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HomeMy WebLinkAbout1984 MONROVIA AVE - Building Permits . 7 ,' CITY OF COSTA MESA BUILDING DIVISION >::gat.),, x. DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4. 3 PERMIT Sk+r'oaarw`t X4-01503 (714)754-5273 • Fax(714)754-4856 •'www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 1984 MONROVIA AV Status: ISSUED Suite: Applied: 08/25/2004 Vicinity: Issued: 08/25/2004 Parcel Number: 42251328 Zoning: Applicant: GRAY, WAYNE - ISSUED BY: /Li Address: . 21907 ERIE LN , - , . - - Phone: 949-707-5222 LAKE FOREST,CA-. . • Zip: 92630 Owner: PORTER, MADELINE ' Address 7<984MONROVIAAVE'. - - - �; , � ' v; 'l , > Phone: /.COSTA MESA,CA'.; , • Zip: 92627-4134 t. Contractor: 'Q,M H S INC . " Address: 21907ERIE LN' _ Phone: 949-707-5222 LAKE FOREST,CA Zip: - 92630. l .License: 591333 ' Arch : - - ' Eng: , _ ,.-, . Address: - - Address:• 1 , C1 - . Phone:" " .Phone: Zip: -, License: License: 1 ,p- SCOPE-OF PERMIT - -.-'„ -. , - REPLACE 3 EXTERIOR DOOR CASINGS IN AN EXISTING SINGLE-STORY SFD.. - ' NO OTHER WORK AUTHORIZED WITH THIS PERMIT. - FEE SUMMARY s Plan Check: $0.00 - Calc Valuation: $1,100.00 Permit:' $41.80 - , ' _ _ , Claim Valuation: _ 31,100:00 ySMIP Res: "• $0.50 SMIP Corm:, $0.00 _ ' Other: , ,-$0.00 • 'Inspection:.- ,$0.00 • , Total: $42.30 .1 , ' \ PLANNING.&ZONING '` 7�7/i(// SETBACKS*- "` _ " �.0% i MAIN STRUCTURE Front 0-0 - Rear 0'0 Left - 15-):11---` Right - 0-0' /.,,,/,21/1/ t ACCESSORY Front. 0-0 Rear -0-0 _ Left 0_'.0 -'', Right 0;01// -, PARKING Existing: 0 Required: 0 Proposed: ' - 0 "� NOTICE: The work authoriied by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 244646(6100) Via DECLARATIONS l ) ( } WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. ,,, i have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. My workers'coy en atlon IGS ronce vier and policy number are: Cartier: 5/'/ /.tel f Policy Number:" 74;057 -e-9O 3 (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ 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 workers' compensation laws of Californi5ia,,`/-aaa gree that If I should become subject to the workers'compensation provisions of Section 37 of �e,I shall forthwith oomph/with these proWsippn//% EA Applicant Signature: /�/'i1 ill-- Date: WARNING:FAILURE TO SECURE WORK 5'COMPENS ION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THC SAND COU-ARE($100,C00),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under•roision�Chapter 9(commencing with Section 7000)of Division 3 of the Business and Prole sions Cod', =n• license is in full force and effect.Lic.#• - Class# C Contractor's Signature: .. L!,i�� Date: a��,� CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom end the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,end who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) . license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this Li a plication appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 if a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. = �# Is al!• n: s) Date - And/Or Authorized Applicant /Date E9.17Ls INSPECnQN TYPE gdI€ INTITIALS CODE( INSPECTION TYPE PAU INTITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1286 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign222 Final Site /Z _ 20'� 204 Final Demolition� 250 Final Building/Occupancy 1Y CITY OF COSTA MESA j'�.,4) BUILDING DIVISION F I ---- - • DEVELOPMENT SERVICES DEPARTMENT PERMIT NU BER tIliiiiita PERMIT ry// ittitiforeamo 60 PO4-00591 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 1984 MONROVIA AV Status: ISSUED Suite No Applied: 08/25/2004 Issued: 08/25/2114 Vicinity: • 1 - ISSUED BY: AVIA, Parcel Nunmber: 42251328 1 - . -. / Applicant: GRAY, WAYNE-',. Address: 21907 ERIE"LN' ` - Phone.' 949-707-5222 " LAKE FOREST,CA - Zip: -92630 - , , / i i" - A .1 Owner: PORTER, MADELINE _ Address 1984 MONROVIA AVE • . Phone: ' , , ' COSTA,MESA,CA Zip: 92627-4134 ,, A Contractor: Q M H S INC ` Address: 21907 ERIE LN , " Phone: •949-707-5222 / ' LAKE FOREST,CA Zip: 92630 - - , . License: 591333 ` " / I Arch / Eng :, [ - . _ - - . • Address: i , Phone: . / • - - - _ __Zip.• - - - - - - _ - License: - , �' . - SCOPE OF PERMIT -- ' ''"- REPLACE THE OVERHEAD WATER HEATER IN AN EXISTING SINGLE-STORY SFD. 1 WATER HEATERNENT = 'r..- -_ NO OTHER WORK AUTHORIZED WITH,THIS'PERMIT.- • - , ,i;;; FEE SUMMARY , C;'-:,---J /./ , ' / AMT QTY - -AMT QTY - / /' N , ' AMT QTY ISSUE FEE �' , .'$23.50 Laundry Tub/Washer ," $0.00. 0 ,Sump Pump-�; N/ $0.00 0 Backflow inigaton� C;,, $0.00 , 0 ; Landscape Imgation, , $0.00 0 - Swimming'Pool �'/ $0.00 0 Backflow Preventer $0.00 0 P-Trap' ._ , - $0.00 =0-- - /Trap•Primer /-7.7 ., $0.00 0 Bathtub ,\ ' .\-$0.00- 0 Pressure Regulator . ' '_$0.00: 0 ` Urinal< '' 7/.77 ,/ $0.00 0 Clarifier System \ N$0.00 0 i Process Piping(per 10 ft) $0:00 0. `, " Vacuum Brk6Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 - Receptors $0.00, -0` ,• Vacuurf-BikrBkflow(5+) $0.00 0 Dental Units $0.00 . 0 Septic Tank ' $0.00 0 • Wash•Basin $0.00 0 Dishwasher $0.00 .0 . Sewer Cap forDemo $0.00 .0 Wash Basin Set $0.00 0 Drain, Floor $0.00 0 , Sewer Connect $0.00 0 ' ,7,'%�Waste and Vent System $0.00 0 • Drain, Rainwater $0.00 0 "- Sewer Private Line.- $0.00. .'0' Water Closet(Toilet) $0.00 0 , Drain, Roof $0.00 0 Shower-' _ ,-' -' ----'$0.00- 0 Water Heater/vent $12.30 1 Drinking Fountain $0.00 0 Sink,bar - - $0.00 0 Water Piping(Inst or Rep.) $0.00 0 I NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§1, 12-21-92) EXPIRATION:'This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days.' INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(&0o) DECLARATIONS l ) ( i WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the /work for which this permit is issued. A ''have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued. My workers'compens tlon nsuran/ce�a,Tn'er a policy number are: Carrier: S12Tp / Policy Number: /7/So S/' 7oo3 (This section need not be completed/ the permit is valued at one hundred dollars($100)or less.) ❑ 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 workers' compensation laws of Calitomia,.a •ree that if I should become subject to the workers'compensation provisions of Section 3700 of the bor Code,I shall forthwith comply with these pr• •- -. s Applicant Signature: i% /war./l - Date: ' �y, 7' J 1 9/ WARNING:FAILURE TO SECURE W• ERS'COMPEN • ION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO GRIM! PENALTIE AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000).IN ADDITION TO THE-Se OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions C••e,and my license is in full force and effect Lic.q i Class k ° r Contractor's Signature: :% Date: r /• w • CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,CMI Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not appy to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) . license pursuant to the Contractors License Laws). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,Califomla Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file end certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the❑applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? Yes No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification end filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes 0 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health end Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 6 (If"yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application end state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. eget Owner(s) •n-Or Autho i=• :r licant Date CODEC 1NSPECIION TYPE / PAIL INTMALS CODE. INSPECTIONTYPI RAIL .011 1616 Fixed System Final Fire Prevention 206 Final Mechanical AIF 1268 Pool Spa Final 208 Final Plumbing �� 7 200 Final Re-Roof 210 Final Electrical 201 Final BIocWRetalning 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 p5 F CITY OF COSTA MESA 4 BUILDING DIVISION - o F • •- DEVELOPMENT SERVICES DEPARTMENT ERMIT NUMBER 1111•911.1.0.1 I t PERMIT • �; B01-00885 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.cBaU�LDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1984 MONROVIA AV Status: ISSUED Suite: Applied: 06/13/2001 Vicinity: Issued: 06/13/2001 Parcel Number: 42251328 Zoning: Applicant: LEE ROOFING OF COSTA MESA ISSUED BY: V Address: 1653 SUPERIOR AVE , Phone: (949)642-7222 COSTA MESA,CA Zip: 92627 Owner: PORTER, MADELINE K Address 1984 MONROVIA AVE • Phone: COSTA MESA,CA Zip: 92627 Contractor LEE ROOFING OF COSTA MESA Address: 1653 SUPERIOR AVE _ Phone: (949)642-7222 COSTA MESA, CA Zip: 92627 License: 349686 Arch : Eng: Address: Address: Phone: _ Phone: Zip: License: License: SCOPE OF PERMIT • TEAR OFF EXISTING COMP. ROOF. INSTALL 1 =30 LBS FELT AND 25 YR COMP. SHINGLE. , FEE SUMMARY Plan Check: $0.00 - Calc Valuation: $3,376.00 Permit: $97.25 - Claim Valuation: $3,376.00 SMTP Res: $0.50 „ SMIP Com: $0.00 , . ' Other $0.00 Inspection: , $0.00 • Total: $97.75 ,`,�- , PLANNING/&ZONING= SETBACKS :- C MAIN STRUCTURE Front 0-0. - Rear 0-0 Left 0-0 Right 0-0' ACCESSORY Front 0-0 ' Rear 0-0 Left 0-0 Right ' 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 , NOTES: - NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS c_J U rX • ' J WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: 22,1 have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I have and will maintain workers compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number:- (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ 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 workers' compens: '- - 's of California,and agree that if I should become subject to the workers'compensation• •i ions of Section 3700 of the Labor Code,I shall forthwith co •• . " h thes:provisions. �..;:nt Signatur= Date: INO: • ••E TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUEDE • EMPL• •CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED -+•D DOLLARE(S100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR I ION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED C• •AC a- D LARATION: I hereby:• rm tha am license• nder provisions of Chapter 9(commencing with Section 7000)of Divisi of the Business and Professions Code,and my license is in full force: d effe . 'c.# _--.--Crass a Co. rector- Ignature: / Date: --- CONS CONS -U - •N LENDING AGENCY: IN :reby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: . I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to en owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 if an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes j�No (Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air(Duality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Ot Legal Owner(s) Date And/ nzed App nt ` Date CODE I INSPECTION TYPE all INTRIALD CODE I INSPECTION TYPE \ DAg INTTAIS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1268 Pool Spa Final 208 Final Plumbing / 200 Final Re-Roof P'&2'19( t 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place _ 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy . .. _.. -_ - - - - _ Applicant to fill.in all spaces except-those within heavy border-lines and-sign all appropriate-declarations. •- p♦/ - -- ' - .- CITY OFCOSTA MESA CONSTRUCTION PERMIT _ PER NO. • " TRACT NO. LOT-NO.- UNIT-NO. ' • '- ' • i• f O /-17-g6- • [5.00 ? /99y • -X09:425/33 . Prolect'Address / AJ206!/4 � I i - 12/2"--1 t - cfC /D�� �) M/9/N CrD,c.9.rtoL� TYPE OF CONSTRUCTION ❑ NEW .0 ADD IJ ALTERATION U.REPAIR. ' 2 Ap�pl ipcant's Mailing,�A,dd`ress !`� "'❑ CONVERSION."❑•DEMOLISH ❑ OTHER- - - ' - neFR^Ella, tg�q G4E L9y�rtr{E5!°tfphone77174180 A.P. „ , - Zone, 6 � - DESCRIPTION OF WORK/USE OF BLDG. • • � Qs /O�� A.r. y-1,gyw fT. Gee-tir/� _ ` r-- S Main Building' Accessory Building ' li ,AaP" rA ss - I " TVPE OF PERMIT _❑ GRADING U FOUNDATION LJ STRUCTURAL TFront' 1 ! -V- Arch/Eng: - ti/�� License No. .. _ •Address. _ ' _- ' ❑ TENANT ❑ ELECTRICAL '❑ PLUMBING 1❑ MECHANICAL' --- - - B Rear -,• ! �j •� ❑ ,OTHER ~ , .. - A -Contractor's Namn /GSSG E Tod- Phone 77/7 F - 'C RightPROJECT DESCRIPTION SQ. FT. ' - - OCCUP NCYYy�,� - _ ' -Address(mailing) /0$/^1t ti..' c� !N • ST' �+�'-dam CONSTRUCTION SVPE - VALUATIO r�A•CJ eS S Left • •City License No. ' W39/ 0 IBJ' ' '/ ZONE' `LICENSED CONTRACTOR'DECLARATION - - • , _ GRADING CV.YDS. ACRES -• Ping. Ref. # Parking Req./Provided _/ ` I hereby affirm that i am licensetl untler provisions of Charter 9 (commenclog Remarks: Tei.. v /J tanning Notes: ' • - ' i 'with section:7000)of'Division 3 of the Business antl Professions Code, antl /Zf7,64,.-c CQ y •" aF c/ /.Se`?-s' - t%�e- d/r•s��' _ ` ;my I¢ense is m full force and eff t / • 1- .. -License Class C g Lice,se No' - , - - , i Date /'v7L'B� Signature - / - 1 i PLUMBING FEES • 1I WORKERS'COMPENSATION D lyi • • ' •hereby affirm that I have a Certificate of consent . self-insure or a certificate • Bar Sink Showers 1 ELECTRICAL Workers' -Compensation •Insurance, Ora certified-copy thereof (Section• gacktld Prev¢nter • ServiceSink ' .800, Lab. C.) �cf 9 - ' - Automatic Washer• • Transformer ❑ 15-50 KWP_olic No. P3N�1Compan n_/ ' • : 'v y zE - ; Backflow Irngetion Sewer Cap Construction Pole Sub. ' ❑ 50+ KWified copy is hereby furna tl.•l ertified cogY�Isjfled with th city B ' : •, ' a ' Bathtubs - Sewer Connection Cooking Unit, - Meter ❑up to 100 ampsD. e AP can /�/ ' - •EXEMPTION FROM WORKERS' Or '• SAT ECLARATION - . ' ! Clarifiers _. -. - ..•�; Solar Collectors '-. - .. - -. _ , Dishwasher _ _ -. .Meter_❑over�100 amps_. .(Thissection need not be completed if the permit for one hundred ($100) or , ,less): r , Dishwasher Solar Piping. Dryers ❑Gas ❑Electric ' Sub;PanelI 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 Motors❑0.1 HP ❑1%'8 Workers' Compensation Laws Of California. - -. Date !- Signature ' Floor Drains Swimming Pool w/Spa. ' FAU ' Inc.Solar ❑9-15 HP ❑16-15+'NOTICE:If,after making this declaration, you should become subject tolthe ' __ _ _ _ _ - - Workers' Compensation provisions of the Labor Code;you must forthwith , -' - Floor Sinks - • - Urinal ' Fixturescomply with such provisions Or,•this permit` shall be deemed revoked. ( , Microwave l • CONSTRUCTION LENDING.AGENCY " • - - - , Gas Service . Outlets "Water Closet Device Boxes Pole Light1 hereby affirm that there is a construction lending agency for the performance - ' _of the 'work for .which• this permit •is. issued'(Section '3097 Civ. ,C.) ' Interceptors • • Water Heater - Outlets Range !Lender's Name - - • Lentler's Address - - Kitchen Sink Water Service T i,' Switches SignOWNER BUILDER DECLARATION ' - • - • - -I hereb affirm that I am exempt from the Contractor's License Law for the , Lavatories` ` -.. ' - ' •y - _ Auto-Wash - Garbage Disposal ;Standing Sectionsfollowing reason (Section 7031.5 Business antl Professional Cotle: Any city or ' _ - _ s - •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 issuance, also requires the applicant for suvision of _4o file a Tactor statement that he/she is licensetl pursuant to the provisions of ' ROOF Drains - '.the Contractor's License law(Chapter-9 (commencing with Section is7000)'of - - -{ion 3 of the 'and Professions ption or that he/she is exempt - '�ids-b antl the basis far the allegedrm exemption. Any viplabon of Section ! y�, I l-';-e,5:..5'by any applicant for a permit subjects the .applicant to a civil n _-,,.."I1ta of not more than five hundred dollars loyees($500)., 4 ' $ '3 ' ,'co I', as owner of the property or my-employees with wages as their sole Reiuspection:•Fee 1 $15 'Issue Fee' 1 _ ^ - - 1compensation, will do the work,and the structure ivnot intended or offeretl r - Reinspection Fee ;J $15 Issue Fee (, for sale (Section 7044, Business;and Professional Code: The Contractor'ses , MECHANICAL . •� FEES - -. License Law.does:not apply to an owner of a property who builds or improves . - • thereon', and' who does such work-himself/herself or through his or her own ' , I DEVELOPMENT SERVICES REQUIREMENTS: i employees, provided that such improvements are not,intended or offered for •• Boiler ' ' Hood or Type I ❑ , . .. 1 sale. If, however,the builve the urden ement is sole,wlthin one year of com- - Canopy, Type II 0 • -r Zoning Approved By • Date pletion, the owner.will have the burden of proving he/she did not build or im- Duct-Under Ground I , • Y ' prove for the purpose of sale). I I I 1 Building Approved By• ///'D) Date ' 0 I„as owner olithe property,am exclusively contracting with-licensed con-; • Duct-Structural - Refrigeration System ' Application Issued By I CD Data ' /-/7-eta tractors to construct the project (Section 7044,Business and Professions Code: I _ ❑0.100,000 BTU .0.100,000 BTU • I p� -The_Con Vattor's License Law.does.not apply to an owner of property who.' Duct-Ventilating - ?- -- - - i$UMJ�('1�,pAA/��Rv jl FEES ] builds or improves thereon:and who contracts for such projects with aeon- . - 1 t ' / / ••• V • L`/VI tractor(s) license pursuant to the Contractor's License Law). I am aware that 4 - Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT - $ T CCCC//// SMTP t $ - proof of their Worker's Compensation insurance should be provided to me., _• PLAN„CHECK $ PERMIT 0.1 am'exempt under Section B.& P.C.for this reason I Firepl/Fact:BIt. ICBO'# Fire Dampers ! . ) ISSUANCE $ ' ' PLUMBING •• $ ' Date • Owner Heating System& Ducting: . Registers .er PLAN CHECK '25%' $ ENERGY P.C.: $ I hereby certify-that I have read this application antl state that the above •.- ❑o-100,000 BTU ❑100,000BTL I ' GRADING $ ' information is correct. I a• •.� mply with all city and county ordinances . - - - ELECTRICAL ' $ - i • and state laws r- dll construe ,hereby authorize repre- - I ' • MICROFILM ' $ I sentatwes of • • ..•ove-mentioned property for I PLAN CHECK 50% $ - [�q inspection ..../..- - ' t/ •R� I - MECHANICAL I $ ' - ' TOTAL FEE ' $ IS:D � ; $ignatu �-' ' Date • Reinspection Fee I $15; Issue Fee $ 3 PLAN CHECK -25% $ - a , Drivers-.License or SS _ s CMF 0865-46,rev,10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING Y POO' :PA Date- . Inspector _ •Date Inspector APPROVALS Permit# ' APPROVALS Pe...rit# •..,1. Temporary Electrical Service or Pole'. 52. Pool & Equipment Location - • - • 2. Soil Pipe-,Undrgrnd. , " ;y. - 53. Steel Reinforcement ' '- 3. Electrical Conduit'Utility-Undrgrnd. - 54. Forms 's; r• - 4.''ElectricalConduit-Undrgrnd. - 55. Electrical Bonding • . • . 5. Steel Reinforcement- '" •I • ' - - 56. •Rough Plumbing & Pressure Test . . • 6. 'ElectricaI UFER•Grnd:., 57. APPROVAL TO COVER-GUNITE . . . 7. •Footings' 11';•id'r'y 58. Electrical Conduit-Undrgrnd. I 8. Foundation i ii .59. Gas Pipe, 0 Undrgrnd., Test - 9. Water°Pipe-Undrgrnd. 'i ✓`' �)'i. 60. Backwash Lines, P-Trap, 0 Undrgrnd. , 10. Structural Floor Syuem , - . ` :, c �/7' 61. APPROVAL TO DECK - 1.1. Property Sewer Lige& House Corinection Z4y64 i eV 62. Backwash; & Receptor-Final 12. Sewer<'Cap , I=L ' i 63. Heater & Vent-Final - •• 13. Roof:Drains 'rj • ! 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. dough Wiring Sign 68. APPROVED FOR PLASTERING ' 18. Rough Electrical-T Bar Ceiling.: - 69. POOL/SPA SYSTEMS FINAL • _ ' 19. Rough Heating & Air Conditiohing FIRE DEPT. REQUIREMENT ' : 20. Rough Factory Fireplace , :, APPROVALS Permit# 21. Ducts, in Structure + • 70. Underground Hydro . 22. Ducts, Ventilating ' , 71. Product Piping 0 Gas ❑Oil • 23. Gas Pipe-Rough & Test - - 72: Underground Flush • . • 24. Roof Framing 73. 'Undergrnd.Storage Tank Gas 0 Oil 25. Roof Sheathing . 74. Overhead Hydro - - _ 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical - 27. Frame and Flashing I ; 76. Dry Standpipe - - - 28. Lathing & Siding , 77. FIXED SYSTEM FINAL • 29. Insulation _ 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat i - 79. FINAL INSPECTION . - -- 32. Electrical Power Meter-Final : ' 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 512ei4' S 4.4/i4 4...tett_ ort. CCI) _ I 34. Final Heating& Air Conditioning 35.'Filial Gas Pipe-Test . . 36. Hood or Canopy I - r 37. Final Factory Fireplace ' ' . _ - ' . 38. Final Plumbing , - . 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. Handicap Regulations - 1 47.,FINAL STRUCTURE& BUILDING . 48. Special'Requirements Completed - , 49. Electric Release to Edison . • . • - - - • ' -.- . 50. Gas Release to Southern California Gas Co ' • 51. CERTIFICATE OF OCCUPANCY . - : - - ' No. - Date .. • - - ORANGE COUNTY BUILDING DEPARTMENT APPLICATION FOR PERMIT .- 636 North Broadway SANTA ANA, CALIFORNIA -B U I .D NG FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY ' ' _ RECEIPT NO. PERMIT NO. BUILDING ADDRESS 1984 Monrovia • i - 8--/ 7 'Y/i fl c SCHOOL DIST. OR TOWN Costa Mesa REC( IBY DATE RECD. DATE ISSUED NEAREST CROSS ST. VVPrgreen Plane - (R_?fij"-'' b—P ` , j Homes BUILDING (� OWNER Cherokee Homes Inc. • ADDRESS . / / 1y / ' • . ADDRESS 9363 Wilshire Blvd SCHOOL DIST. 1 ♦ OR TOWN f ) 4 4' Beverly Hills TELcITY NoliR 54361 CROSS NEAREST T. 4 1/'1/ I ' ' ARCHITECT OR LIC. ZONE NO. OF �; TYPE GROUP ENGINEER ElM n eQi McTCe rr R[`.F-I%DI^ .til / I PLANS J ADDRESS 2110 E.Walnut—Pasadena APPROVED O. ��- ',TRACTOR Newport Vi eta No b ] 35882 BY DATE / CORRECTIONS ADDRESSQ. gr Wi gin 1 rc—RP on7+1 ! 1-1111 A LEGAL DESCRIPTION I NO.NOT 522 I BLOCK I TRACT 1'712 (ATTACH METES B BOUNDS) NO. OF BLDGS. SIZE OF LOT 6A X 110 NOW ON LOT 0 ' USE OF I NO. OF I NO. OF EXISTING BLDG. FAMILIES ROOMS ' - - ' SETBACK LINE FROM: REAR YARD 251 ' CENTER OF STREET 5nft SIDE TARIMI P-1 n DESCRIPTION OF WORK a NEW I X I ALTERATION I I ADDITION I Z REPAIR I I MOVING I I DEMOLISH I rr BUILDING NO. OF SIZE 1034 RC_ft MS 5 STORIES 1 / EXTERIOR WALLROOF Compo AIRING tucc0 I 'COVERING 4hing1 e lv , SOF NEW O DING Re side nce—Att ch_ Carport i APPROVALS FOUNDATION:MATERIALS INSPECTOR ^`DATH, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS FORMS, MATERIALS, T (%fl DTA DATE APPLICATION AND STATE THAT THE ABOVE IS CORRECT UNDER-PINNING AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FRAME: FIRE STOPS. U/jp /A 4011>e n AND STATE LAWS REGULATING BUILDING CONSTRUCTION. BRACING, BOLTS fG.///�///Jr V` �V J LATH. INT. .9 T X t ♦ /� LATH. EXT. /v ���� SIGNATURE PERMITTEFF e Ort Yp >,Io /W�j�• J/' +✓i PLASTER, INT. , �] -.(J'{ AUTHORIZED AG i //� V�// �` '� PLASTER, EXT. �/T/w� 11/i� ) 2 �/! JTFEE $/ ..._.n. MASONRY REINFORCED VALUATION $ 4830.00 PLAN CHECKS 2- ^''`� BOND BEAM /� --.2./'594_' TOT �'� A FEEAL $� I FINAL 3 SM 9-90-98 • • Z.7 Z w J J • • • • i• - a c. STREET- - PLOT PLAN • - Show location and distances from • property line and between buildings.• - -