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Home My WebLink About3001 GARFIELD AVE - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DflIVE, GOSTA MESA, GA 92626 BUILDING PERMIT ,lob Address: 3001 GARFIELD AV Suite: Vicinity: FRONT OF RESIDENCE Parcel Number: 14113435 Appiicant: DIEGO RIVES Address: Zoning: Phone: 714-748-4295 Zip: Owner: ORTEGA, ARNEL AND HYACINTH Address 3001 GARFIELDAVE COSTA MESA, CA Contractor: ONE WAY CONSTRUCTION Address: 12847 SUSSEX CI GARDEN GROVE, CA Zip: 92840 Arch : Address: Phone: 949-292-4904 Zip: 9262E2841 Phone: 714-748-4295 License: 835864 Eng: Address: Phane: Status: ISSUED Applied: 10/13/2004 Issued: 01/03/2005 ISSUED BY: Phone: Zip: License: License: SCOPE OF PERMIT CONSTRUCT EXTERIOR R4MP AND SLOPED WALK IN FRONT OF SFR FOR WHEELCHAIR ACCESS. Plan Check: $54.11 Permit: $83.25 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $137.86 SETBACKS MAINSTRUCTURE Front 0-0 ACCESSORY Front 0-0 PARKING Existinq: o NOTES: Rear 0- 0 Rear 0- 0 Required: 0 FEE SUMMARY PLANNING & ZONING Left 0- 0 Left 0- 0 Proposed: 0 Calc Valuation: Claim Valuation: Right 0- 0 Right 0- 0 sz,soo.00 $2,500.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 7, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work Is suspended or abandoned for a period ot 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all epplicable codes, and all requlred Inspeetlone and (inal approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this parmit. FOR INSPECTIONS CALL: (714) 7545626 � , zats-ae (rvao� WORKERS'COMPENSAnON DECLARAnON: � I �ereby affirm unCer penalry of perjury one of Ihe following declarations: ❑ I heve end will malmein a certificata of consem to setl-Insure for workers' compensation, es provided tor by section 3700 of [he Lebor Code, tor the pertormence of ihe work for which this permit is issued. ❑ I hava and will maintein workers' compensatlon Insurance, as requiretl by section 3700 of I�e LaUor Code, for Ihe peAortnanca ot ihe work for which this pertnit is issued. My workers' compensation Insurance carrier entl poliq number are: Carder. Policy Number. (lhls secfiar neetl nof be comp/ete0 i1 the permit is velued af one hundred dollars (3f 00) or /ess.) I rtify that in Ihe perfortnance of the work for which this pertnit is IssueQ I shall not employ eny person in eny manner so as to become suD�ect to Iha workers' ' ampensatlon laws oi California, antl egrea thet II I shoultl hecome sub ect to dcers' compensetion provisions of t$ection 3J00 of ha Lebor Catle, I shall forihwith WAM�I nmFN�ILUS RE TO SECURE WORKERS' COMPENSATION CAVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPI.�E7�/ER�t T�N\ E/�S AND CIVIL FINES UP TOONE HUNDRED �?�Y TIqU$AND OOLLAFE ($10p,000), IN AD�ITION TO THE COST OF COMPENSATION, DAMhGES AS PFOVIDED FOF IN SECiION 3]OB OF THE L4BOR CODE, IfJrEREST, AND ATTORNEV'S FEES. LICENSEO CONTRACTORS DECLARA710N: (commencing with Section 7000) of Dlvision 3 oi the Business antl Professions Cotle, and my license Is in full CONSTRUCTION LENDING AGENCV: ❑ I herehy atfirtn ihat there is a construction lending egency for the peAormance of the work lor which fhis pertnit is issued. (Sec. 3097, Civil Code). Lender's Neme: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm thet untler penel�y of perjury tha� I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Buslness entl Professions Code: Any ciry or counry which requires e permit to constmct, elter, improve, demolish, or repeir eny stmcwre, prior to its issuance, also requires the epplicant for such pertnit b flle e signetl statement Ihat he or she is Ilcensetl pursuem to the pmvlsions of the Contrecbrs Licensa Lew (Chepter 9(commencing with Sectlan 7000) ol Division 3 of the Business end Professions Code) or that he or 5he is eaempt theretrom and Ihe basis for tha ellaged Bxemption. Any violetion of Section 7031.5 by eny eppliwnt tor a pertnil subjecis ihe epplicent ro e civil penalry of not more than live huntlrea Collars ($500).): ❑ I, es awner of the property, or my employees wilh wages es their sole compensation, WILL DO THE WORK, end the structure is not intendetl or oXered tor sele (Sec. 7044, Business and Professions Code: 71�e Con�ractors Ucense Law Aces not apply to en owner ol property who builds or improves Ihereon, flrW who does such work himselt or herselt or Ihmugh his or her own employees, provided thet such improvemems are noi Intentled or ottered for sale. If, however, t�e building or impmvement is sold within one year ot completion, �he owner-builder will heve Ihe burden of proving that ha or she tlid not build or improve for purposa of saleJ. ' ❑ I, as owner ol Ihe property. em E%CWSIVELY CONTRAC7ING WITH LICENSED CONTRACTORS lo construct the project (Sec. 704d, Busine55 and Pmfesslons Coda: The wnlrec�ors License Law tloes not appty to en ownar of pmperry who builds Or Improves ihereon, entl who contracts lor such project wit� a contwctor(s) license pursuam to Ihe Contraaors License Lews.). ❑ I am ezempt untler sec. Business end Professions Code tor this reeson: SigneWre: Date: Ownar ID verified by drivers license. ❑ Yes ❑ No Drivar's License No. Vedficetion oi Ownership by (type of dxumem, i.e. - propeny taz bili or daed): Expires: DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: � I hereby cenify that no excavation five (5) or more Ieel in depih into which a person is required to descentl, will be meda in connection with work euthonzetl by ihis pertnit, and Ihat no building siructure, scalloltling, talsework, or demolition or dismantling ihereof, will be more than �hirry�six (36) teet high. (C�ep. 32, Grp 2, Art 2, Sec. 341, Title 8, Celibmia Atlministrative Cotle). . ❑ As owner-builder, I will not employ enyone to tlo work which would require a permit trom the Divlsion ol Industnal Satery, es noted above, unless such person has e permil to tlo such work irom the division. Signature: Date: Division of Indusirial Sefery Permit Number: CERTIFlCA7E OF COMPLIANCE AND AllTTlOfiIZA710N Of ENTHV: I certify untler penalty of perjury that I have read this epplication and stete thet lhe infortnation given is wrrecL I egree to comply with all state lews entl ciry ordinences relating to builaing conswction, and euthonze representatives ot tne Ciry ot Casta Mesa to enter upon the ebove-descnbed property for inspection purposes. I agree not to occupy or allow occupency of eny building authorized by �his permi� until final inspection. COOE �. INSFECTIONTYPE 1616 Fized Sys�em Final Fire Prevention 7266 Pool Spe Final 200 Finel Re-Roof 201 Finel BlaklRetaininq Wall 202 Finel Factory Fire Place 203 Finel Sign 204 Final Demolition Qejf, AL �( INSPECTIONTYPE 206 Final Mechanical 20B Finel Plumbing 210 Final ElecMcal 212 Finel Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Builtling/Occupancy QB¢, INTIfIALS (71a) 75a-5273 • Fau (774) 754-4856 • www.ci.cosia-mesa.��LDING PERMIT �� FAIR UHIVt, GU51 A MCJA, GA yZtiLO Jobnddress: 3001 GARFIELDAV Suite: Vicinity: Parcel Number: 14113435 Zoning: App�icant SORGE, DAVE Address: CITY OF COSTA MESA 77 FAIR DRIVE Phone: COSTA MESA, CA 92626 Zip: Owner: RODRIGUEZ, FRANCISCO O& IRMA Address 3001 GARFIELDAVE Contrector. Address: Zip: Arch : Address: COSTA MESA,CA Phone: � Zip: 92626 Phone: License: Eng: Address: Phone: ISSUED BY: Status: ISSUED Applied: 11/17/2000 Issued: 11/17/2000 Phone: Zip: License: License: SCOPE OF PERMIT CONSTRUCT 1 LF. AND 14 LF. SECTIONS OF 6' HIGH BLOCK WACL PER CITY STANDARD. NO FEE. CITY PROJECT. Plan Check: $0.00 Permit: $0.00 SMIP Res: $0.00 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $0.00 SETBACKS` MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0- 0 PARKING Existinq: o NOTES: Rear 0- 0 Rear 0-0 Required: 0 FEESUMMARY PLANNING & ZONING Lek 0- 0 Left 0- 0 Proposed: 0 Calc Valuation: Claim Valuation: Right 0-0 Right 0- 0 $300.00 so.00 NO710E: The work authorized by this permit shall comply with all applicable handicap access requiremenis undar California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. ,, , INSPEC710NS: In order for the work authorized under this permit to be considered legal, such work must comply wiih all applicable codes, and all requlred inspect(ons and final approval must be obtained. Failure to obtain inspections and final approval will result in tha expiration ot this permit. FOR INSPECTIONS CALL: (714) 7545626 2d46-4fi (N00) WORKERS' COMPENSATION DECLARATION: f I hereby aHirtn under penalry of peryury one of the following declarations: � ` ❑ I �ave and wlll maintain a certificate of consent to self-Insure tor workers' compensation. as provitletl for 6y saction 3700 of the Labor Coda, tor the pertormence of the work tor which thil�ermit is issued. ❑ I have and will maint8in workers' compensation insurance, as required by section 3700 of the Labor Code, for ihe pedormance of the woM for which this pertnit is issued. My workers' compen5at�n Insurence carner antl policy number are: Carner: ti' Policy Number: (This section need not be com0�etetl il the permi[ is valued at one huntlred dollars ($f 00) or less.) ❑ I certify ihat in ihe peAormance of ihe work for which this permit is issued, I shall not employ eny person in eny manner so es to become subject to the workers' compensation laws of California, antl egree that If I should become subject to the workers' compensation provisions of Saction 3700 of the Labor Code, I shall forihwith comply with these provisions. Applicant Signature: Dele: WARNING FAILURE TO SECURE WORKERS' COMPENSATIIXJ CAVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMiNAL PENALTIES AND CIVIL FINES UP TOONE HUNORED TqUSAN� DOLLARE (5100,000), IN AODITION TO THE COST OF CAMPENSATIQV, DPM4GE5 AS PROVIDED FOR IN SECiION 3)O60F THE L4BOR CADE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS UECLARATION: I hereby aNirm that I am licensed under provisions of Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code, end my licanse is in tull force and eftect. Lia x Class x Conlrectors5igneWre: . Date: CONSTRUCTION LENDING AGENCV: ❑ I hereby aHirm ihat there is a cons�ruction lending agency for the pertormance of ihe work for which this permit is issued. (Sec. 3097, Civil Code). Lentler's Name: Lendar's Address: Signature: OWNER-BUILDER DECLARA710NS: Date: I hereby eHirtn that under penalty ot perjury that I am EXEMPT FROM THE CONTRAC70RS LICENSE lAW tor the following reason (Sec. 7031.5, Business end Protessions Cotla: Any ciry or counry which requires e pertnit to construct, alter, impmve, tlemolish, or repair any structure, prior to its issuanca, also requires ihe applicant for such permit to file e signetl statement �hat he or she is licensed pursuant to Ihe provisions of the Coniractors License Law (Chapter 9(commencing with Section 7000) ot Division 3 ot ihe Business and Professions Code) or Ihat he or she is exempt iherefrom antl the basis for tha alleged exemption. Any violation of Section 7031.5 Dy any applicant for e permit subjects the applicaN to a civil penalry of not more ihan five hundred dollars ($500).): ❑ I, as owner of Ne properry, or my employees with wages es Iheir sole compensation, WILL DO 7HE WORK, and ihe stmcWre is not intended or oMered tor sale (Sec. 7044, Business and Professions Code: The Coniractors License Law does not apply to an owner of property who buiids or improves ihereon, and who tloes such work himself or herself or thmugh his or her own employees, provided that such improvemenis are not intended or oHered for sele. If, however, ihe building or improvement is sold within one year of completion, the ownerbuilder will have ihe burden of proving that he or she did not buiid or improve for purpose oi sele.). � I, as ownar of the property, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construci the project (Sec. 7044, Business and Professions Cotle: The coniractors License Law tloes not apply to an owner of property who builds or improves thereon, antl who wntracts tor such prolect with a contractor(s) license pursuant to the Contractors License Lews.). ❑ I em exempt under sec. Signature: Owner ID venfied by dnvers license. ❑ Yes ❑ No Business and Professions Code tor this reason: Veniication of Ownership by (type of tlocument, i.e. - properry tax bill or deed): DIVISION OF INDUSTRIAL SAFEN PERMR CERTIFICATION: Dnver's license No. Date: Expires: ❑ I hereby certify that no excavation five (5) or more fee� in depth in�o which a person is requirad to descend, will be made in connec�ion with work authorized by this permit, and that no building stmcture, scaHoltling, falsework, or demolition or dismantling thereof, will be more ihan ihirty-six (36) feet high. (Chap. 32, Gry 2, Art 2, Sec. 347, Title B, Calitornia Adminisirative Code). ❑ As owner-builtler, I will not employ anyone to tlo work which would require a permit irom ihe Division of Indusinal Sefery, as noted ebove, unless such person has e permit to do such work from ihe division. Signature: Date: Division of Indusirial Safety Permit Num�er. CERTFlCATE OF COMPLIANCE AND AUTHORIZA710N OF ENTRV: I certify under penalry of perjury that I have read this application and state ihat Ihe information given is correct. I agree to comply with all state laws and ciiy orainances relating to builtling constmction, and authorize representaiives of ihe Ciry of Cosia Mesa to entar upon the above-descnbed property for inspection puryoses. I agree not to acupy or allow occupancy of any builtling authorized by this pertnit until finel inspection. (\ Signature Of egal Owner(s) ( D�/e \ \a..� �/� �T4 — �� 1 2L 1 Z�Q -� AnNOr Authon d Applican Da e COUE �, MSPECTIONTVPE 1616 Fixetl System Final Fire Prevention 1266 200 201 202 203 204 Pool Spa Final Final Ra-Roof Final BIocWPetaining Wall Final Factory Fire Place Final Sign Final Demolition [IAj� INTRIRLS ��_v1 � CO�E 1 INSPELTION TYVE 206 Final Mechanical 208 Final Plumbing 210 Final Elet�rical 212 Final Fira Prevention 220 Final Planning Approval 222 Final Si�e 250 Final Building/Occupancy OdSE IrmruLs ,. • 2HI5 SKEIQi LS FOR INFORMATIONAL PURFO66 � ONLY. APPLICAM 15 RFSPONSIBLE FOR PROVIDWG AN ACCURATE REYRFSFN7A770N OF T}�Qt PROPERtY IN CASE'li� SHAPE AND SIZE DO NOT CORRFSPOND WiTH T[-IE INFORMATION PROVmID ON THIS Stg'Ff. � ' �'---------------- � �--- !� - _ • SOLiD WALLS/FQJQ�S B£IWEII4 2'�' k 6' A] }IDGtCf SHALL BE SEfBAIX AT LFASi 10' FROM FRONf PRdpIIt2Y LINE • SOIID WAiSS/FFN�S SFIAI.L NOi &�C�FD Y 6' Q�1 FQ�7CtIf NTIt�I 1V OF IHE FAON7 PROPERIY III�i� (NO'I CURB IAIE�. • VERIFY DSGN� FROM CURH I'O PROPERiY LINE AND 9-IOW ON PNN. VERIFIG1tON FROM IHE QIYS HJGINffitINC DIVSION 6 REQUIR�. CAIS (!1�) 7545,347 POR INFORMAT[ON. 6AKER { STREET a � : � -EX� 57'%N4. �.vMj%L � { / �' t. r. ue� ac oc,�c �✓�� ]', Jo,n/ E.Xlst:nlCa. � .' � BLOCK WALL LAYOUT FOR BUILDING PERMIT _. _- - _--_ _------- - ------ . . ., - ,..._. � Z� .. ` PLANNING DIVISION ' ... . A 7 � _,! �L. �v�.11 �_� ��v' ��( �(.F' � �� o� �� 7�%a� �'u�u��ut� Z��uiO,�a�t PERMIT PROCESSING CENTER SUBMITTAL APPLICATIO Project Address: 3001 GARFIELD AVENUE Development Project Numbcr. SUBMITTAL TYPE: ❑ Building ❑ Planning ❑ Electrical O[her �, � I .I �(/l/ 1/ Activity Number: Received By: Suite/Unit _ (if applicuble) OFFICE USE ONLY ❑ Engineering ❑ Grading ❑ Plumbing ❑ Sanitary District ❑ Sign ❑ Mechanical ❑ Fire � r Description of work to be performed: (please be specific) C s e/Sf/tuC/ / L. � Qn/D �� L� F S�GT�on�S ca p�� yiC�Hy G�� THic� t_.sek G✓ALL P�2 CiT� a� ��,s>� vYI ETA- � u� � �, ,✓C, b� ✓�.r, e�✓ s7.n-.d�.�o b�Ta � �, Sq. Footage: Type of Consh _ ccupancy Type: OccupantLoad: v Owner/fenant• �/L'�` Address: City: ApplicantlAgent: Address: City: ArchitecUEng.: Address: City: Valuation: Grading: CuUFill � cubic yds. SCiI� +Y��PA�.� Sui[e/CJnit State: Zip: Phone No.: Suite/Unit CDL#/SS#: S[a[e: Zip: _ Reg. No.: S[a[e: Phone No.: SuiteNnit Zip: Contractor: Phone No.: Addtess: Sui[e/UniC City: State: Zip: _ S[a[e License No.: Class Expiration: Workmads Comp. Policy No.: Expiration: Insurance Company: (SEE BACK FOR lTEMIZED ELECTRICAL, MECHANICAl. AND PLUMBlNG) (256ld6) 2546d6 (rev.5/99) 2546d6 (rev. )N9) DECLARATION OF AUTHORITY FOR AGENTS OF PROPERTY OWNER- TO APPLY FOR PERMITS 3001 GARFIELD AVENUE Street Address Bldg. Permit # This Permit # 141-134-35 1. I(we), �a�1CiSE.o £� l t2M�L ��2rG4E� declare that I am the of the above referenced real property, and that I(we) hereby authorize: C�Tq m� �°osra �1Fsa- Name L/{�2 92�J� M to obtain permits in my behalf, as owner/builder, for atthe above referenced property. �u) 7S�F - Zip �� 2. Should any person become an employee engaged in the improvement of the property, I(we) mediately provide Worker's Compensation Insurance coverage and cause a certificate of that to be filed with the Building Division of the City of Costa Mesa, as required by State of Califor 3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any c son, company or corporation. 4. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless claim resulting in damage or personal injury to myself or any other parties as a result of work ai by the permits from the City of Costa Mesa. 5. I declare under the penalty of perjury that the foregoing is true and correct. Zo e e �� Executed this zr day of SE'PY � , at �A- •�•�r- �+ta��sc� � �2�,a 20� 6� 9-.2 s— a000 Printed Name . Date � / / �c[� � ��o np Signature V �— NOTE: This authorization does not grant authorization to perform the work as owner, it ; for limited power of attorney to secure this permit in any behalf. NOTARIZATION REQUIRED one as Ipe�. vs�i of Title II im- ��age laws. r per- i any ia. provides C'',it.�y o� C''.oa.�a ��leQa S'u�r�� Dwi�io� OWNER-BUILDER ! VERtFICATION A city or county, which is reyuired to give notice pursuant to Section 19830, shall attach [o such notice, and, as a condition prcccdent to issuing a bui(ding permit, require the completion and �equire the're[um of, an owner-builder verification. Attention Property Owner: ' An `owner-builder' building permit has been applied for in your name and bearing your signature. I Please complete and retum this infortnation in the envelope provided a[ your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No buildingpermit will be issued until this verification is received. � 1. 1 personally plan to provide the major labor and materials for construction of the propc property improvement. ❑ Yes �No 2. 1(h� ave noQ f/A ✓F2- ,c/vr signed an application for a building permit the proposc work. 3. I have contracted with the following person (firm) to provide the proposed conswction: Name THL� �=+Ty D Address Phone ( City — Contracror's Lic. No. 4. 1 plan to provide ponions of the work, but 1 have hired the following person to coordin� supervise and provide the major work: Name .�//,4 Address City Phone ( ) Contractor's Lic. No. 5. I will provide some of the work but 1 have contracted (hired) the following persons provide thc work indica[ed: Name Address Phone Type of t0E2-46 (REV. 9y8� � M ::�` f 1 OG.00' GURVE D/`"I`, A � 242°00' 2.0' R �ao.00' L � I�o8.g5' w � `� �f� � �, ;, ;; , - � �� p �; _ . ,.. �, ��-- � . �—_ .: � � . _ , . , r:<. �.;->�:� �� 0 cuRvE � = 3l°� R�t00 L - 54 � p/�T /� �' 10.. )C' ` _ _,_ _ _ T�-a )C, � 7'yQ'I \J 1\ 1 +00 Rn0 pT. �'Z.I I ( ig Z-1 O ��' � CUQvE �'31°C � iGC. L� S4 �� . PflOJECT AOOBESS: � O O 1 GAR c I ELD AC' • OWNEF'SNRME: FORESIA MICHAEL N noonEss: lR7_20 S�N GABRIEL AVE CERRSTOS,CA 9Q7U1 (715)637-1142 /�1 � UNIT: _ —.t- - AHCM/ENGINEEH: XEG.NO.: IIOOHESS: UNIT: PEflMITTEE: TCAA�I� �ORESTA ( 71 4) 637-11 42 aonness: 3U01 GARFIELD AV COSTA MESA CA 52626 LICENSEO CONTHACTOB OELLABATION: I hereby allirm thal I am licensetl untler Omvisions ol ChaO�er 9(commencing wilh Sec�ion 7000� ol �ivision 3 of Ihe Business and Pmiessions Code, ana my license is in lull force and elfec�. CITY LIC.: STATE IIC.: CL15S: Date: SignaWre: WOBREXS' COMVENSFTION UECIAHRTION: I hereby alfirm tha� I have a cerlilicale o1 consen� to setl�insure or a certifica�e oI Workers' ComDenSaiian Insurance, or a cer�ihed copy �hereol (Section 3800, Lab. C). POLICY NO.: EXP. DFTE: �� COMPRNY: �1 Cetli�ietl coOY is hereby IumisheU. ❑ Certilied copy is IileO wi�h Ihe cily Building �ivision. �- I �a�e: Applicani: E%EMP710NFNOMWOBNEBS'COMPENSATIONOELLAHATION: (ThissectionneetlnotUecampletetlifihepermitisioronehunaretl(51W�orless�. I ce0ily ��at in �he pedormance ol Ihe wark far which Ihis permi� is issued. I shall not employ any person in any manner so as 10 �ecome sublect lo Ihe Workers' Compensation Laws ot Cah�omia. 2 �L Oate: ?� 3 �' 4 Z Signa�ure: � // /�U NOTICE: IL aller making Ihis declara�ion. you 5hou10 become sublec� Io �he Workers' Compensa�ion pmvisions of �he LaDor Code. you mus� totlhwilh comply wilh such provisions or Ihis permii shall �e tleemetl revoked. CONSTflUCTION LENOING RGENCY: I hereby alfirm Ihat there is a conslmciion IenOing agency br ihe peAormance oi the work 1or which Ihis permil is issuetl ($ec�ion 3097, Civ. C�. IEN�Efl: AODNESS: OWNEB BUILDEfl DECLHBRTION: I hereby affirm Ihal I am exemp� �mm Ihe ConVac�ors' State Cicense Law �or �he following reason (Section 7031.5 Business antl Pmiessional Coee: Any ciry of coun�y which repuires a permit �o cons�mct, alter, impmve, demolish, or repair any s�mciure, prior to II5 issuance. also reQuires Ihe applican� lor sucA permit �o lile a signed ifalement ��at he/she is licensetl pursuam m the pmvisians of Ihe CONrac�ors' State License Law �Chapter 9(commencing wiih Seclion 7000) af Oivision 3 0� IAe Business and Prolessions Cotle) or thal he/she is exemp� therelmm and Ihe hasis �o� ��e allegetl exemp�ioa Any violalion oi Sec�ian 7031.5 by any applicant �or a permi� suhlecis ��e apDlicant to a civil penal�y oi noi more,�han �ive hunJred tlollaro ($500). I, as owner o� Ihe O�operty ar my employees with wages as Iheir sol¢ compensalion, will tlo lhe work, antl Ihe ❑ stmcWre is no� imenaetl ar oHere� for sale (Set�ion 70dA, Busine55 and Pro�essional Code: TOe ConVattofs' S�a�e license Law tlaes noi apPly to an owner o� a pmpehy who builas ar impmves lhereon, antl who tloes such work himselflhersell or ��mugh his or her own employees, pmvided �hat suc� imOmvements are not in�en0etl or ofleretl for sale. It, however lhe 6uiltling or impmvement is sole wiihin one year oi completioq the owner will have ihe burAen of pmving he/she OiA not huiltl or improve for ihe Durpose ol salel. I. as owner ot the pmpetly, am exclusively conVac[ing with Iicen5e0 conVac�ors �o con5�mci Ihe Orole�� (Sec�ion 7044, Business ❑ and Pwiessions Cotle: The Contradors' S�aie License Law Ooes no� aD�ly to an owner o� D�opehy who builds or improves thereon antl who coniracis �or such pmjecis vA� a conVacloqs�license pursuan� to ��e Contractors' Sia[e License Law). I am aware Ihat pmol ol iheir Worker's Compensation insurance 5houltl Ge D�oviOed to me. � I am exempt untler Section: $ P% � Q 4 B. 8 P. C. mr mis reason: ALL WORK B Y OWNER �� a�e'. � ��_ Q? Owner I Oo hereby cenily Ihat I am aware ol an0 unaerstand ��e requiremems o� Califomia Health anE Sa�ery Code Seclions 25505, 25533, antl 25534 and Ihal 1 or any INure �uiltling accupan� wilt/will nol (circle one) neetl lo comDty wilh sai0 sta�e cotles and Ihe repuirements for a permii lor canslmclion or modi�icatmn Imm �he Air Oualiry Management �iSVicL Re5i0ential cons�mction applica�ions are exemp� fmm ihese v�ovisions. Da�e: Npplicanl: I hereby cer�i�y Iha� I have reaOlhis apPlication and slaie thal lhe above inbrma�ion is correci. 1 agree lo comply wi�h all ci�y antl counry ortlinances antl siale laws reiating to 6mlding cons�mction an0 here6y aWharize representalives ol �his city to en�er upon �he a0ove-mentioned pmperiy lor inspetu0n purpo5e5. `AA oaie: Z-3 0 �' Z si9�awre: �/�"/ od�ers uce�se or souai secu�iiy x: 16abJ6 Wh��e—Bwldinq; Green—Cade EniorcemenC Canary—!oolicanl: Pink—Revenue: Goltlenrod—Assessor CITY OF COSiA MESA - BUTLDING PE3MIT ��xM NU: � u7nsn9 PEAMIT NO: B 0583R4 PLAN CHECK NO: N c;uvi: n surr: rv CONSTRUCTION T'YPE; 5-N FERMIT TYPE: STR PURPOSE; AL'P JOH DESCRIPT70N : REROOF WITH COMP OVER ON� EXISTING COMP 5(1 FT: 2,000 CLAIM VALUE; 2,000,00 CALC-VALiJE; 2,U00.00 GROliP OCC: R-3 /M-1 COMMENTS: SMORE DETECTOR(5) RE�OIRED zN .HOME. 6M4� ��,TECTOR #*xx***��**x*��;�**�*t�**u��r*� r�*x**x*�x-*xr�x�*3:.�c�**�*+�***. � . �**ku��t�* Z O N I N GS ERTEBQAUC1H�5� M E N T S REQU�RED ------------ M.AIN BUILDING ---------- --------- RCCESSORY BLiILDING --------- FRNT; F7' IN REAR; FT IN FRNT; FT IN REAR; FT IN LEFT: FT IN RGHT; FT IN LEcT; FT IN RGHT; rT IN PARKING RE • PROV; PARCEL; 14113935 ZNE; REF �10; PLAhNING N 'tES> i *�*x*�***��**�*��r�**��c****�**�•�**��c*****��*��*+��**��*��**��:�*�*�u�*�*�� D E V E L O P M E N T 5 E R V I C E S R � Q U I R E M E Ni3 S �i: ZONZNG APPROVED bY , llATe: - HUILDZNG APPRQVEU BY ; APPLICATSON ISSUED BY: iEiEiEifiF3F-IEiEif3EiEiEiF#fiEiFiEiflfrtiFiE n-tr r. vi�x r � f(� iE iF iE iF iE iE iE if �F iFiE M.� if� iE if )E �F iE k 3f iF iE if iF if iE 3E if� if %� 3Flt �%%i(� LEGALI7.ATION;N F E F: BLDG AMT PLt7MBINC> ELECTRIC NECHANIC PERMIT 45.00 PI.AN ISSUE FF.E S U M M A R Y DATE; DATE• "f/s��2 1�iF3i�iFa(�ifiFiki(�iEifiFK�iFk k x'ir')k :E if� )FiE #�K 341F iF * iF iE ii� #� %� 1Gif -}E it� ii- IF if �1i� ik i6 dt- STRUCTURAL SEGMEI�T;y FIRE SMIF/RES� GRADZNG .50� SMTF�lNON�,RES �/� BUII�DING-DSV-> PERMIT ZSSUE PLAN-CHECK TOTAL PAID ' DJE TOTALS----y 95,50 0.00 0,00 45.50 45,50 ,00 REVENUE DIVISION TOTAI,S--> CULLECTED; 95,50 UVER/SHORT; � ,OQ BL�45P00 pLUMBING ELECTRIC N,ECHANIC FIRE SMIP/TO�T GRADZNG��LAN-CHECK Y /!. 3P iE lE !f� �lF if ik iE IE 3f iE �E ff �IE it i!' 3F # if 1'r if if �1F if if 1f iE iE if� �)f ii� af� �1f �lf 1F 3f iE aFif ii� ie,F iE if IF Y-�JF �iFiF ib �%3i i's-1E iF if iF if iP�1(� ie'k ik iF iPT: � iE 1F � iE iF 3i� �F �N� iE?h ih iF I N D I V Z D U A L F E.. B R E A K D O W N TYPE QTY D E S C R I P T I U N UNIT CUST �OTAL COST SFR 2000 REROOF HY �'ALUE RfiSIDENT'ZAL NOZONE END OF' FEES i, � U // 2 � � � �, 0 � � 7 � / � 1'�l QQ1i�T-:�7:_�r--�.� /. ... -�^T�• .u" �c, - j_`. � CON3TRUCTION AND PLANNING POOI �PA . APPROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector i. Temporary Electrical Service or Pole 52. Pool & Eq�ipment Location � 2, $oil Pipe•Undrgrnd. 53. Steel Reinforcemen[ ' , 3. Electrical Conduit Ui(lity-Undrgrnd. , 54. Forms 4. Electrical Conduit-Undrgrnd. �� 55. EleCtrical Bonding . � 5. Steel ReinforGement . 56. Rough Piumbing & Pressure Test 6. Electrical UFER Gmd. 57. APPROVAL TO COVER�GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, [7 Undrgmd., Test ' 9. Water Pipe-Undrgmd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Fioor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & ReceptorFinal 12. Sewer Cap 63. Heater & Vent-Final " " 13. Roof Drains 84. P1umUin9 SYstem � Final � '' 14. Rough Piumbing 65. Electrical-Final 15. Rough Electrica�-Conduit 66. Solar System-Final � i6. Rough Electric Wiring 67. Fencing & Access Approval 77. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrica6T Bar Ceiling 69. POOUSPA SYSTEMS FINAL 19. Rough Heating & Air Condi:ioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Stiucture 70. Underground Hydro 22. Ducts, VentilBting 71. Product Piping OGas OOiI 23. Gas Pipe•Rough & Test 72. Undarground Flush 24. Roof Framing 73. Undergrnd, Smrage Tank � Gas ❑ Oil 25. Root Sheathing 74, Overhead HYdro 26. T-8ar Ceiling (Struc[urall & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Sidin9 77. FIXED SYSTEM FINAI 29. Insulation 78. FIRE PREV. FINA� 30. Drywall Nailing ' HEALTH DEPT. REQUIREMENT i � 31. Plaster Brown Coat ' 79. FINAL INSPECTION 32. Electrical Power Meter�Final � � �� 80. FO00 CERTIFICATE ISSUED 33. Final Electric Notes: 34. Finai Fleating & Air Co�ditioning ' � 35. Final Gas Pipe-Test � 36. Hood or CanopY 37. Final Factory Firepiace �. '� 38. Final Plumbin9 39. Water Service�Pinal , 40. Gas Service-F�nal 41. Solar pomest�c-Final �� 42. Backflow Preventer 43. Backflow IrrigatiQn� 44. Landscape Irripacl� System 45. Sound AttenuatJDn �• � : 46. Handicap Reguldt�'qn�'i� 47. FINALSTRUCZ�E&'BUILDING .!� �u,� �� !i _ �� .�� 48. FINAL PLAN �ING �; , ', 49. Eleccric Releaseib Ed�son : 50. Gas Release to; utharn California Gas Co � 51. CERTIFICA7L"OF OCCUPANCY ' No. � Date CITY OF COSTA MESA BUILDING DIVISION OWNER-BUILDER VERIFICATION A city or county, which is required to give notice pursuant to Section 19830, shall attach to such notice, and, as a condition precedent to issuing a building permit, require the completion and require the return of, an owner-builder verification. Attention Property Owner. An 'owner-builder' building permit has been applied for in your name and bearing your signature. Please complete and return this information in ihe envelope provided at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. 1. I personally plan to provide the� jor labor and materials for construction of the pro- posed property improvement. C�"Yes ❑ No 2. I(have/have not) ,¢ �/� signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction: Name _ Address Phone ( City Contractor's Lic. No.. 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work: Name _ Address Phone ( City Contractor's Lic. No.. 5. I will provide some of the work but I have contracted (hired) the following persons to pro- vide the work indicated: Name Address Phone Type ot Work I hereby affirm that ! have received a copy of the information set forth in Section 19830 of the State of California Health and Safety Code and have completed the above information to the best of my per- sonal knowledge, in compliance with this State law. Signed: � � Date: 7 ' 3a Name: �/C� �ov �ST�9 (Printed or Typed) c.d.�. # o� s.s. # � 754-5273 � GE] ��,� Gas `� Wa1 � Roo � Pro � �; 1 Mis �j' Rou or Date BUII,DING PERMIT NO. OF NORK SUBCONTRACTOR � ' , 245.'�2 �OSTA MESA BUILDING-SAFETY DEPARTMEMT � P.O. BOX 01] COgTp MHBA, CALIFORNIA For Appl7canf to Fill In Complefely TYPE OR PRINT BUILDINa ADDRESS �O COSTA MESA, CALIFORNIA � ARCHITECT NO. OP oLOOB. USE OF EXISTINa BLDO. aerawcK uNe vnon DESCRIPTIQN OF WORK BUILDINO NO.OP SIZE ROOM9 EXTERIOR WALL ROOF COVERING GOVER USE OF BUILDING AI�D WORK TO BE SLd� '�.tn �- r� II HERHOY �CKNOWL8O08 TNAT � ryqyg qg�p TM19 �PPLICATION •ND 9TAT8 TNAT TM8 ABOVE I9 CORRHCT AND AORHB TO COM. PLY WITH ALL CITY OpDINANCpg AN� 9iATH LAWO H80YL�TINO oWLDINOCON8TH1�¢1QN. /7 0 AUTHORIZEDAGENT BUILDINQ ADDRE59 FIRH CItY 0�' C�3 �A MFSA No.O� r1aH8 °�'�� R6CHIP� NO. ➢PI YARDBAPPROVED MAIN BUILDINO VAR. iC `� - 3 5 BHALL BE LE89 THAN (U.B.C.REQUIREMENT� YAROSAPPROVED ACCESSORY BUILDINO - - � ,. i� �.I • ��/�� TN8 AMOUNT BHOWN UNDER VALUATION IB POR TX! PUFPOBB OP 88TABLI8HIN0 A PEpMIT P8E ONLY. VALUATION PERMITFEE S - =�d o— TOTAL FEE $ � � GENERAL VALUE SUBCONTRACTOR '. 245�1 }COSTA MESA BUILDING-SAFETY DEPARTMENT • P.O.BOX 91] COHTI�MB9A,CALIPORNIA For Applicanf to Fill In Complefely TYPE OR PRINT / ILDIN� _ /'f i�" � � / f^/� ■ MAIL COSTA MESA, CALIFORNIA � 6.a USE OF EXISTIN6 BLOO. BETBM1CK LINE FROM TEL. NO. TEL. NO. 4T � � I ��'--�—�� DESCRIPTION OF WORK BUILDIN6 NO.OP SIZE ROOM9 BTOP EXTERIOR WALL I ROOF GOVERING GOVERINQ USE OF BUILDINB Af�ID WORK TO BE PfiRFORMEO aL6c,( r/e L � 6C"r5 � K 30" 1 H6RHBY ACKNOWLH�OH TXAT � NAVB NEAO TH19 FPPLICATION AND 6TFTE TNAT TH6 ABOVE 18 COHRECT ANO AONEH TO COM. PLY WITX �LL C�TY OqO�NANCH6 AND 9TAT8 LAW9 R80ULATINO BUILOINO CON9TRYRION. SIGNATUREOF � \ PERMITTE AUTHORIZED AGHNT CfTY OF CLS tA M AUG 1.6 1965 ZON NO. OP U680F NiW /A�/� C� / PLANH � BUILDINO �� D68CPIrTION �llJ / � CC� � A.P.NO. k ��I I >�' �� NOTE: NO EAVE OVERHAN6 SHALL BE LE95 THAN YARD9APPROVED MAIN BUILDIN6 // „ VAR. # VAR�SAPPROVED ACCESSORY BUILDII I �� FI. 3 0' ,Q,S�"`a- —,. i �iZ7— OATE THE AMOUNT BXOWN UNGBH VALU�TION 19 POR TH8 PURPOSE OF EHTAeLIBHIN� A PEFMIT FEB ONLY. VALUATION � y s �}/i✓p� JOB ADDR ROUGN PLUMBING PROP. SWR. LINE � HOUSE CON. � SPRINKLING SYSTEM MISCELLnNE0U5 ROUGH MEPTING ANO �IR CONOITIONING TEMPORARY SERVICE OR POLE UNOERGROUND � POWER � ROUGH WIRING TRENCHES FOHMS STEEL RE FLOOR SYSTEM BONO BEr1M � STEEL REINFONCE � $NEATNING FRAME INO FLPSMING LATMING — IN (� OUT (—I PLASTER,BROWN CO�T STRUCTURqL, FINPL TING, VENT., REFRIG. �N� R.C., FI dBING, FINAL AND GA$ TEST n ELECTRIC, FINAL BUILOING, FINnL �ni� R_ �-7 BUILDING PERMIT KTnn�liou P�� SUBCONTRACTOR � 4254� COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 7200 COSTA MESA, CALIFORNIA 92626 For Applican[ to Fill in Comple[ely — Use Ink Only gUILDING ADDRESS �) OWNER /C(/D A/�Y I_L�/SI�O� CIYY ADDRESS ARCHITECT OF ENGINEEF ADDRESS TEL. NO. TEL. '�:�:2_'.-7C>'�'u0Q168�' r�'��10.5C ��,—�, APPLICATION FOR STRUCTURAL PERMIT RECEI i D BV D TE EI D TE ISS�1 EO r � A� ✓ �� ._,�/� PERMITNO A.P. NO. .I BUILDING � I �A,'C�71�,� ADDRESS // �f riL � f�Yj TRACT Gr5[ LOT BLOCK A _/ (� OwNER � � �r�(� i VALUE s "� ��- s FIRE ZONE PE GROUP APPROVED av DATE i ADDRE55 � `� TEL. Z�NE NO.OF CIYV NO. P�� Z F STATE CITV VARDSAPPROVED � LIC. NO. LIC. NO. MAIN BUILDING W SIZE NO.OF BLDGS. (FROM C/L STREET) �+ OF LOT ) Q NOW ON LOT FRONT T.. N VSEOF � /�� EXIST�NG BLDG. FG F ti F «'� � / �_/I FSeparate permits are required (or L. SIDE � electric, plumbing and heating work. REAR ^� /lF' 5 BUIL ING Af��WOPK TO BE PERFOFMED DISTANCE BET. ❑ ♦ MAIN BLDGS. �1 VAP. 3W Q yO C.V.P.Sy� � APPROVE � ,. �w � a W � 1 �ereby ecknowlatl8e that I have reatl ihls epplication entl stete (� that the above information Is correci antl aprea to comply wlih a oll Inws repulatlnp builtlinp consvucNon, and I shell not employ z any Person in violotion of Me workman's compensallon lows o( � the Stete of Celifornle. 3 I hereby certlfy 2hot I em properly IIc¢nned as a contractor under 5�. F the State of Cellfornie eusinesa antl Profeuiona Cotle, Dlvislon 3, THE AMOUNT Chepter 9, antl Nat svch Ilcanvas ara In full force end effect, or I TME PURP06E C om exempt trom the provisions ot the State of California Buainecs V A�UATION nnd Professione Cotle, i Ision 3, Chepcer 9. Slpnetura af �']�� O � Permittoe $`/; G Aut�orizad Agant E OF NEW [��,�p� LDING �� 1; VARDSAPPROVED BET. MAIN ACCESS. Bl DATE r23 ��(Q n m i . m N I UNDER VALUATION IS FOF m G A PERMIT E O e P EE y ' a J� n PLAN CHECK § ^� 0 TAX S LL f U TOTAIPAID E Q. Lo� rRncr 4z_z. � : ��.`-��Jo7 COSTA MESA BUILDIN6-SAFETY DEPARTMENT P. O. BOX 917 C08TA M68A. CALIRORNIA For Appl)eanf fo Fill In Complefely TYPE R P IN)' ��/' nCe. BUILDING �y ADDRESS � COSTA MESA, CALIFORNIA OWNER K Sc K DEVFL OPMENT CO: I NG ADDRESS � PLACENTIA AVENUE cITY NEWPORT BEACH No.MI G ZZ ARr- 'EGT .. TEL. K.W DNEWPORT BEACH 61195 No: M� 63227 1 C NO. OP BID09. � X 1 Z 1� I R R I G• NOW ON LOT BHTBACK LINH PROM C¢NTLR OP 8TIi88T � REAR YARD Z � SIDE YARD I LEFT �� I RIGHT �� DESCRIPTION OF WORK OF WALL TO BE PERFORMED I GARAGE �' �. �' K k.l, �PT. t U � SEP 27196) FINANCE DE CITY OF COSTA MESA APPLICATION FOR PERMIT BUILDING For Office Use Only RECGIPT NO. lBRMIT'NO• •' JL:3:,''i;3: � RCC¢1y�y. BY Oy� RECEIVED UAT¢ 188UHD !iL_ Y.--15—_ SFP 2 7 196i COSTA MESA, CALIFORNIA FIRE ZONE APPROVED ZONING ZONE NO. OF UBE OP N6W Jw� �./n �--� I PLANB � I BUILDINO W �ea�e,e..�� y 7-� v Z 3 L I HHRCBY ACNNOWLBDOE TNAT � HAVE ReAD i3118 MPYGTION THE AMOt1NT BHOWN IINOER VAIUATION IB FOR TNe AND BTATE TMAT TM6 ADOVE 16 GORRBGT AND AGPlB TO COM- pURP04¢ OF EBTA9LIBXIN6 A PfiRMIT FEE ONLY. PLY WITX ALL CIiY OIiDINANC69 MlD BTATE LAWB MEOULATING eU1LD�N0 CONBTRUG'f10N. VALUATION SIGNATURE OF % f PERMIT FEE $��i � PERMITTE /� S�C� '7 L a S � PLAN CHECK $ / // CJ �G Z AUTHORIZED AGENT � � � 4 TOTAL FEE