HomeMy WebLinkAbout1397 GARLINGFORD ST - Building Permits ,4/1 S 9 CITY OF COSTA MESA
BUILDING DIVISION
F .�...+c"F , DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
y+y PERMIT E03-00643
rill
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 1397 GARLINGFORD ST Status: ISSUED
Suite No Applied: 07/21/2003
Vicinity: Issued: 07/21/2003
Parcel Number: 14102104
Applicant: KEITH COBB ISSUED BY:
Address: 416 S LORETTA
Phone: 714-538-1569
ORANGE,CA Zip: 92869
Owner MARTINEZ, ROSS
Address 1397 GARLINGFORD ST
Phone:
�\
COSTA MESA,CA Zip: 92626-2631 t \,/1
i (, Ili .
Contractor: SOUTHERN PACIFIC ELECTRIC DA'
Address: 416 S LORETTA
Phone: 714-538-1569
ORANGE,CA Zip: 92869
License: 747793
SCOPE OF PERMIT
UPGRADE ELECTRICAL SERVICE TO 200 AMPS.
FEE SUMMARY
• Quantity Quantity
ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0
Temp service test $0.00 Busway/100 ft $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 0
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 ' - 0 Low Voltage Equipment $0.00 0
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 0 Misc. Conductor $0.00 0
Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0
Motors to 1hp $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 100hp $0.00 0
Communication drops $0.00 0 Investigation Fee $0.00
Sub panel to 200a $0.00 0 Plan Check Fee $0.00
Pole Light Pkg $0.00 0 Reinspection Fee $0.00
Sign Circuits $0.00 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1,12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6100)
DECLARATIONS '
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
I certify that in the performance of the work for which this permit Is issued,I shall not employ any person in any manner so as to become subject to the workers'
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: 2- 21- D
WARNING:FAILURE TO SECURE WO COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLAAE(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Businessand Professions Code,and my license is in full
force and effect.Lic.# 74_ 77 4 3 Class k G
Contractors Signature: 53 -P__Z. g( //'- Date: 2^07—03
CONSTRUCTION LENDING AGENCY:
9 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom 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(5500).):
❑ 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 properly,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. 0 Yes 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: •
I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑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 preparee an RMPPP(RRiskk 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 II an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which ii the subject of this application apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes 0 No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 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 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 city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
S' nature Of eget wrier s) Date
d }-moi a 3
And/or Authorized Applicant Date
CODE 1 INSPECTION TYPE DAIS raffia* POnF• INSPECTION TYPE PAIS 1NIIlS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
4
.
CITY OF COSTA MESA
<4, -fieke BUILDING DIVISION
> l�,,;,, ; DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
J: / • PERMIT `
b-`^twerermin / B01-01809
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 1397 GARLINGFORD ST Status: ISSUED
Suite: Applied: 11/13/2001
Vicinity: ROOF Issued: 11/14/2001
Parcel Number: 14102104 Zoning: R1 R1
Applicant: MARTINEZ, ROSS ISSUED BY:
Address: 1397 GARLINGFORD ST
Phone: 714-444-4161
COSTA MESA, CA Zip: 92626 •
Owner: MARTINEZ, ROSS AND JAMIE
Address 1397 GARLINGFORD ST
Phone:
COSTA MESA,CA Zip: 92626 -
Contractor: OWNER-BUILDER
Address:
Phone:
Zip: License: 0
Arch : - Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
CREATION OF A GABLED ROOF&EXTENSION FOR THE FLAT ROOF PORTION OF AN EXISTING SFD COVERING A
FAMILY ROOM&GARAGE(WITH CALIFORNIA TIE-IN).. REF: BO1.01523(#SQUARES CALCULATED WITH A GABLED
ROOF).SMOKE DETECTORS REQ'D PER 1997 UBC.
PROPOSED 24'HEIGHT;BUIDLING IS SET BACK A MINIMUM OF 20'FROM THE REAR PROPERTY LINE.
FEE SUMMARY
Plan Check: $72.31 Calc Valuation: $4,900.00
Permit: $111.25 Claim Valuation: 54,900.00
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $184.06
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0 •
NOTES:
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void it work Is not commenced within 180 days,or if work Is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(600)
0
WORKERS'COMPENSATION DECLARATION: •
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit Is issued.
❑ I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed if the permit is valued et 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 AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(5100,000),IN ADOmON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS 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.a Class a
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: 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 pem'4
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
I`7,11 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 ere not Intended or offered for sale.If,however,the building or improvement Is
sold within one year.f 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 oft 4'roperty,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The • f' ctors License Law does net apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursi.nt to the •ntractors License Laws.).
❑ I am r der s: Business and Professions Code for this reason:
Signature:
Expires:' 7(
610
/6
Verification of Ownership by(type of docu ent,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,es noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be tiled with the Costa Mesa Fire Department by every
business which has at any one lime 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 feel 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 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 en RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes U 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 Yes 0 No
8 (If yes',attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I c:- •• 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 an. - '• ions.
Signature: Date:
CERTIFICATE OF COM-4 ' D AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and slate that the information given is
correct.I agree to cot,' al state laws .nd ci ordinances relating to building construction,and authorize representatives of the CI of C to Mesa to enter upon the
above-described pr./7' for ins•ecfion p ;- : agree not to occupy or allow occupancy of any building authorized by this permit 911 al' action.
if Y
/ An :Of Legal Owner(s) Date
And/.r Authorized Applicant Date
coos L INSPECTION TYPE DAIS IfITmALS ;ODE! INSPECTION TYPE 12,,1E Ui�ALfl
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof _ 210 Final Electrical
201 Final Block/Retaining Wall _ 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site �/
204 Final Demolition _ 250 Final Building/Occupancy Y 2"T't22
. c. . . .
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 the 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.
I. I personally plan to provide the major labor and materials for construction of the proposed
property improvement. [f Yes ❑ No
2. I (have/have not) //iry✓tli 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 City
Phone( ) 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 City
Phone ( ) Contractor's Lic. No.
5. I will provide some of the work but I have contracted (hired) the following persons to
provide the work indicated:
Name Address Phone Type of Work
1042-46 (REV.9/96)
f ) a •
5� F CITY OF COSTA MESA
4Li9 BUILDING DIVISION
Pt.> :� �; DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
F �� i PERMIT 7B01-01523 v "owtow
(714)754-5273 • Fax(714)7544856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 1397 GARLINGFORD ST Status: ISSUED
Suite: Applied: 09/27/2001
Vicinity: RESIDENCE ONLY Issued: 09/28/2001
Parcel Number: 14102104 Zoning: R1 R1
Applicant: MARTINEZ, ROSS ISSUED BY:
±41,..,;,_
Address: 1397 GARLINGFORD ST
Phone: 714-444-4161
COSTA MESA,CA Zip: 92626
Owner MARTINEZ, ROSS AND JAMIE
Address 1397 GARLINGFORD ST
Phone:
COSTA NESA,CA Zip: 92626
Contractor: OWN ER-BUILDER
Address:
Phone:
Zip: License: 0
Arch : - Eng:
Address: Address:
Phone: Phone?
Zip: - License: License:
SCOPE OF PERMIT
REROOF RESIDENCE ONLY:T/O EXISTING WOOD SHAKE,7/16"OSB, FELT PER MFGR SPEC,APPLY 25-YEAR
TIMBERLINE COMP SHINGLES.40 SQUARES
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $4,000.00
Permit: $97.25 Claim Valuation: $4,000.00
SMIP Res: $0.50
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $97.75 , • -
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTES:
•
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-48 WOO)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. •
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed it 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 AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARS($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under 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.It Class 11
Contractors Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: 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 end 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 fore parr*'
sybjects the applicant to a civil penalty of not more than five hundred dollars($500).):
1}�}'t 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 Professio s 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 thro • Cs 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 o dation,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•• ••..• ,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contr: • 'nse Law••..s not apply to an owner of property who builds or improves thereon,end who contracts for such project with a contractor(s)
license pursu/ . e C-ntracto 'en - .ws.).
❑ I am exempt . der sec. Business and Professions Code for this reason: 1
Signature: i r ./ Date: /Owner ID vent'.d by driv' I . e. 0 Yes 0 No Drivers License No. Expires:
Verification of Ownershi• •y type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds.or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP Is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification
from the South Coast Air(Duality Management District or from any other air pollution control district or agency? LJ 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? 0 Yes 0 No
8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and- '-sions.
Signature: Date:
CERTIFICATE OF COMP '. •• AUTH• r • •• 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 corn:y1. if st to la i•• city ordinances relating to building construction,and authorize representatives of t91e City f Costa Mesa to enter upon the
above-described prope nspe•Ion j•oses. agree not to occupy or allow occupancy of any building authorized by this p�rpliybntjl fir @pection.
ice
•n=.-r f Legal Owner(s) y //0 ate J
And/Or Authorized Applicant Data
;ODE/ INSPECTION TYPE QATE INTRIAL$ CODE! INSPECTION TYPE DAM IMIDE&
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
_G^2_J
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
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 the 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 major labor and materials for construction of the proposed
property improvement. [(Yes ❑ No
2. I (have/have not) /WV 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 City
Phone( ) 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 City
Phone ( ) Contractor's Lic. No.
5. I will provide some of the work but I have contracted (hired) the following persons to
provide the work indicated:
Name Address Phone Type of Work
1002<6 (REV.9/98)
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. 4211 C,
CITY OF COSTA MESA CONSTRUCTION P RMITPERMIT NO. • TRACT-NO. LOT NO. UNIT NO. _ G a 6/05/85 50C I L
I• P /e D -�
Project Addiess _ 1/1. /_• /� U ADD. LI ALTERATION Ll REPAIR
G �' / ,A p� TYPE OF CONSTRUCTION. LI NEW- '
Applicant's Mailing Address
��U� ': .❑ CONVERSION ❑ DEMOLISH ❑ OTHER - A.P.# (Zane
Owner's Name 1/4.5.
e j�lEt Phone DESCRIPTION OF WORK/USE OF BLDG. •
Address �1 N/ - - - S Main Building: Accessory Building:
Arch/Eng. - - - --- - License No. TYPE OF PERMIT ❑ GRADING u/❑V./DUNDATION ID STRUCTURAL T. Front - 0
•
Address •)) //'�� 1f// h�nQe259Q01).5-
C q �-R ❑ TENANT 0 ELECTRICAL Ltl PLUMBING 0 MECHANICAL B Rear - N
Contractor's Name!�u C/IV -�11 ,l hone �J �7 /V ❑ OTHER. .A ,
p � (�., h }�.,f J �A 1� ( PROJECT DESCRIPTION SQ.• FT. OCCUPANCY K Right G'
Address(mailing) /1 ( _( /VA/(�/}� /"" �/u � CONSTRUCTION TYPE VALUATION$ S Left - . '
City License No. Jl� f/✓L ZONE ' GRADING CU.YDS. :ACRES - R
LICENSED CONTRACTOR DECLARATION Ping. Ref. # Parking Req./Provided E
I hereby affirm that I am licensed under provisions of Charter 9(commencing Remarks: _ Planning Notes: M
with section 7000) of Division 3 of the Business and Professions Code,and •
_
my license:is in I ace and effect. - ' r�11 • ' T
License Cl. - / i��L�LI e� .o. Yfy/s a PLUMBING FEES • S
Date _. 'Signature_� _/ •0/L.` - '
WORKERS COMPENSATION DECLARATIONgar Sink Showers •
I hereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES ;
if Workers' Compensation Insurance, or a certified copy thereof (Section_ _ -
Backflow Preventer . Service Sink "' - " '
G �1 Automatic Washed • Transformer ❑ 15-50 KW
Polio, Lab. C.). Automatic
VIi0 Rta�
Policy No. 1�V✓ �_ Company I1LCa Backflow Irrigation Sewer Cap , ff 0 50+KW ,
Construction Pole-Sub.
..,_certified copy Is hereby furnished. t
•CCerY}}tti d� py is filed with the city�d�}pIn og. �/ A, 1.`. Bathtubs Sewer Connection . Cooking Unit 'Meter ❑up td 100 amps ' •
DateXPT DN Applicant_COMPENSATION
LM-i(R-/TI Clarifiers • Solar Collectors Dishwasher I-. Meter Dover 100
EX EM PT fON FROM WORKERS'COMPENSATION DECLARATION amps
(This section need not be completed if the permit is for one hundred ($100)or -
less). 1 ' Dishwasher Solar Piping a DD Dryers ❑Gas 0Eleciric Sub Panel •
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 Drinking Fountains Solar Tank Fan , Motors❑0-1 HP ❑1'h-8
Workers' compensation Laws of California. , • '
Date • Signature Floor Drains, Swimming Pool w/Spa F.A.U. Ina Solar ❑9-15 HP ❑16.15+
'NOTICE: If,after making this declaration,you should become subject to the
-
Workers'- Compensation provisions of the Labor Code, you must forthwith - Floor Sinks _ -Urinal - Fixtures - -- - '
comply 'with such provisions of this permit shall be deemed revoked. ' IMiCrOwbve
CONSTRUCTION LENDING AGENCY' • Gas ServiceOutlets Water Closet Device Boxes
I hereby affirm that there is a construction lending agency for the performance Pole Light
of the work for which this permit is Issued (Section 3097 Civ. C,) Interce tors - Water Heater - -
Lender's Name - • p Outlets Range
Lender's'Address • - - - Kitchen Sink , Water Service - Switches Sign
•
OWNER BUILDER DECLARATION '
I hereby affirm that I am exempt from the Contractor's License Law for.the Lavatories.. Auto-Wash •
•-
Disposal Standing Sections
following reason (Section 7031.5 Business and Professional'Code: Any city or _ '
county which requires a permit to construct,alter,Improve,demolish or repair P-Trap Laundry Trays • - Generator 00.5 KW ❑5.15 KW Trash Compactor
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 Roof Drains - -
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 ,
'herefrom 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 -
enalty of not more than five hundred dollars($500). . •
❑ I, as owner of the'property or my employees with wages as their sole . Reinspection Fee $15 Issue Fee $ 3
compensation, will do the work,and the structure Is not intended or offered • - Reinspection Fee I $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's - MECHANICAL FEES.
License Law does not apply to an owner of a property who builds or Improves
thereon, and who does such work himself/herself or through his or her own - • DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I ❑
sale. If, however, the building or improvement Is sold within one year of com- Canopy Type II ❑ Zoning Approved By Date
•
pletion,.the owner will have the burden of proving he/she did not build or im- Duct-Under Giound _
prove for the purpose of sale). • Building Approved By Date
, ❑ I, as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Date 6/S 42.
tractors hi construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating . ❑0-100,000 BTU 0100,000 BTU SUMMARY OF FEES
builds or improves thereon,and who contracts for such projects with a con- 1
r
tractos) license pursuant to the Contractor's License Law). I am aware thatExhaust System ❑ Multiple❑ System Repair/Alteration •
BUILDING PERMIT $ SMIP ' $
proof of their Worker's Compensation Insurance should be provided to me. •
_ PLAN CHECK $ '\ PERMIT
❑1 am exempt under Section B.& P.C.for this reason Firepl/Fact.Bit. ICBO# • Fire Dampers PLUMBING $ '.%1I/yV ISSUANCE . $
HeatingSystem& DuctingRegisters PLAN CHECK 25%
Date • Owner Y $ ENERGY P.C. $
, I hereby certify that I have read this'application and state that the above ❑0100,000 BTU 0100,000 BTL • ' - - ELECTRICAL $ GRADING $
information is correct. I agree to comply with all city and county ordinances
and-state laws relating to building construction, and hereby authorize repre- • PLAN CHECK 50% $ MICROFILM $
sentatives of t s ci y to dote upon the above-mentioned property for • q�l
inspection cur•. s. , •/ I - _ _.__ MECHANICAL $ TOTAL FEE $ �V v
Signature IA_ r �� IIJ& IL-- Date lit I
Drivers' License or SS# - Reinspection Fee $15 Issue Fee $ 3 I PLAN CHECK 25% $
CMF 0865-46,rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor 111
•
CONSTRUCTION AND PLANNING POOL 3PA
APPROVALS Permit# Date Inspector APPROVALS Permit 916
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 UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 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 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/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 ❑Gas ❑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 `) p
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. Special Requirements Completed
49. Electric Release to Edison
, 50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
^PPLICATION FOR A BUILDING PEP'-'T
•
✓- ✓ ✓ BUILDING PERMIT NO. Electrical E.
Tract Block Lot Permit No. _
E:
Builtl in9 1 s9Plumbing
Address ` 7 A A ���•_�-Dp d.--- ('T(�/ Permit No. to
st,.Il ' /n`1 G-Cross ` v / D�v M chaniral a
Area 1`I v1-K-4 e•_� vt c Street Pe it No.
Owner FW 4 t�[ ` Type of Project: ❑ NewB
Me.-4,-1\45...
�Q 1\4 5.` A O f��
j S ❑ Alt r ❑ Addition
Address `\I 391(��>a�} - c I M 5-t O'`- t' ❑ Repair ❑ Convert ❑Demo ❑ Occupancy Pmt.
Sup. ./
City etw)crt, l `t\�g� ZIp IZGZ4 Phone] cl6�7(. A.P. Insp. to
Ins..A a
Architect/ p�
Designer CfWua/[OScN License No. Zone Spl.Pmt.No.
is Setbacks P/L Front C/L St. Street Width
Address
Yards Left Right Rear
City Zip Phone
Eave Prof. Left Right F.P.
r. Engineer License No.
C Parking Spaces Required Provide Covered
0. Address
m CityZip Phone Struct No.of o.of
Height Stories 'amity
S LICENSED CONTRACTOR'S DECLARATION Park Fees ❑ Yes ee ,
co Required No C.T. Receipt
Ea- I hereby affirm that I am licensed under provisions of Chapter 9
.0 Zoning with Section 7000 of Division 3 of the Business and Zoning Approved By: Date
.. Professions Code,and my license is in full force and effect). _
License Class License Number
_5- Date Contractor Misc.
E Address Proposed Use
of Structure
li City and Zip Phone—
w CONSTRUCTION LENDING AGENCY
sti
E I hereby affirm that there is a construction lending agency for the
0- performance of the work for which this permit is issued (Sec. 3097, las
CType Code
Civ.C.I. Class Com . Year
C Lender's Name USE/OCC PANCY SIZE SQ. FT.
Lender's Address
OWNER-BUILDER DECLARATION
r I hereby affirm that I am exempt from the Contractor's License Law 1.
Ofor the following reason:
0 I, as owner of the property,or my employees with wages as their 2.
C
sole compensation, will do the work, and the structure is not
_int' ended or offered for sale.
3 I, as owner of the property, am exclusively contracting with 3
licensed contractors to construct the project.
.d„ 0 I am exempt under Sec, B C for this reason 4'
C Datn12 -4'VjOwner A5 8_4_0
E WORKERS'COM NSATION DECLARATION Total Valuation
3 I hereby affirm that I have a certificate of consent to self-insure, Encroachment Permit Requir.d ❑ Yes ❑ No
y, or a certificate of Workers' Compensation Insurance, or a certified
O copy thereof, Grading Pmt. Grading
r9 Policy No. Company Required ❑Yes ❑No Pmt.No. •
a ❑ Certified copy is hereby furnished. Rough Grading10
Q ❑ Certified copy Is filed with Orange County, EMA. CO
Approved by: Date
Date Applicant 3
CERTIFICATE OF EXEMPTION a'
FROM WORKERS'COMPENSATION INSURANCE z
(This section need not be completed if permit is for $100 or less). C
I certify that In the performance of the work for which this permit is V
issued, I shall not employ any person in any manner so as to become co
subject to the Workers'Compensation Laws of California. PERMIT FEES
Date Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Structural $ Plan Check $
Exemption, you should become subject to the Workers'Compensation
provisions of the Labor Code, you must forthwith comply with suchSpecial
provisions or this permit shall be deemed revoked.
Electrical S Invest. $
I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE Plumbing $
THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO
COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
RELATING TO BUILDING CONSTRUCTION,AND HEREBY AUTH- Mechanical $
IZE REPREfS- ` • S OF THIS COUNTY TO ENTER UPON
TH AB V 't ' TIO • PROPERTY FOR INSPECTION �� pre-Grade $
...)1
7!// Inspection
�' Pre-Grade Permit
n .ure of Applica' •r Agent Date y S�
$ $
rd 9 Zu Rec.No. Issue
S�/�'s/ Na4 4 t 7-8 pI
Print Applicant'ss/Agent'ss Nammee N Z�pQ Tpu
All spaces within this box must be completed to process Cppr ve
Check By: Asuancetl:
CMF 033546(BU-28) rev.6/80
•
a OWNER HARBOR HALL OF FAME HOMES, INC. DATE 0CLL6_1964_ •
N- JOB ADDRESS 1397 Garlingford. St. BUILDING PERMIT NO. 23103 . .-
C- -ERAL CONTRACTOR Lifetime Res. Bldg. Corp. VALUE $ 2,955.00 Relocate Move
A .o. 11L1-021-01F LOT I3 TRACT .0 c� FIRE ZONE 3 DESCRIPTION OF WORK In Res.+NewGar.
INSPECTIONS . Signature DATE GROUP I&J TYPE V ZONE Rl Int.Wal
e Soil - _ PERMITS ISSUED
S. Gas SUBCONTRACTOR DATE NUMBER
Water
4 Rough Com. Refrig. 0 Air Cond. 0 i014
Rough Heating _ - Ini✓„✓I'
Rough Plumbing TZ-7 „_% ...... _ , i.Z/ A- 4' • _ 1 j
Miscellaneous / ,,�-, _ —_��
Prop. Swr. Line House Con. C St. Swr. ❑ �t ,✓_� . ii�.r4 y y/CO '
Sprinkling System
Construction Pole /Z/(14 /""C q ` _dn Lim_ . X0/294 .2 3 6 3 _I '
Underground ❑ Power p �/" " iP
Rough Wiring 1-14,"-ed >,-/- . //71;34K _ /6. l O[ ,
Trenches fil Forms'[' Steel Reinf. 0 4740 / 9P / ,A
Floor System
Bond Beam 0 Steel Reinforce 0 _
Shea thingamity.
Flashi ,y /amitr, drift '—6 "�//
91� ' /r). / i�L' ,
I ig— In, Out�p� 1 _7/1771/47
-
Plaster, brown coat /f4 i>/ey/rr _
Refrig. 0 Air Con. 0 Final
`Heating, Final _/_
Plumbing Fixtures, Final a , (J- -
zZ-1j—Y' 42y'
` :;. 23103 J ► FEE RECEIcr-
VED
COSTA MESA BUILDING-SAFETY DEPARTMENT FOFT6NCE 1964
- P.O.BOX 317 COSTA MESA,CALIFORNIA DAMM
For Applicant to Fill In Completely APPLICA- TION�FOR�PPPillfl'E$A
TYPE OR PRINT BUILDING
For Office Use Only
ADD ESSG 1397 Garlingford St.
RECEIPT NO. •�P RMIT NO.
COSTA MESA. CALIFORNIA p( /03
RECEI DBY DATE RECEIVED DATE ISSU D
OWNER Harbor Hall of Fame Homes, Inc /.0�l/0'le ID /61,0
BUILDING (L
MAIL BO ADDRESS �.� �•`•X . ./ .ice- s
ADDRESS P.O. BOX 2066FIRE /
TEL-.' ZONE TYPE !- .'OUP 1,• / •
CITY Santa Ana No549-2204
ARCHITECT TELLA� APPROVED (iNid y rT ,
OP ITECT R Levanas NOS�73-7010 BY •/I/ DATE YCi/ /9 VI
NING I
ADDRESS Via Oporto Newport Beach /
E Z I NO.ANBOF 7T USEOFNEWBDILDIND ria
CONTRACTOR Lifetime Residential Bldg. Co D ' ( F
LEGAL
ADDRESS P.O. B_OX 2066 _ DESCRIPTION �-U(r 3I / " ' /131
CITY Santa
208676Ana — A.P.NO. ( y / 'Gi� - 0 C(
NOTE: NO EAVE OVERHANG SHALL BE LES /THAN
STATE TEL
NO. 90"TO SIDE a REAR P.L.
I
LIC.NO.
SIZE V,.� EAVES
OF LOT 651 x1241 I NO.OF BLDGS.Q ALLOWED (U.B.C.REQUIREMENT)
NOW ON LOT
YARDS APPROVED YARDS APPROVED
USE EXISTIF NG NG BLDG. Single Samily dwelling MAIN BUILDING ACCESSORY BUILDING
C (FROM C/ REET)
REET)
SETBACK LINE M 5
CENTER OF STREET01 REAR YARD 26E FRONT T FT. r FT.
SIDE YARD LEFT 51 I RIGHT 5$ R.SIDEIFT. FT.
DESCRIPTION OF WORK r r.
NE ALTERATION ADDITION _ �•
BET.MAIN Q
X - ACCESS.BLDGS.
REPAIR - MOVING X. DEMOLISH
DATE
BUILDING NO.OF
SIZE lly4.6Q ROOMSB $ STORIES 1 APPROVED
EXTERIOR
---TERIOR WALL ROOF I (/// 6
COVERING Rtll(`L`Q COVERING shingle BY �(• �� � /Iv1/
USE OF BUILDING AND WORK TO BE PERFORMED 1
Re ai rl enc_e
ZAS
e/0/59-k ,e SS a/),0ai6' rI/�
4 O .FT MnJtdi',/4-04It,.
I HEREBY ACKNOWLEDO AT 1 14 E - • THIS APPLICATION THE AMOUNT SHO N UNDER ALUATI N IS FOR THE F'
AND STATE THAT TH . B• E IS ••'-E•. ND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. G
PLY WITH ALL CITY -•I ANC-. A�,• ' LAWS REGULATING VALUATION OW p
BUILDING CONSTR •..
42
SIGNATU' �, / / efi PERMIT FEE - `} .1
PERMITT- y1/45-cc- P'V
/ S4 - A . . E
AUTHORIZED AGENT /� r
i
TOTAL FEE $
`;vn vin — s -��••• UAICIA cu
.JOB ADDRESS 1397 G€arlingford St. BUILDING PERMIT NO. 38616
IGENERAL CONTRACTOR Standard American Bldrs. DESCRIPTION of WORK Add Fam.Rm. to Res.
� 41
1< 'o. 10@1-04 LOT TRACT FIRE ZONE VALUE £8,613.00
`
\It. ECTIONS Signature Date TYPE V GROUP J ZONE R1
SOILI
GAS PERMITS ISSUED
SUBCONTRACTOR
Date I Number I Signature
WATER Plumbing
ROUGH PLUMBING
PROP. SWR. LINE r, HOUSE CON. f
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING .
TEMPORARY SERVICE OR POLE
UNDERGROUND d POWER 0 /
ROUGH WIRING ' i Heatin• and Vent. n
TRENCHES [_ FORMS H STEEL HEINF. L7 ./' - iivrar itren n nn ' '° Q ‘..7--
FLOOR SYSTEM r-I ,
^
BOND BEAM L STEEL REINFORCE ` I ' q��
SHEATHING Fi•l� `[s '1y.
FRAME AND FLASHING /'G1'.) 6.7574/
LATHING - IN S4 OUT l /2ijf�'/5'�q/ //1//tL/n7a
PLASTER, BROWN St
7 i/.I/ 10-16-"79
5 rURAL, FINAL / �7 �yj�,
HE...,NG, VENT., REFRIG. AND A.C., FINAL •20.-:r S / -k-7, /j/11r/.17,/wlP e)50a - ./'1 rta7 ,
PLUMBING. FINAL AND GAS TEST H ,
ELECTRIC, FINAL /0-140‘710
BUILDING. FINAL 45-l0
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant
rfto Fill in Completely RECEI /D Dq/,TER C(E/IVED D/p(TE ISSUED
BUILDING I 7 Gt (2L.I L►G�R IO sr / t(J O' 't' )2-71-
ADDRESS
1l
v // PERM( O..
OWNER F2DkiK- c2 & 1 A.P. NO 7/ 9. � -'O / 0�rb
MAIL • BUILDINGDRS 111/(1 �Qi/A1G�ICD St
Z ADDRESS 3� 1.--)14 t ADDRESS { / -7
Lu ui TEL.
n- Z CITY Co sm. l 4est, NO. 557-00, TRACT�5JS LOT �3 BLOCK
1Z Q CONSTRUCTION NEW AQD ALTER REPAIR (MOVING DEMO'ISH
OI- LENDER " —
aco
J D BRANCH
OWNER p /1 /
Z—GC�A-7
ADDRESS ..r/
L m S!$E
oa�-rT .VALD$ foi3,
gRCHITECT TEL.
Q OR ENGINEER NO.
Z N FIRE
a
W W ADDRESS ZONE GROUJ.APPROVED4,4/"
C- /� 7P
mO CONTRACTOR siku so_o ks•(♦='�, LpRtS , BY DATE lb (/`G '1�
Z
71 tr ADDRESS 145 Li, MAIL(el Lk Bt-V h.
w w TEL. ZON NO.OF USE OF NE
O= CITY 1� 1-ti- NO. PLANS BUILDING
z� /� M ro3S.�4 `� ooh /4�p
wO STATE �t CITY 2 YARDS APPROVED YARDS APPROVED
to CC LIC. NO. psiQ 947 LIC. NO.546.7 MAIN BUILDING ACCESSORY BUILDING
D O NO.OF (FROM CAL ST T) LS ,-t�A
OIF LOT I NOW ON LOTS FRONT 4 r9/ eV FT.
USE OF
1777{ / //
EXISTING BLDG. �,�', P{.(E el-C1^, Q G-jt 'qp(T'� R,SIDE z.�r-iC FT/' FT.
I- SIZE OF NO.OF
2 NEW BLDG. ROOMS STORIES L.SIDE FT. FT.
Q EXTERIOR WALLROOF // /�
fJ COVERING CLO COVERING L/� RThy_�( - REAR /7 F6 FT.
USE OF BUILDING AND WORK TONO
nBE PERFORMED DISTANCE BET. BET.MAIN&
_ K_p 0 tr-w La LL� Y enL MAIN BLDGS. ACCESS.BLDGS. ��//
Q 1 VAR.# z-7'/ APPROVEC6;17-271
DATE
OC.WI'.sW `/I—
rn P ,Q 1'/
Z - APP S,q !su DATE �„ —7T
OI hereby acknowledge that I have read this application and state j
Dthat the above information is correct and agree to comply with f/,
all laws regulating building construction, and I shall not employ 'S4-
CC
any person in violation of the workman's compensation laws of
H the State of California. 21C/5--* '9
Z I hereby certify that I am properly licensed as a contractor under SO. FT. O
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9. and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY;
CC
am exempt from the provisions of the State of California Business VALUATION
and Professions Code,Division 3,Chapter 9 //J N
/'� VC PERMIT FEE $ 3
Signature of /� �� //(( ( / /� 2 m
tee �!/i`*"� 1V�( sdi $ J PLAN CHECK $ pr O,, O E
0
Authorized Agent /_ 45-0 LL
N. TOTAL FEE $ CCCCCCJJJ
.�UmNLI kLUKAYt FrankUAIt }—}1—/�
JOB ADDRESS 1397 Garlingford Street BUILDING PERMIT NO. 39768
GENERAL CONTRACTOR Owe r-B1dr. DESCRIPTION of WORK Patio Cover
qt^ko. 141-021-04 LOT TRACT FIRE ZONE VALUE 5620.00
1;1;:'c_CTIONS Signature , Date TYPE IV GROUP J ZONE Rl
solL
SUBCONTRACTOR
PERMITS ISSUED
Date 1 Number Signature
\ GAS
\WATER Plumbing
ROUGH PLUMBING
PROP. SWR. LINE ❑ HOUSE CON. El
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING .
TEMPORARY SERVICE OR POLE
UNDERGROUND ❑ POWER ❑
ROUGH WIRING Heating and Vent.
TRENCHESFORMS fl STEEL REIN F.
FLOOR SYSTEM
BOND BEAM fl STEEL REINFORCE n
SHEATHING
FRAME AND FLASHING
LATHING — IN n OUT n
PLASTER. BROWN COAT
ST 'URAL. FINAL Flertrie
HI G, VENT., REFRIG. AND A.C., FINAL
PLUMBING, FINAL AND GAS TEST n
ELECTRIC, FINAL
BUILDING, FINAL p .0 s(v1�/ 4
PAII.
39768 aR �, ,sTy.o0 958 5
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
PPL ION FOR BUILDING PERMIT
For Applicant to Fill in Completely
BUILDINGR V DATE RECEIVED DASE I UED /
ADDRESS 1397 Garlingford Street - , Js 7J
/V/ 0.2/
w/_ V PERMIT O�
OWNER Frank Zuray A.P.NO. .[, C/^�"
MAIL BUILDING q ` I
ADDRESS 1397 Garlingford Street ADDRESS/c.J� 4r//oq SA
Z (a/{
CL o CITY Costa Mesa N S57-0659 TRACT%,777555rr LOT /3 BLOCK
F-Z CONSTRUCTION NEW ADD(ALTER REPAIFL�MOVING DEMO/LSH
ON LENDER None X lI
n,m
J D BRANCH
OWNER Pin 4 /f frN5 . 1 C. 2urix
y/�
ADDRESS y rrr���z��sJ 14
J m ARCHITECT None TEL. USE aIuY O (ea AL $ //V
///C
OR ENGINEER NO. (�
Z ct FIRE
Z CCADDRESS ZONE OUPWE33/-2ci_ APPROV
JZ CONTRACTOR Owner-Builder BY &, I/1rYPE
DAT
CO zKsst6',OJ/ `rtb PL-#1.-.) 233
J ADDRESS
W TEL. ZO NO.OF //�� USE OF NEW U mCITY �i NO. I �PLAnS / BUILDING a COt_(!/ q
c2. t--
1
W O STATE / nAn CITY YARDS APPROVED YARDS PPROVED
j O LIC. NO.(� ` Y LIC. NO. MAIN BUILDING _ ACCESSORY '.:
.". 2,15
,VV (FROM C/LST EET)
L NO.OF BLOTS. �r/'
OF LOTnV`u 1n* NOW ON LOT 1
OF FRONT (� �_ 54pFT.
USE OF idenc /A= /
EXISTING BL e _R,SIQE 16T (�!' PGte/FT.
I— SIZE OF /Sr NO.OF sSi v
Z NEW BL ROOMS 'STORIES L.SI Es/ FT.
Q EXTERIOR COVE /_ // YCi
V EXTERIOR
COVERING L v� RE �/ FT.
USE OF BUI ING AND WORK TO BE PERFORMED DISTANCE BET. B MAIN&
Install cover over existing MAIN BLOCS. ACCESS.BLOCS.
a0 patio slab. VAR. +���(J�L APPROVED447.7c
I— APPROVED _ I J n J"4
2 Ry LTJ/�.LJ DATF
4-4 .7r nr��
UI hereby acknowledge that I have read this application and state /
D that the above information is correct and agree to comply with `/ ( t
CC all laws regulating building construction, and I shall not employ rlV 'Q
any person in violation of the workman's compensation laws of V �,
the State of California. /) _ 1 `T�( m
zI hereby certify that I am properly licensed as a contractor under !r�"h•/vl}SQ. FT. O
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR 5
Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY; o
am exempt from the provisions of the State of California Business R
VALUATION
and Professions Code, Division 3,Chapter 9. �rs� n
PERMIT FEE $ O
Signature .o. 77 620
2�1 m
Permittee�3[1 $ /A /// PLAN CHECK $ E
111(((iii /v �"
Authorized Agent 7 U.
TOTAL FEE $ _ _
OWNER MR_ & ice. JOf]N ROUSE DATE 12/4/80
JOB ADDRESS 1397 r rlingford Street BUILDING PERMIT NO. 51098
f-"ERAL CONTRACTOR Owner-builder DESCRIPTION of WORK FiLeplace, French Doors
,o. 141-021-04 LOT 13 TRACT 4355 FIRE ZONE VALUES 3,000.00
INSPECTIONS Signature Date .TYPE V GROUP R-3 ZONE R1
SOILPERMITS ISSUED
GAS SUBCONTRACTOR
Dote I Number I Signature
WATERn Plumbing uu.�, c
ROUGH PLUMBING
fr / L W-// 78853
PROP. SWR. LINE n HOUSE CON. D
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE LJ
UNDERGROUND POWER ❑
ROUGH WIRIN Heating and Vent.
rI TRENCHESRIZ FORMS STEEL REINF. 4,(r/i /2.✓7 'j'i
Pro FLOOR SYSTEM Y
BOND BEAM n STEEL REINFORCE n
L-' SHEATHING
FRAME AND FLASHING
IA LATHING - IN 0 OUT D
AF 'ER, BROWN COAT
tai _ Cr URAL, FINAL arillre Electric
HEATING. VENT.. REFRIG. AND P.C., FINAL y�
PLUMBING. FINAL AND GAS TEST ��o 1.1I S Ago
ELECTRIC, FINAL �]
BUILDING, FINAL e--;e y /j-i//J
•
COSTA MESA BUILDING-SAFETY DEPARTMENT$ APPLICATION FOR STRUCTURAL PERMIT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
RE JyEL�'BV (PERMIT *t0 51098
For Applicant to Fill in Completely — Use Ink Only 1 1 V
BUILDING Q -J r: _ A.P. NO. i OZ
a.
ADDRESS 4 V ` ( /\R til tete. Sc L' BUILDING //
OWNER OR N� f Nis,.JOH-K Rim's ADDRESS ` 3Q ?L'Gj l,�,,,,;,f
TENANT
UNIT OR
MAILING 1 n SPACE NO.
ADDRESS \��� S�iaIZsjµA- ir{SrL4
T B.[J(�, LOT BLK.
TEL _ 19 1
CITY CnS"T� NA aria. NO. tiG6`(Tt NEW ADD ALTER REPAIR MOVING DEMOLISH
CONSTRUCTION 7
LENDER Nt[/A tv f /L
/ ��
BRANCH / A_ //j_ _ t/ J _
OWNER �((i(ir l.�LtJO'�ilL
ADDRESS VALUE ^� , ..,
ARCHITECT 1. I'/� TEL.
USE ,/{ Ca/ EJ�IJW
OR ENGINEER 1 NO. (r,�� z
ADDRESS ZONE / TYPE VTGROUP " —.3
APPROVED
CONTRACTOR. Owetet\1-colt -�?"._ BY DATE tzbe-leo
ADDRESS
TEL.
CITY NO.
F STATE CITY APPROVED SETBACKS
i—iLIC. NO. NSA LIC.NO. �/
W OZE NO.OF BLOTS. (FROM C/L STREET) `),
A. SIF LOT NOW ON LOT FRONT FT. r
a USE OF I
i—iEXISTING BLDG. R SIDE 1 1
rn1 1
HSeparate permits are required for L. I . I FT.
G electric,plumbing and heating work. R R 4Y1_l �A,
F USE OF BUILDING AND WORK TO BE PERFORMED PLAN 4 G AC I Al
et
DATE
i-r-C.-- I APPROVED
�� ! r i i Ir /n et)
.r.1 - act-
� rGC. r HEY RDEy DAT( 2— r
IXm
0 I hereby acknowledge that I have read this application and state
X that the above Information is correct and agree to comply with
L all laws regulating building construction, and I shall not employ i
Z any person in violation of the workman's compensation laws of 2
S the State of California.
ilo-
contractorSO. FT.
I hereby certify that I am properly licensed as a contractor under w
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR o
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FE ONLY: b
am exempt from the provisi ns of th• ate of California Business /� v
VALUATION PERMIT FEE S L . O�
and Profe Code, Div' ,Chap - 9. n
Signature of PLAN CHECK E i S, 4 O mo
Permittee • rx_ S 3I DO� TAX E O Sa u.
Authorized A nt Dateu.
�-+ I O s / 0 U
TOTAL E