HomeMy WebLinkAbout1731 IOWA ST - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
ELECTRICAL PERMIT
Job Address: 1731 IOWA ST Status: ISSUED
Suite No Applied: 07/27/2004
Vicinity: LEFT SIDE SFD Issued: 07/27/2004
Parcel Nunmber: 13906207
ISSUED 8Y:
Applicant: SHUMAKE, FRED
Address: 181 CECIL ST
Phone: (949)645-0112
COSTA MESA, CA Zip: 92627
Owner: FARREN, WILLIAM M TR
Address 1731 IOWA ST - -
Phone:
COSTA MESA, CA Zip: 92626
Contractor: FREDERICK C. SHUMAKE
Address: 181 CECIL ST
Phone: (949)645-4112
COSTA MESA, CA Zip: 92627
License: 586675
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
244&66 (N00)
SCOPE OF PERMIT ,
CHANGE -OUT OF AN,ELECTR_ICAL SERVICE IN AN EXISTING SF_ D.
1 SERVICE TO 200A
NO OTHER WORK AUTHORIZED WITH THIS PERMIT
,
FEE SUMMARY
Quantity
Quantity
'ISSUE FEE
$23.50
Temp Dist System / Lighting
$0.00
01 .
Temp service lest
$0.00
Busway/100 fl
$0.00
0
Res. a/c package
$0.00
Standing Section
$0.00
0
New Res (1-2 units) .
$0.00
0
Misc Electrical Equipment
$0.00
01
New Res (3+units)
$0.00
0
- Transformers up to 1 kva/kw
$0.00,
0
Pool / Spa
$0.00
0
"' ................up to 10 kva/kw
$0.00 -
0
Lighting Fixts
$0.00
0
.................up to 50 kva(kw"-
$0.00
0
Recept Outlets
$0.00
0`'
.................up to 100 kva/kw
$0.00
0
Switches
$0.00
0
..................over 100 kva/kw -
$0.00 ,
, 0
Non Res Appl
$0.00
01
Low Voltage Equipment - -
$0.00 C/,o
/.
Res Appl
$0.00
0,
Low Volt Wiring System / Ckt
$0.00
0
Service to 200a
$30.50
1 -
Misc. Conduit _
$0.00
0
Service to 1000a
$0.00
0Misc.
Conductor
$0;00
0-
Service over 1000a
$0.00
0"
Circus (gen or ride),
$0.00 ; -
0
Motors to 1 hp
$0.00
0 -
Circus (mech ride or lights)
$0.00 ;;'�
0
Motors to 10hp
$0.00
0
Christmas Tree Stand
$0.00'
0
Motors to 50hp
$0.00
0
Fireworks Stand
'$0.00
0
Motors to 100hp
$0.00
0-
Other Electrical Fee -.
$0.00
Motors over 1 00h
$0.00
0'
Communication drops
$0.00
0
- - Investigation Fee
$0.00
Sub panel to 200a
$0.00
0
Plan Check Fee
$0.00
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
244&66 (N00)
DiCLARATIONS
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ 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, tot the performance of the
_
n cr which this permit is issued.
6 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 workerrg' compensation Insurance carrier and policy number are:
5�Ll
C�amen. 7/4/� FV/o ii Policy Numher. C�!i
V(R1islsectlon need not t be completed if the permit is valued atone hundred dollars ($100) Orissa.)
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 California, and agree that if I should tocme subject to the Workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with these pre ion .
A�plicanFSignatuna.. ;,A ( �Oele. .. f)%/`Z7/O L�
01
WARIaNG`FAILURE TO SEC W RKERS' COMPENSATION65 GE IS UNLAWFUL AND SHALL SUBJECT AN EMP( ER CRIMINAL PE TIES AN CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOARE 1$100, ), IN ADDITION TO THE COSTO PENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37M OF THE LABOR CODE, INTEREST, AND ATTORNEY'S
LFEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full
force and effect M-70 G Class4Pl U
COhtiadoTs,Slgnatur IDat�' e: a7 '�-7 v
�a
14/
CONSTRUCTION LENDING AGENCY:
❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lender's Name: 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 penalty of not more than five hundred dollars ($500).):
❑ 1, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not intended or offered for sale (Sec.
7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work
himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. 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 drivers license. ❑ Yes ❑ No Driver's License No. Expires:
Verification of Ownership by (type of document, i.e. - property tax bill or dead):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this
permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title 8, California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑ Yes ❑ 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).
......�to file
registration forth for acutely materials? ������Yes ������No
.....................................................................................................I............................. .. .
2
as or will the applicant or present or future building occupant need to e a g s y ❑ ❑
(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 en RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No
...........................................................................................................................................................................................................................................................................................................................................................
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication aEEermlt for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? jj 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?
❑ Yes ❑ No
(If "yes", the facility must meet the requirement of .
.Sections 25534 and 42303 of the California Health and Safety Code).
....
......................................................................................................................................................................................................................................................................................................................................................................................
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Ves ❑ No
.....................................................................................................ro*l.........................11ut.......................................................................................................................................................-.....................................
B (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: 1 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.
Sign to ner(s)d% [ 7 atm—N
A b. izeillicant �7/ - a fo
SvQQE-E, INSPECTION TYPE 2AM INTMALLS CODE INSPECTION TYPE DATE INITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Root 210 Final Electrical / r.o O
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
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa. WILDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 1731 IOWA ST
Suite:
Vicinity: ROOF
Parcel Number: 13906207
Applicant: MC CARL, TIM
Address: 126 COMMERCIAL WAY
COSTA MESA, CA
Owner: FARREN, WILLIAM M TR
Address 1731 IOWA ST
Zoning:
ISSUED BY:
Phone: 949-548-5569
Zip: 92627
Phone:
COSTA MESA, CA Zip: 92626
Contractor: GARY REES DBA CRANK BROTHERS ROOFING
Address: 126 COMMERCIAL WAY
COSTA MESA, CA
Zip: 92627
Arch :
Address:
Phone: 949-548-5569
License: 736549
Eng
Address
Phone:
Status:
ISSUED
Applied:
11/03/2003
Issued:
11/03/2003
Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF EXISTING ROOF. INSTALL 50 YEAR, CLASS A, FIREFREE SHAKES. 2,900 S.F. INCLUDES ATTACHED GARAGE.
Plan Check:
$0.00
Permit:
$251.25
SMIP Res:
$1.44
SMIP Com:
$0.00
Other:
$0.00
Inspection:
$0.00
Total: $252.69
SETBACKS
MAIN STRUCTURE Front 0-0
ACCESSORY Front 0-0
PARKING Existing: 0
NOTES:
FEE SUMMARY
Calc Valuation: $14,368.00
Claim Valuation: $14,368.00
PLANNING R ZONING
Rear 0-0 Left 0-0 Right 0-0
Rear 0-0 Left 0-0 Right o-6
Required: 0 Proposed: 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-26, § 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
246646(6=)
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ 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 hich this permit i5 issued.
I have a Wi ai din wool rS�pompensa n insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
M wor s' o t n ion ns nce carr s and y.Ii,c nump er are: —1 /
Carrier:y p\--li''P N Policy Number. 1 1 ,2 k 9IT.2 — Z o e
(This secri d not be completed r e permit is valued et ane hundred cllers ($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 Ii 'a, and a that if I shWId become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with these p v' i p_t,/_V\ /I
Applicant Signature: Dale: 1 i 1 / O
WARNING: FAILURE TO E WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE TIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3108 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES,
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full
force and effect. Lic. # Class #
Contractors Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lenders 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 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 apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ 1 am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑ Yes ❑ No Driver's License No. Expires:
Verification of Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person Is required to descend, will be made in connection with work authorized by this
permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title 6, California Administrative Code).
❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building Occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑ Yes ❑ 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 fee.t of compressed gas at standard temperature and pressure).
.
........................................................................................................................................................................................................................................................................................................................................................................................
2 Does or will the applicant or present or future building Occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity Of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume Of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
....................................................................................................................................................................................................................................................................................................................._....................................................................
3 Does or will the appplicant 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 tiling with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
...................................................I....................._.................................................................................................................................................................................................................................................................................................................
4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No
..............................................................................................................................................................................................................._..........................................................................................................................-.............................................
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication 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? B Yes a 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 pan of the facility to De constructed under this permit be wlihin 1000 feet from the outer boundaries of a school? ❑Yes ❑ No
(if yes', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
F.W. 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
..................._..................- ... _....................... .__............. .................................................. __.......................... _._.............................. _...................................... _............................................................................ ................... __..............
8 (If yes', attach certificate of Compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the Information given above is correct. I agree to comply with all state laws and all 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.
re f Legal Ow (s) I I / f7ate
And/Or AUMUffized ApplicaM I Date
CODE r. INSPECTION TYPE 2AM INTMALS CODE INSPECTION TYPE JIM IN7111ALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re -Roof Z ���" 210 Final Electrical
201 Final BIocWRetamIng 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
I
Applicant to /III in all spaces except those within heavy border lines and sign all appropriate declarations.
CytYOFCOSTAMESA CONERUCTION PERMIT
7oject Address - ''''��
Appttcant's Mailing Address
wner'z Name /s Phone S—��
Address 7-,/ 1,74-* f� 027
Arch/Eng. License No.
Address
Contractor's Name Phone
Address (mailing) 1
City License No:
LICENSED CONTRACTOR DECLARATION
1 hereby affirm that I -am licensed under provisions of Charter 9 (commencing
with section 7000) of Division 3 Of the Business and Professions Code, and
my license is in full force and effect.
License Class License No.
Date Signature
WORKERS' COMPENSATION DECLARATION
',reby affirm that I have a certificate of consent to self -Insure or a certificate
Workers' Compensation Insurance, or a certified copy thereof (Section
.00, Lab. C.)
Policy No. Company
BCertified copy Is hereby furnished.
Certified copy is filed with the city Building Division.
Date Applicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section need not be completed if the permit is for one hundred ($100) or
less).
certify that in the performance of the work for which this permit is issued, I
sh not employ any perso any manner so as to become Sub act to the
W rkers'
mo
s i of Calitornjl'JJq /
IF
Ignature =Lf7 �/�(f
-
'NOTICE: I , after me <i ng this declaration, you should becomeS6bject to the
Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked -
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 (Section 3097 Civ. C.)
Lender's Name
Lender's Address
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional 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/she is licensed pursuant to the provisions of
the Contractor's License Law (Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code) or that he/she is exempt
herefrone and the basis for the alleged exemption. Any violation of Section
/031.5 by any applicant for a permit subjects the applicant to a civil
nnalty 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 (Section 7044, Business and Professional Code: The Contractor's
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
employees, provided that such improvements are not Intended or offered for
Sale. If, however, the building or improvement is sold within one year of core-
plelion, the owner will have the burden of proving he/she did not build or im-
prove for the purpose of sale).
I, as owner of the property, am exclusively contracting with licensed Con-
tactors to construct the project (Section 7044, Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who
builds or Improves thereon, and who contracts for such projects with a con-
tractor(. license pursuant to the Contractor's License Law). I am aware that
proof o� their Worker's Compensation insurance should be provided to me.
❑ 1 am exempt under Section - B. & P. C. for this reason
L�vers' License or SS
CMF 0865-46, rev. 10/84
I have read this application and stale that the above
I agree to comply with all city and county ordinances
to but Iding construction, and hereby authorize repre-
to enter upop the above-mentiop€d property for
6V93Z)
TYPE OF CONSTRUCTION LJ NEW LJ ADD ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER/�
DESCRIPTION OF WORK/USE OF BLDG. r —G B
TYPE OF PERMIT LJ GRADING LJ FOUNDATION LJ STRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION SQ. FT- _ C__ OCCUPAN �j
CONSTRUCTION TYPE VALUATION� / L`
ZONE GRADING Cu. YDS. ACRE
Remarks:
PLUMBING
2674 10/2t/65
s -Ca SE '{L
A.P. #
Zone
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By
Building Approved ByDate
Application Issued ey
ELECTRICAL FEES
S
Main Building:
Accessory Building:
Backflow Irrigation Sewer Cap
Bathtubs Sewer Connection
E
Cooking Unit Meter ❑up to 100 amps
Clarifiers Solar Collectors
SUMM RY OJ�FEES
$S1
$
$
$
$
$
$
$,
Z
Dishwasher Solar Piping
T
Front
Drinking Fountains Solar Tank
O
Floor Drains Swimming Pool w/Spa
AN
Rear
Floor Sinks Urinal
Gas Service Outlets Water Closet
C
Right
Interceptors Water Heater
N
Kitchen Sink Water Service
SLeft
Switches Sign
Lavatories Auto -Wash
G
R
P—Trap _ Laundry Trays
Ping. Ref. #
Parking Req./Provided
E
Planning Notes:
M
T
S
PLUMBING
FEES
1 $15 1 1 Issue Fee
Bar Sink Showers
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By
Building Approved ByDate
Application Issued ey
ELECTRICAL FEES
Backflow Preventer Service Sink
Automatic Washer Transformer ❑ 15-50 KW
Construction Pole Sub. ❑ 50+KIN
Backflow Irrigation Sewer Cap
Bathtubs Sewer Connection
Cooking Unit Meter ❑up to 100 amps
Clarifiers Solar Collectors
SUMM RY OJ�FEES
$S1
$
$
$
$
$
$
$,
Dishwasher Meter ❑over 100 amps
Dishwasher Solar Piping
r SVV
al,.s
Dryers ❑Gas ❑Electric Sub Panel
Drinking Fountains Solar Tank
Fan Motors ❑0-1HP❑1'h-8
Floor Drains Swimming Pool w/Spa
F.A.U. Inc. Solar 09-15 HP 1116-15+
Floor Sinks Urinal
Fixtures Microwave
Gas Service Outlets Water Closet
Device Boxes Pole Light
Interceptors Water Heater
Outlets Range
Kitchen Sink Water Service
Switches Sign
Lavatories Auto -Wash
Garbage Disposal Standing Sections
P—Trap _ Laundry Trays
Generator E10 KW 05 15 KW Trash Compactor -
Roof Drains
Reinspection Fee 1 $15 1 1 Issue Fee 1 $ 3
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Bit. ICBG #
Heating System & Ducting
❑ o.t 00,000 BTU ❑ 100,000
Reinspection Fee
Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor
$15
Hood or Type O
Canopy Type 11 ❑
Refrigeration System
00-100,000BTU ❑loo,o0o
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
FEES
Reinspection Fee
1 $15 1 1 Issue Fee
$ 3
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By
Building Approved ByDate
Application Issued ey
Date
Date
BUILDING PERMIT
PLAN CHECK
PLUMBING
PLAN CHECK 25%
ELECTRICAL
PLAN CHECK 50%
MECHANICAL
PLAN CHECK 25%
SUMM RY OJ�FEES
$S1
$
$
$
$
$
$
$,
SMIP
PERMIT
ISSUANCE
ENERGY P.C.
GRADING
MICROFILM
TOTAL FEE
$
$
$
$'
$
, $
'
r SVV
al,.s
$ 3
" CONSTRUCTION AND PLANNING
`APPROVALS Permit # Date
Inspector
POC SPA
APPROVALS Permit #
Date
Inspector
1. Temporary Electrical Service or Pole
52. Pool & Equipment Location
Z. Soil Pipe-Undrgrnd.
53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd.
54. Forms _
4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding
5.. Steel Reinforcement
56. Rough Plumbing & Pressure Test
.
6. Electrical UFER Grnd.
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
'
8. Foundation
59. Gas Pipe, ❑ Undrgrnd., Test
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P -Trap, 0 Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK
11. PropertySewer Line & House Connection
62. Backwash & Receptor -Final
12. Sewer Cap
63. Heater & Vent -Final
13. Roof Drains
64. Plumbing System - Final
14. Rough Plumbing
65. Electrical -Final
15. Rough Electrical -Conduit
66. Solar System -Final
16. Rough Electric Wiring
67. Fencing & Access Approval
17. 'Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough Electrical -T Bar Ceiling
69. POOL(SPASYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping 0 Gas 0 Oil
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank ❑Gas OOil
25. Roof Sheathing
74. Overhead Hydro
26. T-Bar,Ceiling (Structural) & Monocoat
75. Dry Chemical
27. 'Frame and Flashing
76. Dry Standpipe
28. Lathing & Siding
77. FIXED SYSTEM FINAL
29. Insulation
78. FIRE PREV. FINAL
.30. Drywall Nailing
HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat
79. FINAL INSPECTION
32. Electrical Power Meter -Final
80. FOOD CERTIFICATE ISSUED
33. Final Electric
Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe -Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
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
47. FINAL STRUCTURE & BUILDING
10
'
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
OWNER WHEELER, Mr. & Mrs. Tom DATE 3-19-62
JOB ADDRESS 1731 Iowa St. BUILDING PERMIT NO.. 16780
GENERAL CONTRACTOR George Potts VALUE $ 101.00
AP No. 113-502-05 LOT TRACT FIRE ZONE DESCRIPTION OF WORKComm. Mock Wal.
INSPECTIONS
Signature
DATE
GROUPB1.1da11TYPE ZONE R-1
Soil
SUBCONTRACTOR
PERMITS ISSUE
Gas
DATE
_
NUMBER
Water
Rough Com. Refrfg. ❑ An, Cond. ❑
—
Rough Heating
Rough Plumbing
Miscellaneous
Prop. Swr. Line ❑ House Con. ❑ St. Swr. ❑
Sprinkling System
Construction Pole
Underground ❑ Power ❑
Rough Wiring
Trenches ❑ Forms ❑ Steel Reinf. ❑
Floor System
Bond Beam ❑ Steel Reinforce ❑
-,
Sheathing
Frame. and Flashing
Lathing — In ❑ Out ❑
Plaster, brown coat
efng. ❑ Air Cond. ❑ Final
—
Heating, Final
Plumbing Fixtures, Final
Final Gas Test
Electric Fixtures, Final
Building, Final
OCCUPANCY
FIRM RI16 - FM - 7.91 1 n t nt I
I.
t ! 6780
COSTA MESA BUILDING -SAFETY DEPARTMENT
P. O. BOX 917 COSTA MESA. CALIFORNIA
I For Applicant to Fill In Completely I
TYPE OR PRINT
COSTA MESA. CALIFORNIA
FEE RECEIVED
MAR 191962
FINANCE DEPT.
APPPRO��"IT
BUILDING
For Office Use Only
LOA
I]
W
E
4
RECEIPT NO.
P RMIT N
OWNER �-
C// 7
MAIL //,,// //
RECEIVED BY DATE REC81 HO I
I3-��.��
DATE ISBIfP�
ADDRESS W -YmL
TEL
CITY ,f.$%i F $moi 6 NO / _d a
BUILDING
ADDRESS
/- /
3 �OLC A
5g /
ARCHITECT TEL.
OSTA MESA. CALIFORNIA
OR ENGINEER NO.
ADDRESS
FIRE
ZONE
TYPE GROUP
CONTRACTOR f-oleg fi G —'S
APPROVED
BY
DATE
J
A/
(/ �
:71e2/
ZONING
ADDRESS T .E��'O/✓ •
�1
CITY ee.5 r15LBUILDING
ZO
NO. OF
USE OF NHW
BTC.TN NO./// fe,>Z+
DEGAL
SCRIPTION
I' v
SIZE Q" I NO. OP BLDOB.
OF LOT l/ Now .v BLOT LOT
A. P. NO.
USE OF
5�'u�L f� F4/11.,S
YARDS
EVES
EXISTING BLDG. -
APPROVED
ALLOWED
SETBACK LINE FROM
CENTER OF STREET REAR YARD
(CENTER LINE
FRONT
BTA .��--7j
J v FT.
IN.
SIDE YARD I LEFT
( RIGHT
R. SIDE
FT.
IN.
DESCRIPTION OF WORK
L. SIDE
_ _____--
FT.
IN.
/
I II
NEW X I ALTERATION ADDITION I
REAR
��
IN..
REPAIR MOVING DEMOLISH
APPROVED
DATE
i6 v
BUILDING NO. OF
SIZE ROOMS STORIES
EXTERIOR WALL
IROOF
COVERING
COVERING
U OF BU NG AND WORK TO BE PERFORMED
(Cl X /
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLIGTION
THE AMOUNT SHOWN UNDER VALUATION•IS FOR THE
AND STATE THAT THE ABOVE IB CORRECT AND AGREE TO COM-
PURPOSE
OF EETABLIBHINO A PERMIT
FEE ONLY.
PLY WITH ALL OM ORDINANCES AND STATE LAWS REGULATING
VALUATION
BUILDING CONSTRUCTION.
SIGNATURE OF //JJ, •/
OG/ Yf/ l�/N%�T�.6-.
PERMIT FEE $
PERMITTE
�O�
S
CHECK S
AUTHORIZED AGEN,' CLQ -
-PLAN
TOTAL FEE
LOA
I]
W
E
4
MR. & MRS. TOM
DATE 1-1
JOB ADDRESS 17,31 W. 1OWa St. BUILDING PERMIT NO. 16204
GENERAL CONTRACTOR George Potts VALUE 5101.00
AP No. 115-802-7 LOT TRACT FIRE ZONE DESCRIPTION OF WORKBlock Wall
INSPECTIONS
Signatur
DATE IGROUP TYPE ZONE Rl
Soil
- SUBCONTRACTOR
PET
MITS ISSUE. _
NUMBER
Gas
DATE
Water
Rough Com. Refrig. ❑ Air Cond. ❑
Rough Heating
Rough Plumbing
Miscellaneous
Prop. Swr. Line ❑ House Con. ❑ St. Swr.
Sprinkling System
Construction Pole
Underground ❑ Power J
Rough Wirin
'1'renchcs Forms ❑ Steel Rein
Floor System
Bond Beam 3& Steel Reinforce ❑
�q
-�(—{—
Sheathing
Frame and Flashing
Lathing — In ❑ Out ❑
Plaster, brown coat
Refrig. ❑ Air Cond. ❑ Fina
_
Beating, Final
_
Plumbing Fixtures, Final
Final Gas Test
Electric Fixtures, Final
Building, Final—
_
OCCUPANCY
FORM B04 - 5M — 7.61
16204
COSTA MESA BUILDING -SAFETY DEPARTMENT
P. O. BOX $17 COSTA MESA. CALIFORNIA
For Applicant to Fill In Completely
TYPE OR PRINT
ADDRESS 1%31 W. lovla St
COSTA MESA. CALIFORNIA
FE RECEIVED
JAN 17 1962
FINANCE OEPrt.
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
OWNER Mr. h Mrs. Tom Wheeler..1
RECEIPT NO. P IT NO.
0
MAIL
ADDRESS 1731 W., Iowa St.
RECE VHD BY
/
DATE RECEIVED D�`TE J"HUED
- - 2 .I /. "(---6-7/
CITY Costa Mesa, Calif. NO. -M 9-069
AUILDING -
DDRESS 1731
W. Iowa St., C. M.
ARCHITECT TEL.
OR ENGINEER NO.
COSTA MESA. CALIFORNIA
ADDRESS
FIRE
ZONE
TYPE GROUP
CONTRACTOR Gnorpe Potts -
APPROVED
BY
DATE
ADDRESS 2214 Harbor Blvd.
ZONING
ZONE (PLANSSTALl� BUILDINN C`�v/L�
CITY Costa Moss, Calif.
C.
LIC. NO 4094 NO. MI 8-8022
LEGAL
DESCRIPTION
A. P. NO.
_ C�,
_ ^�
`
SIZE NO. OF BLDG".
OF LOT I NOW ON LOT
USE OF$ln le Famil $08id0n08
EXISTING BLDG g Y
YARDS
APPROVED
EVES
ALLOWED
""TRACK LINE FROM
CENTER OF STREET REAR YARD
(CENTER LINE ST.)
FRONT
?J T. 2- IN.
SIDE YARD LEFT
I RIGHT
R. SIDE
L. SIDE
LJ FT. IN.
FT. IN. SI
DESCRIPTION OF WORK
NEW Ix IIALTERATION I II ADDITION I
REAR
�7 .(}�
FT.` IN.
/APPROVE
REPAIR I I MOVING I I DEMOLISH I
BY
DATE
BUILDING NO. OF
SIZE ROOMS STORIES
t
EXTERIOR WALL ROOF
COVERING I COVERING
USE OF BUILDING AND WORK TO BE PERFORMED
3 1 of Ste i aste wa
to start at 51 and steD doom to 11.
w°el�xtend from exist. wall to side
1 HEREBY ACKNO."DOE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM.
PLY WITH Al CITY ORDINANCES AND STATE LAWS REGULATING
THE AMOUNT SHOWN UNDER VALUATION IB FOR THE
PURPOSE OF ESTASLIBHING A PERMIT FEE ONLY.
VALUATION
$
PERMIT FEE $
BUILDING CONSTRUCTION. '- -'
SIGNATURE OFAssociate Contractors
PERMITTEE
PLAN CHECK $
, �
AUTHORIZED AGENT �; 4_<Lt�K.—
TOTAL FEE 5
u
JA 1, W. Y'-aI VV
JOB ADDRESS 1713 Iowa Street BUILDING PERMIT NO. 25632
GENERAL CONTRACTOR A. B. Const. DESCRIPTION OF WORK Add Den and Patio
AP No. 1'j9-062-11 LOT TRACT FIRE ZONE VALUES 2,925-00
3 INSPECTIONS Signature Date GROUP I TYPE V ZONE R-1 _
Soil SUBCONTRACTOR I PERMITS ISSUED
Gas Date I Number I
Signature
Water
Plumbing
Rough Plumbing
_
Prop. Swr. Line l7 House Con. 1]
Sprinkling System
Miscellaneous
Rough Heating and Air Conditioning
Temporary Service or Pole
Underground ❑ Power ❑
Rough Wiring
(
Heatin and Veigt.
Trenches �Z Forms p Steel Reinf.
Floor System
Bond Beam ❑ Steel Reinforce ❑
Sheathing
i e
Frame and Flashing
ri 4t
Lathing — In ❑ Out in 64 4
Plaster, Brown Coat
/ a-/, T6e
Structural, Final
Electric
Heating, Vent., Refrig. and A.C., Final
Plumbing, Final and Gas Test ❑
Electric, Final
j r6 t
Building, Final
ti-� r/y GG
LOT 49
TR 4`j22
n -1 -JI
COSTA MESA BUILDING -SAFETY DEPARTMENT
P. O. BOX 317 COSTA MESA. CALIFORNIA
For Applicant to Fill In Completely
TYPE OR PRINT
BUILDING
ADDRESSIOWA STREET
COSTA MESA. CALIFORNIA
FEE gf�,QVED
FINANCE DEPT.
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
K & E bEVELOPMENT CO.)INC.
RECEIPT NO.
PE T NO,
'�
OWNER
1.1 -y3
MAIL
ADDRESS
R8C81 ED BY DA RECE VE
Ia���j�,
DATE ISSUED
9L1Ji
TEL
CITY NEWPORT BEACH
BUILDING
ADDRESS
ARCHITECT - TEL.
COSTA MESA. CALIFORNIA
OR ENGINEER NO.
I
FIRE
ZONE TYPE GROU
[ADDRESS
TRACTOR K.W KOL
APPROVED
BY DATE
ADDRESS I PLACENTIA E
ZONING
ZONE O.UHOF NEW
clrY
g_1 (PLANNSOF 2 (BUIELDING
W $ti ti gar.
STATETEL.
LEGAL
LIC. NO .No. -
DESCRIPTION Int. 49, TrIant'. 3722
SIZE 58-70x100 I RR EG NO. OF BLDGS. 0
OF LOT NOW ON LOT
A. P. NO. RORC
USE OF
YARDS EVES
EXISTING BLDG
APPROVED ALLOWED
SETBACK LINE FROM 1 .]O 1
O L
(CENTER LINE STA
CENTER OF STREET REAR YARD
FRONT 27r, FT.
IN.
(
I
I S/
SIDE YARD LEFT
RIGHT
R. SIDE FT.
IC,
IN.
DESCRIPTION OF WORK
L. SIDE FT.
IN.
NEW I
I ALTERATION I II ADDITION
nn
REAR FT.
IN.
REPAIR I
(MOVING I II DEMOLISH I
APPROVED
BY W. L. D. DATE
n��
10-21-60
434 F
BUILDING -GAR NO.
S
SIZE ROOMS STORIES
ifs F"
EXTERIOR WALL I ROOF WOOD SHINGLES
COVERING COVERING
USE OF BUILDING AND WORK TO BE PERFORMED
AND ATTACHED GARAGE
PiAm 7-R
1 HEREBY ACKNOWL.8P08 THAT 1 HAVE READ THIS APPLICATION
THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THB ABOVE IB CORRECT AND R88 TO COM-
PURPOSE OF ESTABLISHING A PERMIT
Fel ONLY.
PLY WITH ALL CITY ORDINANCES AND TE RSDUL'T
VALUATION
PERMIT FEE
h
$ t%
BUILDING ONN.
SIGNATURE OF _
PERMITTE
/ V
S /
PLAN CHECK
S /r_
�_YY_
AUTHORIZEDAGENT
TOTAL FEE