HomeMy WebLinkAbout273 PALMER ST - Building Permits(714) 754-5273 • Faz (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job Address: 273 PALMER ST
Suite:
Vicinity: BREEZEWAY BETWEEN RESIDENCE & GARAGE
Parcel Number: 42516117 Zoning:
Applicant: MOWERY, SHAWN
Address: 273 PALMER ST � , - � ' " " -
� �� - Phone: 949-6313100
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COSTA MESA; CA� :�-,' ,� , � Zip: 92617
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owner. OSBORNE; LLOYD"B & MOWERY, C. SHAWN -,
Address 273 PALMER ST `, � � - _ ' �
� � . � � � - Phone:
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,"; COSTA MESA, CA . . Zip: 92627
contractor: 'OWNER-BUILDER
nddresg: � � � �•- '
Zip: ,
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Address: -. , - , � ,
- . . ,. , .Phone:
Zip: . " - � .-License:
Phone:
License: � 0
ISSUED BY:
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Status: ISSUED
Applied: 06/14/2001
Issued: 10/29/2007
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Eng:
Address: - � � � •
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License:
� SGUYt Uh F'tKMi l , , � �
.� ENCLOSE 275 SF BREEZEWAY BETWEEN RESIDENCE & GARAGE TO CREATE DINING &�BONUS ROOM FOR AN EXISTING `�
SFD. . „ ... . . . . ,._. . _.. ., _ � , � � �
`,
� . � ' - FEE SUMMARY ;� � . � ' � „ '
Plan Check: _ $24521 � � - � — � " - ` Calc Valuation: � - gzs,siz.so�
Permit: $37725 Claim Valuation: - $o.00
SMIP Res: $2.35
SMIP Com: $0.00
Other. $0.00
Inspection: - $0:00 • : � • - � � ! '
_- �`.��.
.. . - ,. :
, �TotaL• , .$624.81 , . , _... � � � _ �-;:� �. , .
� � � . � RLANNING & ZONING �
SETBACKS. ��'� ' � �
MAIN STRUCTURE Front 25- 0 - Rear 52- 0� tefl 5-0 , Right 10-�0 �'
ACCESSORY Front � 90- 0 �� Rear 14- 0 , Left . 24= 0��� Right � 5- 0.'
PARKING Existina: � 3 _ Required: 2 � Proposed: o . �
NOTES:
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NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 7, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is no[ commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order lor the work authorized under this permit to be considered legal, such work must comply with all applicable codas, and all
requlred inspectlons and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
2666-66(N00)
(
l
WORKERS' COMPENSA710N DECLARATION: � � �
I hereby effirtn under penalry ot perjury ona of ihe following declarations:
❑ I have and will mainiain a certificate of consent to selt-Insure tor workers' compensalion, as provitlad far by section 3700 of the Lebor CoOe, for Ihe pertortnance oi the
work tor which �hi5 Dertnit i5 i55uad.
❑ I have flntl will meintain workers' canpenSaGon in5urance, as requiretl by section 3700 ot ihe Lebor Cotle, for Ne pertortnanca of the work for which Ihis pertnit Is luued.
My workers' wmpensation Insurence cartier antl policy numDer ere:
Carrier: Policy Number:
(This secNon need no( be comp/etetl il (he permitls ve/ued at one hunaretl dollers ($f 00J or less.) .
❑ I certity t�at in the pertormance oi the work for which lhis permit is issued, 1 shall not employ eny person in any menner so as to become sublecl to the workers'
compensation laws oi Califomie, end egree that if I should become sublect to tha workere' compensation provisions of Section 3700 ot Ihe Lebor Code, I shell forthwith
comply with these provisions.
Applicant Signature: Date:
WFRNINO: FAILURE TO SECURE WORKERS' COMPEIJSATION COVEMGE IS UNUwFUL AND SHALL SUBIEGT AN EMPLOVER TO CRIMIN4L PENALTIES AND CIVIL FlNES UP TO IXJE HUNDRED
T410USAND OOLLARE (5100,000),IN ADOfiION TO THE COST OF CAMPENSATION, OAMAGE$ AS PFOVIOED FOR IN SECfION 3IO60F THE UBOR COOE, INrEREST, AND ATTORNEI"S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby effirm Ihat I am licensetl untler provisions of Chapter 9(commencing with Section 7000) ot Division 3 oF ihe Business antl Professions Code, and my license is in tull
torce and ettect. Lia a Class a
Coniraclofs Signeture: Dete:
CONSTRUCTION LENDING AGENCV:
❑ I hereby aHirtn that t�ere is a construction lending agency for the pertortnance oi Ihe work for which ihis pertnii is issued. (Sec. 3097, Civil Code).
Lendefs Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
!i O u .? �
I hereby eftlrtn that undeqpenalry,of per�ury that I am E%EMPT FROM THE CONTRACTORS LICENSE LAW tor Ihe tollowing reason (Sec. 703t5, Buslness end Professions
Code: My ciy or counry wfiicb�requves e pertnu ro wnstruct, alter, improve, tlemolish, or repair any strucWre, prior to its Issuance, also requires t�e epplicant for such pertnit
ro file a signed stetement that Hebr�stiells Ilcensed�Dursuant to Ihe Drovisions of the Camradors License Lew (Chepter 9(commencing with Sectlon 7000) of Division 3 of the
Business and ProfeSsions Cotle) or that`h'e'ar she is exempt iherafrom and the Desis for Ihe elleged exemption. Any violetion of Section 7031.5 Dy any epplicant for e perrr+'
suDjects the apPlicant to e civil penalry of not m`ore than tive hundred dollars ($500).):
❑ I, as owner ot the property, or my,empbyees wi�h we9es as their sole compensation, WILL DO TME WORK, antl the structure Is not iotentled or otteretl for sale (Sec.
7044, Business and Protessions CoderThe Contrectors License Law tices not apply to an owner of property who builtls or improves thareon, and who does such work
himsell or herself or through his or har own employees, provitletl that such improvemenis ere not intendetl or oHered for sale. H, howeveq the building or improvement is
�soltl wiihin one year ot completion, the owner-builder wiil have the burden of proving that he or she ditl not build or improve for purpose ot sele.).
I, as owner ot the property, am EXCLUSIVELV CONTRACTNG WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business antl Pmfessions
Code: The contractors License Law does not appty to an owner oi property who bu1105 or improves thereon, and who contrects for such pmject with a contractor(5)
license pursuant to the Contractors License Laws.).
❑ I am ax rj(f�r . ��� Business end Protessions Cotle for Ihis reason:
Signawre: ( J � /�ll � Date� •
Owner ID veritied by drivers license. Yes No Drivers License No. ,:,�/ ��() Expires:
Venlication ot Ownership by (rype of daumenL i.e. - properry taz bill or deed):
DIVISION OF INDUS7RIAL SAFETY PEHMI7 CERTFICATION:
❑ I hereby cenity that no excavation five (5) or more teet in depih into which e person is required to descend, will be made in connection with work eu�horized by this
permit, and that no builtling sWcwre, scalloltling, talsework, or tlemolition or dismantling thereof, will be more ihan thirty-six (38) feet high. (Ghap. 32, Grp 2, Ar12, Sec.
341, Title e, Califamia Adminisiretive Gode).
❑ As owner-builder, I will not employ anyone to do work which would require e pertnit from the Division of Intlustrial Sefety, as notetl above, unless such person hes e
pertnit to do such work trom Ihe division.
Signature: Date:
Division of Industrial Safery Permit Number:
CERTIFlCA7E OF COMPLIANCE AND AIfiHORIZA710N OF ENTAV: I certify under penalry ot perjury that I have read ihis application and state ihat tha iniormation given is
conecL I a rea to compty wiih all stete laws end city ordinances relating to building construction, and au�honze representatives of ihe City of Cosla Mesa to enter upon �he
ebove-d c Ee ropa in ection purposes. I agree not to occupy or allow occupancy of any building euthorized by ihis permi� until final inspectio�n.7
Signature Of Legal �Date �" �L��
AnNOr Authorize Ap0licani Data
COUE t. INSPECTIONTYPE
1616 Fixed Sys�em Final Fire Preventlon
1266 Pool Spa Final
2pp Final Ra-Root
201 Finel Block/Re�aining Well
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition
QSjF INTIiIRLS CO�EI INSVECTIONTYPE
206 Finfll Mechanical
208
210
212
Finel Plumbing
Pinal ElecMcal
Final Fire Preveniion
220 Final Planning Approval
222 Final Site
250 Final Builtling/Occupancy
P�g 1[�L9
,
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C� �'b' L'� %� 'suu�C�i y I�iuidc.'o�
OWNER-BUILDER
VERIFICATION
A city or county, which is reyuired to give notice pursuant to Section 19830, shall attach to such notice, and,
a5 a condition precedent to issuing a building permit, require the completion and require the retum of, an
owneo-builder verification.
A[tention Property Owner:
An bwnervbuilder' building permit has been applied for in your name and bearing your signature.
Please complete and re[urn this information in the envelope provided at your earliest opportunity to avoid
unnecessary delay in processing and issuing your building permit. No buildine permit will be issued until [his
verification is received.
l. ► personally plan to prou,ide the major labor and materials for construction of the proposed
property improvemenL [� Yes ❑ No
��
2. I have ave not) signed an application for a building permit for
the proposed work.
3. 1 have a
Name
Address
Phone (
the following persnn (firm) to provide the proposed construction:
City
Contractor's Lia No.
4. I plan to provide portions of the work, but I have hired the following person ro coordinate,
supervise and prov e the major work:
Name /1[��__
Address _
Phone { )
City _
Convac[or's Lic. No.
5. I will provide some of the work but 1 have conhacted (hired) the following persons ro
provide the work indicated:
Name
��2�46 (REV.9/98)
Address
Phone Type of Work
; . . �
I hereby affirm Ihat I have received a copy of the information set forth in Section 19830 of the State
of California Heal[h and Safety Code and have completed [he above infortnation [o [he bes[ of my personal
knowledge, in compliance with this State law.
C.D.L.#ORS.S.# ( `
Date: GD' � 9' �l
Far more information call City of Costa Mesa Building Division at (714) 754-5273.
10a2�8 (REV.9/88)
� ORA'NGE COUNTY BUILDING DEPARTMIENT
: _ 636 North Broadway
SANTA ANA, CALIFORNIA
POR APPLICANT TO FILL IN
BUILDING —
ADDRE55 n
SCHOOL DIST. —
OR TOWN
NEAREST
CROSS ST.
OWNER
MAIL � � ��� �� �
A�ORE55 � ( r
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CITY J�n�lI�A,l'Heni'i NO.tiilr'J�/i
AODRE55
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'ACH �5.$90UNDS) � /I�MK�1tA�.l
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NO. OF BLDG3. /
OF LOT (� � I.� 'S I NOW ON LOT
OF NO. OF NO. OF
TI_NG BLDG. FnMw[s I ROOMS �
DESCRIPTION Of WORK
REPAIR
USE OF NEW
BUILDING
- APPLICATION FOR PERMIT .
-___...._� V • ■.� .�_�.:_ ' '__' .
FOR.OFFICE USE.ONLY__ __ �
RECEIPT NO. PERMIT NO.
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CORRECTIONS '
APPROVALS
'FOUNDATION: LOC TIO
I-HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS FORMS. MATc �IAL'.
APPLICATION AND STATE THAT THE ABOVE IS CORRECT UNDER-PINNIN �'
AND AGREE TO GOMPLY WITH ALL COUNTV ORDIN%MJCES FRAME: FIRE STOP `
AND STATE LAWS REGULATING BUILDING CONSTRUCTION. BRACING, BOL�
, LATH.INT.
SIGNATURE OF � LATH. E%T.
PERMITTE
PlASTER,INT.
AUTHOHIZED AGT. �
PLASTER,E%T.
S P' C� $ � n� MASONRY qEINFORCED
� FEE I�/ CQfi BOND BEAM
VALUATION IpOUO• U � s
FEE 7� � FINAL
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OknNGE COUNTY BUILDING DEPARTMENT
;�� 636 North Broadway
SANTA ANA, CALIFORNIA
Yi�
FOR APPLICANT TO FILL IN
BUILDING �1 ^Ji'% /�/ /� y]%��
ADDRESS o1 i� �vtr-x-�-,�,��.��i,-�e�_—
SCHOOL OIST. / � M,�ta
OR TOWN iDJ/ u ���
NEAREST
GFOSS ST
OWNER
MAIL
ADORE55
- TEL. �-Q-+�'
CITY . NO.:
ARGHITECT O qTEI.
ENGINEER �/�e�D� n� /1YN0.
ADDRE55 �
TEL.
CONTRACTOR .wi /�.. O/'C NO.
ADDRE55 � � `j ��Q�
LEGAL
OESCRIPTION I LOT NO.
(ATTACH M ES & BOUNq51
TRACT Q I.�� . n. w
NO. OF / NO. OF
IG. FAMILIES I ROOMS
DESCRIPTION OF WORK
BUIL�INGnd _
SRE �/
WALL .
COVERING
USE OF NEW
BUILOING
APPLICATION FOR PERMIT �
--'--6��. . �.�. .�_�' -'--- -'
j F.OR_OFFICE_USE_ONLY_ �
� RECEIP NO: ERMIT NO.
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nRECEI@VEO F�' �TE�i F p�. OA�IS�Ii� ,
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f�1 �
REAR YARD � j :SIOE YARD / '
BYPROVED I��•, 1 . DATE T�=)
D
CORRECTIONS
i
FOUNOATION: LOC:hT10N
I HEREBY AGKNOWLE'JGE THAT 1 HAVE REA� THIS FORMS, MATERIALS,
UNDER-PINNING
APPLICATION ANO STATE THAT THE ABOVE IS CORRECT FRAME: FIRE STOPS,
AND AGREE TO COMPLY WITH ALL COUNTV ORDINANGES BRACING, BOLTS
AND STATE LAWS REGULATING BUILDING CONSTRUCTION.
LATH.INT.
SIGNATURE OF LATH.ExT.
PERMITTE
PLASTER.INT.
AUTHORIZE� AGT.
PLASTER, E%T.
$ P. C. S I /�w�� MASONRY REINFORCED
FEE I YV
� BOND BEAM
VAWATION `O�d �O �
FEE '� � FINAL
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