HomeMy WebLinkAbout1835 IOWA ST - Building Permits \-4511' - CITY OF COSTA MESA
?`;r �� BUILDING DIVISION
t' DEVELOPMENT SERVICES DEPARTMENT
' x'98-01158
PERMIT PERMIT NUMBER
(714)754-5273 • Fax(714)754-4856 BUILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 1835 IOWA ST Status: ISSUED /�, p-�
Suite: Applied: 06/29/1998 at
Vicinity: Issued: 06/29/1998
Parcel Nunmber: 13905602 Zoning:
Applicant: SIGMOND, JAMES
Address:
Phone:
II, 49
iutOwner. SIGMOND, MARGARET-VTR
2 -,11----- �'
Address 1835 IOWA ST/_ - / r
is J. - I 1-- l . Phone: -
Pe-
COS�RMESA;CA ` •
Contractor Aix,/ A
Address.,,%,7 C '";. - ,
/`%r \\ %',// 1/4; Phone: NYI "/; / ;\,..
/
•
/ 1r '5 /i/;�; Zip: A1� y , •
It'/ / ' ; /i/" •
Licenser•. ,-,:N ,
L'
Arch`/Eng 20 I
/ 'A
/Address:- //;s' NL • • _
�. / � •,•Phone
,� I fi Zip `
/ i ,,,C,/:!;-‘ 'License - -- _---;,,-7; -±‘,' ' _
SCOPE OF PERMIT
. ' Vv ,
`Vo existing and reroof with comp.shingle. Cert.attached to permit. ' , , '_
('
FEESUMMARY
Plan.Check: .. " $0.00 \ Calc Valuation: , $4,200.00
,Permit: $99.75 , r`,(. Claimed Valuation: $4,200.00`.
§MIP Res: $0.50
SMTP Com : $0.00 > J -
y Other x,'$0.00 / /
Inspection $0.00 -_ _ ;.
\Notal $100:25 <;
• ', -PLANNING &ZONING
,•� - ���, i - ice
SETBACKS: • A.
MAIN STRUCTURE Front - 0-0: ., Rear 0-0__` Left' 0-0, ; Right 0;0 ;�5 '
ACCESSORY :Front 0-0- ' -- Rear 0-0 ` Left- ' --6-0 Right'', 0-'0 -
PARKING Existing:, 0 ^ • Required: 0' _ , - , ,Proposed: - 0
NOTES: - / . • -
•
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 Gays,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
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 1 w which 6?s permit Is Issued,
•
❑ I have end 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 i1 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 California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions.
Applicant Signature: Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL MD SHALL SUBJECT M EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND OOLLARE($100,000J,fN A00(TIONTO THE COSTOF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,MD ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I em 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:
h�yP
❑ I hereby affirm that tllers is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: ' &h' 4'... Lenders Address:
Signature: ' fir+''�'� Date:' 6 -29 _Kov
"
OWNER-BUILDER DECLARATIONS: ni`
I hereby affirm that under penalty of perjury that ram 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).):
.. .1d 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 en owner of property who builds or improves thereon, and who contracts for such project with a contractor(s)
license pursuant to the Contractor 'cense Laws.).
❑ I am er.grfirder sec. f/'j Business and Professions Code for this reason:
c _signature: anti--'f mo,. ..Y Date: &n —2 9—CI 5{
Owner ID verified by drivers license. 0 Nes 0 No\\\ Drivers 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 Califomia Health and Safety Code been fully complied with? ❑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 implication apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes L]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? 0 es 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 end city ordinances
regarding Hazardous Materials end Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF E •Y: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 law -nd city ordinance's =lacing to building construction,and authorize representatives of the Cityof Costa Mesa to enter upon the
above-described props r inspectiop.ou ••s;5.I agree not td•• upy or allow occupancy of any building autth000rrriized by this permit�r�j,fi`a1 Irtgpe_ction.
Signature Of Legal•;ner(s) ' (/n Date U) O�
r And/Or Authorized Applicant r.Date—
CgQ 1. INSPECTION TYPE DATE =ALS CODE I DISFFCTION TYPE DATE MODALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 1-17'.paa G'w� 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. _
2446-46
I DECLARATION OF .UTHORITY . Bldg. Permit #
FOR AGENTS OF PROPERTY OWNER This Permit #
TO APPLY FOR PERMITS •
/ 335- _Mw, st
nStt�reet�Address AP Number
I
1. I (we), 1 1 f TV/�r`F1 SIG MO w D , declare that I am the Owner of Title
of the above referenced real property, and that I (we) hereby authorize:
E AME– c 3IGmc� IJb 54545-37
Name Telephone No.
81-3s ZowSt
Street Address
Costa MESA tA- dI262b
City State Q Zip
to obtain permits in my behalf, as owner/builder, for Rao 3-O 13
at the above referenced property.
2. Should any person become an employee engaged in the improvement of the property, I (we) shall im-
mediately provide Worker's Compensation Insurance coverage and cause a certificate of that coverage
to be filed with the Building Division of the City of Costa Mesa, as required by State of California laws.
3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other per-
son, company or corporation.
4. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any
claim resulting in damage or,personal injury to myself or any other parties as a result of work authorized
by the permits from the City of Costa Mesa.
5. I declare under the penalty of perjury that the foregoing is true and correct.
Executed this 2 f naday of J UNE 19(98 , at 6' 14 114E5#, California.
Mnl?GARCT 6IG.MOIUD G- 2q-98
Printed N me Date
c r Signature
NOTE: This authorization does not grant authorization to perform the work as owner, it solely provides
for limited power of attorney to secure this permit in any behalf.
0i
. 41 .t il,,i - i
0779-46(Rev.2/91)
PROJECT ADDRESS: 1835 IOWA ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: P 052302
OWNER'S NAME: SIGMOND, MARGARET V TR
ADDRESS: 1835 IOWA ST PERMIT NC: P 052302 PLAN CHECK NO: N GOVT: N SUPP: N
COSTA MESA,CA 92626
CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: 0TH
545-1539
ARCHIENGINEER: REG.ND.: JOB DESCRIPTION : CHANGE OUT WATER HEATER SQ FT:
ADDRESS: 0 UNIT:
00000 CLAIM VALUE: CALC—VALUE: GROUP CCC: R-3 /
PERMRTEE: NOCK PLUMBING (7141895-1246
ADDRESS: 11610 SEABOARD CIR COMMENTS: SMOKE DETECTOR REQUIRED IN THE HOME
STANTON CA 90680 • z******************************************************************************
LICENSED CONTRACTOR DECLARATION: I hereby affirm Out I am licensed under provisions of Chapter 9(commencing with Section Z ONING \ETBACKS R E QUI R E M E N T S
S
7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. /
CITY UC.: 050386 STATE UC.:511971 /J Cuss: C— b
rate:} 2.-azn -i Signature:�ny ----=— MAIN BUILDING -------- ------- ACCESSORY BUILDING — --
WORKERS'COMPENSATION DECLARATION: I hereby affirm I I have a ccrtllicate of consent to self-insure or a certificate of Workers'
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Compensation Insurance,ora certified copy thereof(Section 3800,Lab.C). LEFT: FT IN R GHT: FT IN LEFT: FT IN RG HT: FT IN
POUCY NO.: 116799290 EXP.DATE: 03/01/92
"OMPANY: STATE PARKING REQ: PROV: PARCEL: 01390560 ZNE: REF NO:
Certified copy is hereby furnished. ® Certified copy is file with the city B 'ding Division. PLANNING NOT ES>
G -/0 - 4/ copy is
I ********************************************** *******************************
�atej Applicant:
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be cow pleted B the permit is for one hundred(3100)or less). DEVELOPMENT SERVICES REQUIREMENTS
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 California. ZONING APPROVED BY : _ DATE:
Date. Signature:
NOTICE:If,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : __ __ -- DATE:
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 APPLICATION ISSUED BY: I/€ �"'�' *
� DATE: yr" //
which this permit is issued(Section 3097,Civ.C). **************************** . T **************************** *******
LENDER: 4*************************************** -*************************************
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SKIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 2.00
repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed 25h' SKIP/NON—RES'
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by PLAN
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(3500). ISSUE FEE 3.00
I, as owner of the property or my employees with wages as their sole compensation, win do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sate(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 2.00 3.00 0.00 5.00 5.00 .00
does not apply to an owner of a property who builds or Improves thereon,and who does such work himLsell/hersell or through
or
orovemet own sol within oneearr od ft such completion,rthements ownerawitnot
have the burden of provingshe/she. e did nothowever
build ort improve REVENUE DIVISION TOTALS—> COLLECTED: 5.00 OVER/SHORT: 00
for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SNIP/TOT GRADING PLAN—CHECK
I,as owner of the properly,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 5.00
❑ and Professions Code: The Contractors'Slate License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects tAth a contractor(s)license pursuant to the Contractors'State License Law).l am aware *******************************************************************************
that proof of their Worker's Compenstbon insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
❑ I am exempt under Section: B.&P.C.
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: Owner: PLU 1 WATER HEATER AND/OR VENT 2.00 2.00
I do hereby certify that I am aware of and understand the requirements of California Health and Safely Code Sections 25505,25533,and END OF FEES
25534 and that I or any future building occupant wilpwill not(circle one)need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from
these provisions. V///
Date: Applicant:
I hereby certify that I nave read this application and state that the above Information is correct.I agree to comply with all city and county
ordinances and state laws relating to building construction and hereby horize represen Ws of this city to ent upon th e-mentioned
property for,'nspection purposes. __ _ _
•
,Date: P9— .. Signature: > J L1:'.:. ...c.....,-71M . ._v
Driver's License or Social Security 0:
1641-46 White—Building:Green—Code Enforcement;Canary—Applicant;Plnk—Revenue:Goldenrod—Assessor
CONSTRUCTION AND PLANNING POt. a SPA
' APPROVALS Permit # Date Inspector APPROVALS Permit# - Date Inspector
r-
1. Temporary Electrical Service or Pole, u 52. Pool & Equipment Location
2 _Sop Piee-Undrgrr4. r- "' 53. Steel Reinforcement
-a-Electrical Cond dict•utility-UndigrndY 54. Forms
4:_electrical Cdnduit-U'r drgrnd. .✓. 55. Electrical Bonding
,5. Steel Reinforcement r. 56. Rough Plumbing & Pressure Test ':-
6. Electrical UFER'Grnd. 57. APPROVAL TO COVER-GUNITE I
'7,i'Footings s 58. Electrical Conduit-Undrgrnd. 1'
8. Foundation F ,''r 59. Gas Pipe, 0 Undrgrnd.,Test '`
9: Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. , .
10. Structural Floor SystemJ 61. APPROVAL TO DECK
11. Property Sewer Line'& Ho se-Connection -
+. 4 62. Backwash & Receptor-Final ,
12. Sevier Cap s r' . 63. Heater & Vent-Final '
13. Roof Drains `'_,_ - 64. Plumbing System - Final ,
14. Rough Plumbing. 1 %' 65. Electrical-Final ..
15. Rough ElectricalConduit 66. Solar System-Final .
16. Rough Electric,Wiring . 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical;T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning _FIRE DEPT. REQUIREMENT
I r' .r t. .I '1 n 7 tri,
r-. r .r
- , ' 7 4e :1-141; e
20.'RoughFectoryFireplace I • ;* - _.a s*•APPROVALS��_Permit #
21.-Ducts, in Structure it •"' -' i` ^" F^]0. Updergrou�r'd;Hydro a
k i•, 4 J if,)::.;
22. Duct's, Ve!')tilatin `` r '` 'G'
g.;* �.1 .•,i t .i r.t<r .31. Product P,ipirog O as ❑.Oil
r
23.•Gas Pipe-Rough & Test _ _ • - -. : S ?,}4. ;2_ Underground�Fluih 2 A
24/Roof'Framing' -c " -, 4 y J -1** „73.-Undergrnd(Storage Tank O Gas 0 Oil
25. Roof-Sheathing -..e 1 .f 1•ti y • > ?'. 74. •Overhead Hydro ,, "'
26. T-Bad Ceiling (Structural) & Mb-no-coat :� j 'I �'. k 75. Dry Chemical .- 3 w ,
•27. Frame and Flashing"' D ' . r - > -! r* 76. Dry Standpjpe ).J •• '1
•28. Lathing & Siding -'i 1.xr I * "I ` I "I'.. 1t 77•=iFIXED SYST,EM,FINALs , 1 r
r i 6r ,a
29. Insulation s* _ .4. •• a 1 ' 1#n 78. ;FIRE PREV. FIIJAP ', ,.
2. • 1 In. 6 ./. •) / .
30. Drywall Failing r i* I I lad -- •-e` •I ALTH DEPT REQUIREMENT
> 7 x I 1r
se r ,.v . .� • ..
31. Plaster Brown.Coatx I ' • *
1 I I* t *79. FINAL INSPECTION * S
32.JElectricaltPower Meier:Final I d u I I !la0 1$0 1.(00D CERTIFICA34TE ISS,�UED _ i
-a. .f a 0
•:33 Final,Electric., ..,a n I S * I I Is a Notes: -I 111 ,. 9 D r
• -. - I I /1„ .. v.. ... n ♦ A. ..
•34.'Finat Heating& AirlConditiohing� n •* I I ••I** T - 1't a -: b 7
-•• • D ra 11 n R7 I 1 • .I*nJ 1 •-1 -t* 1
- ) ., ' 1 o r I , to zr • - -
135. .FineTGai.Pipe-Testi, u •• 0-+ I I I+.F t* n in J••; s* . -T
.,
36. Hodd or Canopy 1::i -) 1 -`t o on I I • h.-*... .» # .-1-
la
I r u.•I 1 ,ru .L '
-$7.,FindlFactory Fireplace; I - y n I I Inn x a v
X38. Fin--Plumbing :J I ': , I t Ina r . , 'S re y
39. Wate? Service-Final:; I * z I I I:* + > ..i ,+
1_, L I...
40. Gas Service-Final o " a'-r n n I In•s it, ')•v
4.
41. Solar Domestic-Final ' r7 " ° i 1 ••.'.
•n * i- 1* * -r -ILD • c
42. Backflow Preventer* .v * I Id n C �•• a;, -,
.. .; 1-1•-. •.•, *a .1 :-n, ) * I- _
it :�eZ * x-:* -Cr-- x- )
43. Backflow lrrig`ation.k r *s: **r, i 4 •' •
44. Landscape Irrigation-System *'n * _t .i : 1 •�a* x 'v h t'9 s* u ..D
'45.,Sound Atten anon ""'t` 'r ar •- - rs*a- .r 4 . .x-1 *
t* --•• •• t* -t -rl fl# ) - r 4 • •--I a
;
46..Handicap.Regulations . • r J e I s*i) .: o: n )
1 -lane n ,n ,-) a
..1,47."(F INAL STR1ICTURE & BUILDING *,e I : *#n N r rtY-
48.:F.INALPLANNINGn I *-r fi•J I I ' kit -i 'n 4 * r
_. 1 -n I I Io e n ra .0 ti 0 4
:49.;Eleciiic Release to Etdison I i* ,K.-U '_'. . ' K
- .50.-Gas•_Relea5e to Southern Califorr+iaGas Co n I I Iw u I- • #.11..71 n 1 •
.51. CERTIFICATE OFOCCUPANCY ' * '*+* : •1 -.) , 'r
No. Date
•
•
PROJECT ADDRESS: 1635 IOWA ST UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO: P 051712
OWNER'S NAME: STGMOND, MARPARET V TR
ADDRESS: 1835 IOWA ST PERMIT NO: P 051712 PLAN CHECK NO: N GOVT; N SUPP: N
COSTA MESA, CA 92626 •
CONSTRUCTION TYPE: V-N PERMIT TYPE; PLU PURPOSE: OTH
ARCH/ENGINEER: 545-1539 REG.NO.:
ADDRESS: UNIT: JOB DESCRIPTION .: CHANGE OUT WATER HEATER SQ FT;
PERMITTEE: CLAIM VALUE; CALC-VALUE; GROUP OCC : R-3 /
ADDRESS: NOCK PLUMBING ( 714 ) 895-1246
11610 SEABOARD CIR COMMENTS : SMOKE DETECTOR REQUIRED
STANTON CA 90680 x************M*****4*******' ***'***********'x *'>FSE**'>E*x4*>:+E.**.*:. ..**%*************x-**
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7 ONING R EQUIREMENTS
7000)of Division 3 of the Business and Professions Code.and my license is in full force and ellect.
SETBACKS
CITY LI.: 050386 STATE LIC.:55119.71 CLASS: C_36
'bale- /_Q T1 CSlgnawre:.__i___ _ './(( -•--- MAIN BUILDING ACCESSORY BUILDING
-WORKERS'COMPENSATION DECLARATION: thereby affirm that I hay'a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR; FT IN FRNT; FT IN REAR: FT IN
Compensation Insurance,or a certified copy thereof(Section 3800. Lab.Cl. LEFT: FT IN RGHT; FT IN LEFT; FT IN RGHT: FT IN
POUCYNO.: 116799290 EXP.DATE: 03/01 /92
COMPANY: STATE PARKING REB: PROV: PARCEL: 13905602 ZNE: REF NO:
i] Certified copy is hereby furnished. 12 Certified copy is rte nth the city Building Division, / PLANNING NOTES>
E� Q ` > •
-Die. r 1 - ll ADp�icant f .( A - ?p*afY****ii!f**k*********?E***if********iF*3fdr***********+E**}'-*****::*****?r*?!.*±e±f****Yi:**
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed it the permit is far one hundred WOO)or less). DEVELOPMENT SER VICES REQUIREMENTS
I cenily 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
subtect to the Workers'Compensation Laws of California. ZONING APPROVED BY .
DAT
Date: Signature:
NOTICE:II.alter making this declaration.you'should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY DATE: _
Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. /r/
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work far APPLICATION ISSUED B Y: '/ DATE
which this Permit i5 issued(Section 3097,Cry.C). ****4(ler****.**.****Pe*************. ,F' 3E .{ - ,.n'ie rw . -TF'*'TFF*�F'3****$****Ti :' 7n")FI•**
LENDER: **')*N(***ifN-*******?P********************************** ******.y.*.********?E****};.****:*
ADDRESS: LEGALIZATION:N F E E SUMMA STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or p ERN I T 2 . 00
repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed _a 5 x
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SM I P/NON-RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN '
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($5001. ISSUE FEE 3 . 00
I. as owner of the property or my employees with wages as their sole compensation, wit do the work, and the BUILDING-DI V-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS----> 2 . 00 3 . 00 0 . 00 5 . 00 5 . 00 . 00
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.It,however the building or
improvement
l within one year of completion.the owner will have the burden of proving he/she did not build or improve REVENU DIBV PMT PLUMBING ELECTRICOMECHAN , FIRE /TOT GRADING PLAN-
D•IC 5. 00
SMZPO /S C
00
farte purpose of sae) BLDGHECK
I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044.Business 5 . 00
❑ and Prolessions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).lam aware **,*****************R.4..**********u,.********************4************************* .
that proof of their Workers Compensation insurance should be provided to me.
c3I am exempt under Section: B.8 P.C. IND I VIDUAL F E E BR EA K DOWN
for tins reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date'. Owner'.
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505.25533,and PLU 1. WATER HEATER AND/OR VENT' 2 . 00
2 . 00
25534 and that I or any future building occupant will/will not(circle one)need to comply with said stale codes and the requirements for a END OF FEES
permit for construction or modificanon from the Air Oualdy Management District.Residential construction applications are exempt from
these provisions.
Date: Applicant: QP f.QO$Si?9- ' r"
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county (,w06�• % L -
ordinancesandstalelawsrelatingtobuildingconstructionandhereb uthorize representatives of this city I.enter upon the above.mentioned 041E: 04/30.91 -Jr. .i..r
property for inspection purposes. I I 10:24
�YYT__ GI/
`Dale k ,Y ` 1— Signature_ ,>✓ 4 - . 1. _
Driver's license on Social Security>:
164146 White-Building:Green-Code Enforcement:Canary-Applicant:Pink-Revenue:Goldenrod-Assessor
CONSTRUCTION AND PLANNING PO._ & SPA
APPROVALS Permit# Date Inspector APPROVALS Permit # - Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. 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 UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7,.Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test .
9.'+Nater Pipe-Undrgrnd. -., 60. Backwash Lines, P-Trap, El Undrgrnd.
10. Structural Floor System - 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains _ 64. Plumbing System - Final •
14. Rough Plumbing I 65. Electrical-Final 1
15. Rough Electrical-Conduit 66. Sola/System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
•
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil •
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
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 4k1
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
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
• 1283� FE RECEIVED
" SEP1bMg
COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT.
P. O. BOX 317 COSTA MESA. CALIFORNIA
CITY OF COSTA MESA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
BUILDING 1835 Iowa Street
ADDRESS
COSTA MESA. CALIFORNIA For Office Use Only
OWNER Amherst Development Co. RECEIPT NO. PERMIT NO.
MAIL St. 1 Oaf-rat
1533 Baker RECEIVED.BY DATE RECEIVED DAT D
ADDRESS Ar_ e9-/.1- QGp 2 9 issn
CITY Costa Mesa TEL.KI 91151 BUILDING
ADDRESS
ARCHITECT Carlson & TEL. COSTA MESA. CALIFORNIA
OR ENGINEER 14i dell ebrook NO.
ADDRESS Garden Grove, Calif. FIRE �) �J
ZONE TYPE V GROUP>..
CONTRACTOR Dike & Colegrove, Inc. APPROVED //
BY DATE I
ADDRESS 1533 Baker Street ZONING
ZONENO.OP I USE OF NEVGZ ngl tam.
I
CITY Costa Mesa, Calif. R-1 PLANS 2 BUILDING
w/ att. Pj'RIT.
Eo. 167293 TNO. KI. 9'1151 LEGAL
DESCRIPTION Lot 214, Tr. 3875
SIZELOT 69 x 100 I NO. OP BLDGSnone
OF NOW ON LOT A.P.NO. none
USE OF none YARDS EVES
EXISTING BLDG. APPROVED ALLOWED
SETBACK LINE FROM
4.315-0 I I.33 (CENTER LINE ST.) �.�/`�
CENTER OP STREET REAR YARD FRONT I� `-' FT. IN.
SIDE YARD I LEFT 101 I RIGHT 51 R.SIDE ✓ T. IN.
DESCRIPTION OF WORK
L.SIDE /0 FT.' IN.
NEW I X IALTERATION I II ADDITION I REAR 33 FT. IN.
REPAIR I V MOVING I II DEMOLISH I APBYPROVED W. L.�/D�•�� DATE 9-15-60
S ZEDING 1445 54.ft ROOMSF 6 STORIES 1
EXTERIOR WAIl,L�L,,� ROOF
COVERING SLUcoo COVERING Rock A/
USE OF BUILDING AND WORK TO BE PERFORMED
i no
Single family residence with / 'T
attached garage. Plan 11CR
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGR TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORD RANGES AND ATE LAWS ULATING
BUILDING CONSTRV VALUATION
SIGNATURE OF !1 n PERMIT FEE $ 35.00 N
PERMITTED �.` _,• $ 15,139. PLAN CHECK 5 17.50 qp
AUTHORIZED AGENT Dike & Co grove, Inc. 52.50 o
TOTAL FEE IL