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Home My WebLink About1725 GISLER AVE - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.6it,�LDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 1725 GISLER AV Suite: Vicinity: ROOF Primary Occ: R3 Parcel Number: 13913119 Applicant: KEN SMITH Address: 11236 WESTERN AV Type of Construction: V -N Zoning: R1 Status: ISSUED Applied: 09/12/2005 Issued: 09/12/2005 f#I tY1 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 U WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: 1 ❑ 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 `w, ork for which this permit Is Issued. r ❑,c%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 worker I mppensatlon Insur osrier and policy number are: / Cartier:. - .= /-r1� - ,r (Policy =`-`• :-(r7 (1In _(This section nifed not be completed /f the permit Is valued at one hundred dollars ($100) or less.) ❑ I certity that in the performance o e work for ich this permit i5 issued, I shall not employ any person in any manner so as to became subject to the workers' compensation laws of Califomia, d agree th i should be n subject to the workers' compensation provisionctiop 3700 1 the Labore, I shall forthwith Comply with 'satiohes (tie v\ ��- DateE- Appllmnt §IW.ture: ti WARNING: FAILURE T SECURE W ERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSANDDOLIARE ADDITIONTO THE COSTOF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION WO6OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am Iicen revisions Chapter 9 (commencing with Section 7000) of Division 3 of the Business tAJTrQfQS4RWACode, and my license Is in full forCe and efl9ct;Lle p Class Y1_ r COL ntredtorsSignature: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: lure: =—VA =—VDate: WA OWNER -BUILDER DECLARATIONS: y� -- 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 then five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for Purpose of sale.). ' ❑ I, as owner of the property, em 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 Cade for this reason: Signature: Date: Owner ID verified by driver's license. ❑ Yes ❑ No Driver's license No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Coda). ❑ 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 WIII the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of Compressed gas at standard temperature and pressure). .._...........................................................................................................................__....................................................................................................................................................................................................................................................... 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gasat standard temperature and pressure). ............................................. _.......... _............... _........... _.................................................................................................................................................................................................. ........................ ................................................................... _.. 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ............................. _........................................................................................................................................................................................................................................................................ _............. _..................... 4 If en RMPP is resent) required, has Section 25534 of the CaliforniaHealth and Safe Code been full complied with? presently q Safety Y P ❑Yes ❑ No 5 Does or will the applicant or present or futureManagement building t occupant require for the work which Is the subject c this a plication agermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? � Yes ❑ 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 Dermit 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 Califomia Health and Safety Code Section 42303 been made? []Yes ❑ No . ................... ...................... ................................. ............................................................................................................... ............................................... ....................... ............... -...................................... ..................................... e (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 Matedals 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 prop rty for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. 1 gn re Of L ner(s) — (0 .J� rAnd/Or Authorized „Applicant - ✓"ate�� CODE E. INSPECTIONTYPE P9LP INTITALS CODE r INSPECTION TYPE QM 1NTFIRAL$ 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 Well 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 JACKSON, 0. A. JOB ADDRESS 1725 Gisler St. GENERAL CONTRACTOR Owner -Builder AP No. 113-376-2 LOT TRACT DATE 4-11-62 VALUE $ 17,505-00 FIRE ZONE DESCRIPTION OF WORK Res.w/att.Gar. .CTIONS Signature DATE GROUP 1 J TYPE 1J ZONE R-1 S i 41 -/q -41U SUBCONTRACTOR PERMITS ISSUED Gas ? DATE NUMBER Water G(!J 4-1 C' L/ -/q -61 Rough Com. Refrig. ❑ Air Cond. ❑ Rough Heating ys/ Rough Plumbing Misceaneou�h E,t;kj .(.' L llSwr. '.3/.4 n _ St° / Ls in 2 -House Con. B.St. Swr. ❑ A& Prop. Sprinkling System L� 1 6 • 3 y /d 1 —r Construction Pole Underground ❑ Power ❑ Rough Wiring ,L. _ __ _ _ �- t✓ ren" es - korms a e .- ,cv -.Zb -y/. Floor System - _ Bond Beam ❑ Steel Reinforce Q Sheathing —2(- Frame and Flashing e— Lathing — In m� Out Z P' -r, brown coat . ❑ Air Cond. ❑ Final h—ung, Final Plumbing Fixtures, Final Final Gas Test Electric Fixtures, Final Building, Final OCCUPANCY FORM aU4-5M — 7-61 .LUUI47 i I 16845 COSTA MESA BUILDING -SAFETY DEPARTMENT P. O. BOX SI] COSTA MESA. CALIFORNIA For Applicant to Fill In Completely TYPE OR PRINT BUILDINGs 174 " ADDRESS t COSTA MESA. CALIFORNIA FRECEIVED EI h1AR 3 FINANCE MR. APPLICATION FORTY EIT MESA BUILDING For Office Use Only ^ /)RECEIPT �-"� NO. OWNER V�/ MAIL / // / RECEI BY DATE RE 1�5ED/ DA E ISSUED ADDRESS .�- ll LG Y+1-�L✓-� - L, y TEL.L CITY Z BUILDING ADDRESS COSTA MESA. CALIFORNIA ARCHITECT TEL. d OR ENGINEER No. S FIRE ADDRESS S J 20NE TYPE GROUPIV CONTRACTOR 4C 1 APPROVED /DATE "KING ADDRESS ZO - NO.OF '� .TE OF HE _ CITY _L r PLANSBUILDI DE'PTION " OT A. P. NO. 7 d n STATE TEL.LeawL LIC. NO. NO. SIZE (./ OF LOT A / b -C / NO. OP BLDG-. I NOW ON LOT USE OF YARDS EVES EXISTING BLDG. APPROVED ALLOW D SETBACK LINE FROM (CENTER LINE ST.) /<� CENTER OF STREET REAR YARD FRONT V V FT. IN. I S SIDE YARD LEFT cJ RIGHT R. SIDE FT. r IN. DESCRIPTION OF WORK L. SIDE FT. IN. I II / NEW ALTERATION ADDITION REAR FT. IN. REPAIR II MOVING I DEMOLISH I BYPRO DATE 9 L- Gv BUILDING NO. OF SIZE ROOMS STORIES J/ R WALL ROOF L�(-C G J, COVERING BUILDING AND WORK TO BE PERFORMED /H _3 rL/,�Y r�A� ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE ATE TNAT THe ABOVE I8 CORRECT AND ACRE¢ TO COM - PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. TH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATIONURE G CONSTRUCTION. OF - ! PERMIT FEE $PERMITE I' $ PLAN CHECK $ ,IZED -A'��L'�Q AGENT TOTAL FEE ✓ J JJOB ADDRESS 1725 Gisler Avenue BUILDING PERMIT NO. 43199 ,.139-131-19 LOT TRACT FIRE ZONE VAL I .CTIONS Si nature Dote 11YC 1V I KUU $O1L SUBCONTRACTOR GAS WATER r ROUGH PLUMBING PROP. SWR. LINE Q HOUSE CON. SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND POWER ROUGH WIRING TRENCHES FORMS 77 STEEL REINF FLOOR SYSTEM BOND BEAM n STEEL REINFORCE ❑ SHEATHING FRAME AND FLASHING LATHING - IN n OUT PLASTER, BROWN COAT _S 'IRAL, FINAL H. VENT., REFRIG. AND A.C., FINAL PLUMBING, FINAL AND GAS TEST ELECTRIC. FINAL 'I ,: 43199 ZON + NO: OF.' "1 USE OFG�NEW COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 or Applicant to Fill in Completely — Use Ink Only LDING RESS.J/ER,,///Y F STATE' a.�•Ar']j,.'f CITU{, ,r'r1J` ARDS APPROVED C✓/ W A/IJQ.C'r Al LRESS �7 Z.•,� `,i / S' .1 /� o-+ APPLICATION FOR STRUCTURAL PERMIT RECFSVa,DBV I DATERECRIVED ..nr.wer_ "'LDING ADDRESS 'J.. pl �j� sN�•'y' aEl... •] it t�- •. TRACT CITY //'i f/f� `/YI/ f•17 \ NO. S/'G CONSTRUCTION, A,// � W ADD LENDER BRANCH •� :•.'r'A_♦ :.O 1, •1't' •Y T .OWNER,. ADDRESS'S ARCHITECT{ .l TEL. S OR ENGINEER•{71z P'/ Ci— • �\ - NO. Sy1 ��•• // 11 / �J FIRE ' ADDRESS 7l9 r/i /l//lam �Oa. %%../p.n../ ZONE '• ,r APPROVED CONTRACTORr-��%u`;o• ✓f `-//J.JL' `BY `r " "'•�' 1. ' ` - '{ 'TEC. - - - ZON + NO: OF.' "1 USE OFG�NEW CITY-,r.=N0.7 /� _Yy[/� // PLANS BUILDIN 'YARDS APPROVED} STATE' a.�•Ar']j,.'f CITU{, ,r'r1J` ARDS APPROVED LIC. NO.CLIC: NO. J- -,MAIN'SUILDING w 'ACCESSORY BUILDING SIZE \ t� NO. OF SLOGS:, (FROMC/LSTREET) - Y. - x%1 , NOW ON LOT OF LOT 'z,, ,• :1 FRONT - -7 7,7- 1 FT. .._ :.,..{•>./. USE OF. ' EXISTING`BLDG. ._/./[N/�//J[✓I �. F FT. • { J fFT. Separate permits are required for L. SIDE - — ] • ` {'~F T. I"' S . t electric, plumbing and heating work. j.e/` REAR e , .FT. t FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. I BET. MAIN MAIN SLOGS. ACCESS, SLOGS. VAR. t 'S DATE lc.U:P. * ' :� 1 APPROVED 1� �;/•-5of APPRO I hereby acknowledge that'I have read this applind state that the above information is correct and agree ply with all laws regulating building construction, and I semploy any person in violation of the workman's compelaws ofthe State of California. I hereby certify that I am properly licensed as a cor under SQ. FT,the State of California Business and Professions Cvision 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and that such licenses are in full forceect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the provisions of the State of CalBusiness Professions Codde, DDivision 3, CChhapter 9.PERMIT VALUATIONentl FEE $ of `S�� *4 PLAN CHECK $Authorized Pemitteenature ` TAX AgentTOTAL PAI D $