��� SgnaWr gal Owner�s) Date
oaie � �f]iLC'/�-e�l / ��o� 3'�
� Ana/orAulnorrzeaApvliWnt Da�e
�""'i' "D" �� /r�e¢CL �A��� f/iuidlQ4L
OWNER-BUILDER
VERIFiCAT10N
Address: Z% 7 �f �� Permit #:
A city or county, which is required ro give notice pursuant to Section 19830, shall attach to such notice, and, as
a condition precedent to issuing a building perniit, require the co�npletion and require the retum of, an owner-
builder verification. ,. - .
Attention Property Owner:
An bwner-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 permiL No buildingpermit will be issued until this
verification is received.
1 personally plan to provide the major labor and materials for construction of the proposed
property improvement. � Yes ❑ No
2. I (have/have not) _
the proposed work.
signed an applica[ion for a buitding permii for
3. [ have contracted with the following person (fimi) to provide the proposed construction:
Name
Address
Phone (
City _
Contractor's Lic. No.
4. 1 plan to provide portions of the work, but I have hired [he following person to coordinate,
supervise and provide the major work:
Name
Address �
Phone ( )
City _
Contractor's Lia No.
5. [ will provide some of the work but 1 have contrac[ed (hired) the following persons to
provide die work indicated:
Name
Address
Phone Type of �Vork
10aa_a6 IRev.ii/o4) •
DECLARATION OF AUTHORITY BIdg.Permit#
FOR AGENTS OF PROPERTY OWNER This Permit #
TO APPLY FOR PERMITS
Street Address: � 7 7 �l �ti
AP Number:
1.QI we), '�`�" �'] v �l ��Z. , declare that I am the Owner oi Title of the above
referenced real property, and that I(we) hereby authorize:
Name: ��t. \ �(>Uf�.C� Telephone Number. L Z C ��y ���` I
Street Address: �T7 � � U�, �W �Qf�. �UL
Ciry: N� State: �+`� Zip: ���V, �
to obtain permits in my behalf, as ownedbuilder, for
at the above referenced property.
2. Should any person become an employee engaged in the improvement of the property, I(we) shail immediately provide Workers
Compensation Insurance coverage and cause a certificate of that coverage to be filed witn the Building Division of the City of Costa
Mesa, as required by State of Califomia laws.
3. As ownerlbuilder 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 Ciry 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 oi perjury that the foregoing is lrue and correct. .
Executed this ��� day of NV—ti4�n.Jl� 20 d1 , at ��' �A � , Califomia.
Print Name: �a✓''�`'�'� G�
��
Signature:
Dale: a i � �1
Note: This auUarvation dces rmt grant author¢atan to perfortn the work as owner,
it solely provides for limited power of attomey to secure this permit in any behaK.
0779A6 (rev.11100)
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.g��LDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
JobAddress: 277 OGLE ST
Suite:
Viciniry:
Primary Occ: MR
ParcelNumber: 42522207
Applicant: SAYWITZ, BERRY
Address: 4740 VON KARMAN AVENUE
NEWPORT BEACH, CA
Owner: SAYWITZ, JEFFREY
Address SUITE 700
NEWPORT BEACH, CA
4740 VON KARMAN AVE
Contractoc
Address:
Zip:
Arth :
Address:
Phone:
Zip: License:
CONDO CONVERSION INSPECTION OF 3 UNITS.
Plan Check: $0.00
Permit: $0.00
SMIP Res: $0.00
SMIP Com: $0.00
Other: $0.00
Inspection: 50.00
Total: $270.00
SETBACKS
MAINSTRUCTURE Front 0-0
ACCESSORY Front 0-0
PARKING Existin : 0
Type ot Construclion:
Zoning:
Phone: 949-930-7502
Zip: 92660
Phone:
Zip: 92660
Phone:
�icense:
Eng:
Address:
SCOPE OF PERMIT
FEE SUMMARY
Rear 0- 0
Rear 0- 0
Reouired: 0
PLANNING & ZONING
Lefl 0- 0
Left 0- 0
Pr000sed: 0
Status: ISSUED
Applied: 02/03/2006
Issued: 02l03/2006
ISSUED BY: I��
Calc Valuation:
Claim Valuation:
Right 0-0
Right 0-0
Phone:
License:
so.00
so.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under Calitornia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRA710N: This permit shall automatically expira and become void if work is not commenced within 7 BO days, or if work is suspended or abandonetl
for a period of 180 days.
INSPEC710NS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
raqulred inapeetlone and final approvel must be obtainetl. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5626
�
WOHKERS'COMPENSAnON OECLARATON�
I hereby eNirm under penalty of perjury one W ihe following declara�ions:
❑ I heve entl wlll maintein a certificate of consent m self-Insure bt workers' compensetion, es provitled for by section 3700 of the Labor Cotle, tor Ihe peAormence of Ihe
work lor which this permi� is issuetl.
❑ I have end will maintain workers' compensation insurance, as requiretl Dy sectlon 3700 oi /he Labor Code, �or Ne peAortnance of Iha work for which Ihis permit is issued.
My workers' compensation Insurance carner and policy number are:
C2rrier: Policy Number.
(This section need nol be cromple(etl il Ihe permit is velued ef one hundred tlW/ers (S 100) w less.)
� I certity that in the peAormance of the wark lor which t�is pertnit is luuetl, I shall not employ eny person in eny manner so as to becoma subjecl to Iha workere'
compensation laws of California, antl egree Ihat it I should become subjecl to iha workers' compensation provislons ot Section 3700 0l the Lebor Code, I shall forihwith
compty with Ihese pmvisions.
qpplicant Signeture: Date:
WpRNING: FAILURE TO SECUFE WORKERS' CAMPENSATION COVERAGE IS UNUWFUT AND SNALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND qVIL FlNES UP TOIXJE HUNDRED
TMOUSAN� DOLL4RE �5100.000�, IN A�DITION TO THH COST OF COMPENSATION, OAMAGES AS PROVIpED FOR IN SECTION 3]O60F THE UBOR CAOE, IMEREST, qND ATfORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
1 heraby aflirm ihal V am litansed untler prov�sions ot Chapier 9(commencing wlih Sedion 7000) ot Division 3 0l the Business and Prolessions Code, and my license is in tull
force end eHect. Lic. # Class q
Camractor's Signature: Date:
CQNSTRUCTION LENDING AGENCY:
❑ I hereby eRirm Ihat there is a construction lentling agency for the peAormance ol the work br which this Oertnit is issuetl. (Sec. 3097, Civil Code).
Lender's Name: Lender's Adtlress:
Signature: Date:
pWNER•BUILDER DECLARATONS:
I horeby ettirm thel under penelty of perjury Ihet I em EXEMPT FiiOM THE CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Business and Professions
Code: Any ciry or counry whic� requires a pertnit to wnsirucc, alter, imprave, demolish, or repair any structure, prior to its issuance, also raquires ihe applicani for such permit
to f�le a signetl sta�ement thei he or she Is Ikensetl pursuant to the provisions ot the Contradors License Lew (Chapter 9(commencing with Section 7000) of Division 3 of ihe
BuSinesS and Prolessions Code) or t�at he or she is enempt iherelrom entl I�e basis lor the alleged exempli0n. Any violation of Section �031.5 by eny applicant for a permit
subjects t�e appiicent to a dvif pe�afly M not mo�a lhan five huntlred tlotlers ($S00).):
❑ 1, as owner ol t�e properry, or my employees with wages as their sole compensation, WILL DO TME WORK, and the structure is not intendetl or otteretl tor sale (Sec.
7044, Business and Professions Cotle: The Contractors License Law does not apply to an owner ol property who builtls or improves thereon, entl who dces such work
himsell or herself or ihrougb �is or har awn employees, provided thet such impwvemenis ere not intended or aHared to� sale. It, howe�er, the building or improvement is
sold within one year of complelion, ihe owner-builder will have the burden ot proving ihat �e or she tlid not build or impmve for purpose ol sale.J. �
❑ I, es owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRALTORS to constmct iha project (SecJ044, Business and Profassions
Cotle: The comractors Licensa Lew tloes not apply to an owner ol propeny who builtls or Improves thereon, antl who contracis br such project with e contractor(s)
license pursuam to the Contractors License Lews.).
❑ 1 am exempt untler sec. Business antl Prolessions Code for Ihis reaso�:
Signawre: Date:
Ow�er ID verilied by tlnver's license. ❑ Ves ❑ No Drivefs License No.
Vehficalion of Ownership by (rype ol dwumen�, i.e. - pmperry tax bill or tleetl):
DIV�SION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
Expires:
❑ I hereby certify �hat no excavetion five (5) or more feet in depth into which e person is reQuired to tlescend, will �e made in connection with work authorized by this
permi�, and ihat no builtling siructure, scattolding, falsawork, or demolition or dismamling ihereol, wiil �e more ihan thiRy-si: (36) feet high. (Chep. 32, Grp 2, Art 2, Sec.
341, Tille 8, Galifomia Atlministre�ive Cotle).
❑ As owner-builder, I wiil not employ anyone to do work which would require a permil from Iha Division of IndusMal Safery, es notetl above, unless such pereon has e
pertnit to tlo such work Irom the tlivision.
SigAature: Dale:
Division oi Indusirial Safery Permi� Number:
CER7IFICATE OF COMPLJANCE AND AUTHORIZA710N OF ENTRY: I ceniy untler penalry ot perjury that I have read ihis application antl state Ihat ihe iniortnation given Is
corrBc�. I egree to comply wllh all stele laws end ci�y ordinances relating to building constmction, antl au�hodze representatives of the Clty of Costa Mese to enter upon Ihe
above-descnhetl property tor inspection purp sq e,s. � agree not to acupy or allow occupancy of any building authonzed by ihis pertni� until finel inspection.
�l � �3f��
i"F�
SignaWreOfLeg Ownerj3y�f'- �Date '��
f�Qpg�, INSPECTIONT'�PE � P�TE IIIIIDB4S
1618 Fixed System Pinal Fire Preventiw�
1268
200
201
202
203
20a
Pool Spa Final
Finel Re-Roof
Final BIocWRetaining Well
Final Factory Fire Place
Final Sign
Final Demolition
COOE I INSYECTIQN TYPE
206 Final Mechanical
20B Flnal Plumbing
210 Final Elecirical
212 Finel Fire Prevention
220 Final Planning Approval
222 Final Site
250 ' Buil]�/nT.^;
�
�e
L�
CITY OF COSTA MESA , ,
BYILD/NG D/VISION
77 FAIR DRIVE, COSTA MESA, CA 92626 • Q14) 754-5273 • Fax (714) 754-0856 • wv✓w.ci.costa-mesa.c s
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER: B07-00991
�
PERMIT TYPE B ROOF2 STATUS: ISSUED
DATE ISSUED: 10/23I2007
• : -.. . - I$SUED BY: RMD
JOB ADDRESS: 277 OGLE ST CM Suite/Unit: --'
Viciniry: 3 UNIT CONDO
Squares: 2700 = : Valuatwn ' $5;000.00
SCOPE OF WORK: REROOF.3 UNIT-CONDQ�TEAR OFF (E) ROOF MATERIALS, INSTALL 1. LAYER OF�30# FELT ON 4:12 PITCHED
ROOF OR GREATER, REROOF�WITH 30 YEAR.ELK COMP SHINGLES, CLASS A, APPROX 27 SQUARES. REPAIR _
AND REPLACE SHEATHING AS NEEDED. GARAGES NOT INCLUDED. � � �
OWNER: SAYWITZ,JEFFREY �, ' -� Address: ,�SUITE�100 .. � Unit NEWPORT
BEACH, CA - � . � ' � �
PHONE: 949-930-7500 ,"'� �� . -, ', " City/State/Zip: 4740 VON KARMAN AVE�
APPLICANT: LA RUE, CHERYL ' Address: 113 SOUTH MINNIE ST
PHONE: 714-7313425 �� - - City/State/Zip: SANTA ANA, CA
CONTRAC70R: WEATHERLINE ROOFING INC � License No.
Address: 113 S MINNIE STUnit: � PHONE:. 714-7313425
Cily/State/Zip: SANTA ANA, CA - 92701 � ' = - . CELL:
ARCHITECT:
ENGINEER:
FEE SUMMARY
Reroof Plan Check:
Reroof Permit Fee:
Reinspectian Fee:
TOTALFEES
Unit:
729560
�
' - ' License No. - _ � � PHONE: �
License No. PHONE:
so.00
y11125�.�. .
$0.00 -.
$111.25 � " .. �
,
NOTICE: The work authonzed by this permit shall comply with all applicable handicap access requirements under Cali(omia statutes and related
regulations. (Ord. No. 92-28, § 1, 72-21-92) � �
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 inspecUons and final approval will result in the expiralion of this permit.
COOEf. INSPECTIONTYPE Dr1TE IN7171AL5 CODEj LNSPECTION7YPE gT€ IN qL
7818 Fixed System Final Fire Prevention 206 Final Mechanical
7266 Pool Spa Final !n' 208 Final Plumbing
200 Final Re-Roof � � 'V �� p10 Final Electncal
201 Final Block/Retaining Wall 272 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition - 250 Final BuildinyOccupancy
WORKERS'� COMPENSATION DECLARATION:
I he{ehy aKrri under penalty of peryury one of.tha tollowing Oeclarations:
❑ I have and will maintain a certifcate of consent to self-Insure for workers'
compensalion, as provided for by section 3700 of the Labor Code, for Ihe
.per(ormance�of lhe work for which this permit is issued.
y�Ad I have antl will maintain wnrkers' compensation insurance, as required by
Sectbn 3700 of Ihe Labor Code, for the peAortnance of the work for which Ihis
pertnit is issued. My vrorkers' compensation Insurance carner and policy
numGerare: �
Carrier: �}'n'�D ��,�
�(Tliis SetYion neep rp( pe Gmmpletetll/lh'e �pertnq is valuetl a! one h�nOredOaMars (Si00) aless J
Policy�N�mber: fX.�-�/ �� ✓ I 3
❑ I certi(y lhat in the peAormance of the work for which Ihis permit is
issued, I shall not employ any person in any manner so as to become subject
lo the vrorkers' compensation laws of Califomia, and agree that if I should
become subject to Ihe vrorkers' compansation provisions o( Section 3700 of
the labor Code, I shall (�Rrthwi omply wilh these provisions.
S�41 l J„Q.r�� 10 a
— Itt�an's5lgnaure �Daie 1
`--- � ��' _ .
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
($700,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE. IMEREST, AND
ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm Ihat I am licensed under provisions of Chapter 9(commencing
with Section 7000) of Division 3 of Ihe Business and Pmfessions Code, and
my license is in full force and e((ecl. � ���
rLic-#"_ Class # �
�" IOI��In 7
omractor's5ignaWre �/ —Dele��
�' V
CONSTRUCTION LENDING AGENCV:
❑ I hereby aKrm that Ihere is a constructbn lentling agency for the
peAortnance of the v.ork fp wfiich this permit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
SignaWre Daie
OW NER-BUILDER DECLARATIONS:
I hereby affrm that under penalry of perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW lor Ihe following reason (Sec. 7031.5.
Business and Professions Code: Any city or county which requires a permit to
wnstmct, alter, impmve, demolish, or repair any stmcNre, prior to its
issuance, also requires t�e applicant for such permit to file a signed statement
that he or she is licensetl pursuant to the provisions of the Contractors
License Law (Chapter 9(commencing with Section 7000) o( Division 3 of the
Business and Professions Code) or that he or she is exempt Nerefrom antl
ihe basis for [he alleged exemption. Any violation of Section 7031.5 by any
applicant tor a permit subjects the appliwnt to a civil penally of no1 more than
five huntlretl tlollars ($500).):
❑ I, as owner of the property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and the structure is nol intended or
oHered 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 vfio does such vrork himself or herself or Ihrough his or her own
employees, provided Ihat such improvements are not intended or offeretl for
sale. If, however, Ihe building or improvement is sold within one year ot
wmpletion, Ihe owner-builder will have the burtlen of proving that he or she
did not build or improve for purpose of sale.).
❑ I, as owner of ihe property, am El(CLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and
Professbns Code: The contractors License Law dces not apply to an owner of
property who builds or imp�oves thereon, and who contracts for such projecl wilh
a coniractor(s) license pursuant to ihe Contractors License Laws.).
❑ I am exempt under sec.
Business and Pro(essions Code for this reason:
Owner ID verifed by driver's li� ,. ❑ Yes ❑ Na +. �
Dnver's License No. � Expires:
Verifiwtion of Ownership by (type of documen[, i.e. - property [ax bill or deed):
DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION:
❑ I herehy cert'rfy that no excavation Me (5) or more feet in depth into wfiich a
person is requiretl to tlescend, will be made in connecfan with work authorizetl
by Ihis pertnit, and that no building structure, scaffdding, talse�wrk, or demolition
or dismantling thereof, will be more than thirty-su (36) feet high. (Chap. 32, Gry
2. Art 2, Sec. 341, Title 8, Califomia Adminis[2Me Code).
❑ As owner-builder, I will not employ anyone to do work which vrould
require a permit from the Division o/ Industrial Sa(ety, as noted above, unless
such person has a pertnit to do such work (rom lhe division.
AOOliwnfs SignaWre
Division of Industrial Sa(ety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicaN or present or future builtling occupant neetl to file and
certify a Business Plan for emergency response to release or threatened
release of a hazardous matenal? ❑ Yes ❑ No
(Section 25505 of the Califomia Health and Safety CoCe requires, with some
exceptions, that a Business Plan be filetl with the CosU Mesa Fire
Department by every business which has at any one time dunng a reported
year a quantiry of hazardous materials equal to or greater than a weight o!
500 pounds, or a volume of 55 gallons, or 200 cubic (eet of compressed gas
at slandartl tempereture and pressure).
2. Does or will the applicant or present or (uWre builtlinq occupant need to file
a registration torm for awtely hazardous ma[erials? ❑ Yes ❑ No
(Section 25533 of the Califomia Health and Safety Code, with some
exceptions, requires registretion with the Costa Mesa Fire Departmenl Dy
each business which at any one [ime has on hand a quantiry o( acutely
hazartlous materials equal to or greater than a weight ot 500 pounds, or a
volume of 55 gallons, or 200 cubic feet ot compressetl gas at standard
temperaNre and pressure).
3. Does or will the applicant or present or future building occupant neetl �o
prepare an RMPP (Risk Management and Prevention Program (or acutely
hazartlous materials)? ❑ Yes ❑ No
(Section 25534 of the Califomia Health antl Safery Code provitles that the
Costa Mesa Fire Department may require the preparation, cenifcation antl
fling 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 Seclion 25534 of the California
Health and Safely Code been (ully complied with7 ❑ Ves ❑ No
5. Does or will the applicant or present or future building occupant require for
ihe work which is the subject of this applicalion a pertnil for such construction
or modification from the SouN Coast Air Qualiry Management District or from
any other air pollution control tlistrict or agency? ❑ Ves ❑ No
(Section 658502 of the CalRwnia Govemment Code requires that the requestetl
intortnation be fumished on applications (a rron-residential building pertnits�.
6. Will any part o( the facili[y to be constructetl under this permit be within
7000 teet from the outer boundanes of a school? ❑ Yes ❑ No
(I('yes", [he faciliry mus[ mee� �he requirement of Sections 25534 and 42303
of the California Health and Satety Code).
7. If a permit from the South Coast Air �ualiry Management DisMct or other
air polWtion contml district or agency is required for the vrork which is the
subject of this application, have all of [he disclosures prescribed by California
Health and Safety Code Section 42303 been matle? ❑ Yes ❑ No
8. (If yes", attach certificate of compliance from the appropnate air pollution
control offcer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
information given above is wrtect. I agree to comply with all state laws and
ciry ordinances regartling Hazardous Matenals and Emissions.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury that I have reatl this appliwtion and state mat
Ihe information given is cortecl I agree to comply with all state laws and city
ordinances rela[ing to building construction, and authorize representatives of
the City of Costa Mesa ro enter upon the above-described property for
inspeclion purposes. I agree not to occupy or allow occupancy ot any builtlinq
authorized by Ihis permi[ until fnal inspection.
SlgnaWreof eg I er(s Da�e
Sipnamre Dale I (� '7
305'I-46 (3/0'!) �L ��
/Andlo.r VmnzetlApplicant Oa�te ,
l/—
, ,� ti , :�:�. )
COSTA MESA BUILDING DEPARTMENT
P.O. BOX 31�
COSTA MESA, CALIFORNIA
FOR APPLICANT TO FILL IN
A�DRE55 2%% � le 5��� A B C
COSTA MESA. CALIFORNIA
OWNER 3anta Ana Patio Homes. Inc.
MAIL 1555 F`lacentia
ADDRE55
c�rv Ne ort Beach Cal.
ARCHITEQ S$TIl8
OR ENGINEER
AO�RE55 $�e
IEGAL LOT [
�ESCfi1PTION NO. O 6lOCK
A.P. NO.
j �� a:�(;ti��g,� .
f N, al�'CE p 1959
, EPT.
�� !Y C� rnqTn
AqCcn
APPLICATION FOR'"PERMIT
BUILDING
FOR OFFICE USE ONLY
RECEIPT NO, p.^�FMIT NC
No: MI 6-322? �o;
LIC. .
NO.
FIRE
ZONI
CITV LIQ zor+�
NO.
TEL. Sa�I1B APPF
NO. BY
rRncr 299fi
NO.OF BLDGS. O
NOW ON LOT
USE OF
E%ISiiNG BLDG.
SETBPCN LINE iROM L ^ q y
CENTEF OF STFEET 4v��(�tt REAR YAR�J YO I
IISID[YARD RIGHT O �EFT ��
� DESCRIPTION OF WORK
NEW p ALTERATION ADDITION
REPAIR MOVING DEMOLISH
5 ZELOING 3123 ROOMS ZV STORIES 2
EXTERIOR WALL .i__ _ _ _ ROOF L_y ___
att. eara�e.
COSTA MESA. CALIFORNIA
STniE THnT TME R90VE IS CORRECT l�NO PGfiEE TO COMPLV WITH ALL
CrtV OR�INnNCES D STATE LnWS FEGULAT�NG BUIL�ING CONSiRVC=
nOrv. /J �J / VALUATION
SIGNATURE OF Ar%( �1 � „ /j"ti� �J � . / .
I(//�J'ilt� F�OHTE
CORRECTION
5 26,378.00
L
PERMIT FEE $ L�6.VV
PLAN CHECK S '���OO
TOTAL FEE g 69.��
\
�.
� Mr