HomeMy WebLinkAbout1705 PALAU PL - Building Permitsr. a
CITY OF COSTA MESA
to
BUILDING DIVISION
77 FAIR DRIVE. COSTA MESA. CA 92626 • (714) 754-5273 • Fax (714) 754-4856 • www.cl.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER: B09-00150
PERMIT TYPE B ROOF2
APN: 13527/13
JOB ADDRESS: 1705 PALAU PL CM
Vicinity: RESIDENCE AND ATTACHED GARAGE
Squares: 3300
STATUS: ISSUED
DATE ISSUED: 08/07/2009
ISSUED BY: BJK
Suite/Unit:
Valuation: $9,500.00
SCOPE OF WORK: REROOF RESIDENCE AND ATTACHED GARAGE: TIO EXISTING WOOD SHAKE ROOF, 7/16" OSB SHTG, 1 LAYER
30# FELT, APPLY "40 -YEAR GAF COMP SHINGLES;" ALL NEW METAL. 33 SQUARES PITCH 4:12
OWNER:
GRIFFEN, CHARLES D
PHONE:
$181.25
APPLICANT:
MC KAY, MIKE
PHONE:
714-517-5531
CONTRACTOR: MC KAY'S ROOFING
Address: 228 SUNBURST LANEUnit:
City/State/Zip:
CORONA, CA 92879
ARCHITECT
ENGINEER:
FEE SUMMARY
Reroof Plan Check:
$0.00
Reroof Permit Fee:
$181.25
Reinspection Fee:
$0.00
Bldg Std Admin Fund
$1.00
TOTAL FEES $182,25
Address: 1705 PALAU PL Unit:
City/State/Zip: COSTA MESA, CA
Address: 228 SUNBURST LANE Unit:
City/State/Zip: CORONA, CA
License No. 773107
PHONE: 714-517.5531
CELL:
License No. PHONE:
License No. PHONE:
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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
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.
CODE #. INSPECTION TYPE DATE INTITIALS CODE* INSPECTION TYPE DATE INTITIALs
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re -Roof T-/1/— (21 kv 210 Final Electrical
201 Final Block/Retaining Wall I 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
ti
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
`ppeerformance of the work for which this permit is issued.
`�yJ have and will maintain workers' compensation insurance, as required by
n 3700 of the Labor Code, for the performance of the work for which this
pennit is issued. My workers' compensation Insurance carrier and policy
number are: fr� ,1f
Carrier 64 �c N. -R iJ
(Tiler section neadnp(be mnple(ed the perm44valueea(one nurareE4tlarsf5100) ortes)
Policy Number: 1!16 Z �7
77�1 t.-ooi�
❑ 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 ke workers' compensation provisions of Section 3700 of
the Labor Co all with comply with these provisions.
SS --)-07
Applicant's 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. 2
(o Class#all, 1
g -`i -ot
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:
Lender's Address:
OWNER -BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5,
Business and Professions Code: Any city or county which requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its
issuance, also requires the applicant for such permit to file a signed statement
that he or she is licensed pursuant to the provisions of the Contractors
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he or she is exempt therefrom and
the basis for the alleged exemption. Any violation of Section 7031.5 by any
applicant for a permit subjects the applicant to a civil penalty of not more than
five hundred dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and the structure is not intended or
offered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not apply to an owner of property who builds or improves
thereon, and who does such work himself or herself or through his or her own
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of
completion, the owner -builder will have the burden of proving that he or she
did not build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and
Professions Code: The contractors License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for such project with
a contractor(s) license pursuant to the Contractors License Laws.).
❑ 1 am exempt under sec.
Business and Professions Code for this reason:
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:
❑ 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.
Applicant's Signature
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future building occupant need to file and
certify a Business Plan for emergency response to release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some
exceptions, that a Business Plan be filed with the Costa Mesa Fire
Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at standard temperature and pressure).
2. Does or will the applicant or present or future building occupant need to file
a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Health and Safety Code, with some
exceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one time has on hand a quantity of acutely
hazardous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
temperature and pressure).
3. Does or will the 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? ❑ 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 a permit 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 Califomia Government Code requires that the requested
information he 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? ❑ 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.
Signature of egal -wood 7
Signature Data
3057-46(3/07)
AnO6 Au norizeE App m -
Date
�_7 -09
Date I -
4�p5� MF q 1 CITY OF COSTA MESA
BUILDING DIVISION PERMIT NUMBER
DEVELOPMENT SERVICES DEPARTMENT
PERMIT E00-00204
(714) 754-5273 • Fax (714) 754-4656 77 FAIR DRIVE, COSTA MESA, CA 92626
ELECTRICAL PERMIT
Job Address: 1705 PALAU PL Status: ISSUED
Suite No Applied: 03/09/2000
Vicinity: Issued: 03/09/2000
Parcel Nunmber: 13927113
Applicant: HARRY DARTER
Address: 8372 KILLARNEY
Phone: 714-636-8091
GG, CA Zip: 92841
Owner: GRIFFEN, CHARLES D
Address 1705 PALAU PL
Phone:
COSTA MESA, CA Zip: 92626
Contractor: HARRY DARTER CONSTRUCTION
Address: 8372 KILLARNEY
GG, CA
Phone: 714-636-8091
Zip: 92841
License: 473166
SCOPE OF PERMIT
REF B00-00300.2 LIGHTS, 6 OUTLETS AND 2 SWITCHES.
ISSUED BY:
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 cox
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of IN
FOR INSPECTIONS CALL: (714) 764-5626
FEE SUMMARY
Quantity
_
Quantity
ISSUE FEE
$23.50
-
Temp Dist System I 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 I Spa
$0.00
0
................up to 10 kva,kw
$0.00 0
Lighting Fixts
$2.20
2
.................up to 50 kva/kw
$0.00 0
Recept Outlets
$6.60
6
.................up to 100 kva/kw
$0.00 0
Switches
$2.20
2
..................over 100 kvalkw
$0.00 0
Non Res Appl
$0.00
0
Low Voltage Equipment
$0.00 0
Res App]
$0.00
0
Low Volt Wiring System / Ckt
$0.00 0
Service to 200a
$0.00
0
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 1 hp
$0.00
0
Circus (mech ride or lights)
$0.00 0
Motors to 10hp
$0.00
0
Christmas Tree Stand
$0.00 0
Motors to 50hp
$0.00
0
Fireworks Stand
$0.00 0
Motors to 1 00h
$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 cox
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of IN
FOR INSPECTIONS CALL: (714) 764-5626
DECLARATIONS
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the
/`^'ork for which this permit is issued.
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 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.)
❑ 1 certify that In the performance of the work for w ieh,I 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 aWl that It sh LId become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with these provisio `7 -
Applicant Signature: Date:
WARNING: FAILURE TO SECURE WO K TIO
RS' COMPENSAN COVERAGE IS UNLLL AWFUL AND SHASUWECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(S100,000), IN TION 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 rovisions 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
Contractors Signal Date: J
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 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 property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions
Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractods)
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 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 Code).
❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Coda 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 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, cenification 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? ❑ Yes ❑ No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication a ffTnit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 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 pan 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).
......_ .............._-.__.........the S-..-..._.__..__.........—_— .._---------_._._.._.-._._..-
7 a a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the Subject of this
application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Ves ❑ No
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 pu oses. I i6r`e-a not to occupy or allow occupancy of any building authorized by this permit until final inspection.
igna re Of gal Owners) ate _
AnZrOr Authori . zddAj5picant Date
CODE 1. INSPECTION TYPE gIJjJ: INTITAL CODE Y INSPECTION TYPE DATE I TyTRIRLL
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re -Roof 210 Final Electrical J/ //
201 Final Block/Retaining Wall 212 Final Fire Prevention TT
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
2446.46
T-
4`051p MFsq �. CITY OF COSTA MESA
BUILDING DIVISION PERMIT NUMBER
DEVELOPMENT SERVICES DEPARTMENT
°a PERMIT M00-00099
(714) 754-5273 • Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626
MECHANICAL PERMIT
Job Address:
1705 PALAU PL
Status: ISSUED
Suite No
Applied: 03/09/2000
FEE SUMMARY
Issued: 03/09/2000
Vicinity:
Quantity
Parcel Number:
13927113
Quantity
ISSUE FEE
$23.50
ISSUED BY:
Applicant:
HARRY DARTER
0
Address:
8372 KILLARNEY
0
Repair / Alt Refrigeration Unit
Phone: 714-636-8091
0
Inst FAU >100 k BTU
GG, CA Zip: 92841
0
Owner: GRIFFEN, CHARLES D
Address: 1705 PALAU PL
Phone:
COSTA MESA, CA Zip: 92626
Contractor: HARRY DARTER CONSTRUCTION .
Address: 8372 KILLARNEY
Arch / Eng :
Address:
.. Phone: 714-636-8091
GG, CA Zip: 92841
License: 473166
Phone:
Zip:
.License:
SCOPE OF PERMIT
REF B00-00300, ALTER DUCT SYSTEM.
FEE SUMMARY
Quantity
Quantity
ISSUE FEE
$23.50
Repair / Alt Absorbtion Unit
$0.00
0
Inst FAU <100 k BTU
$0.00
0
Repair / Alt Refrigeration Unit
$0.00
0
Inst FAU >100 k BTU
$0.00
0
Ventillation System
$0.00
0
Repair / Alt Cooling/Heat
$13.70
1
Evaporative Cooler
$0.00
0
Inst / Rep. Recess Wall Htr
$0.00
0
Commercial Incinerator
$0.00
0
Refrig Sys <100 k BTU
$0.00
0
Domestic Incinerator
$0.00
0
Refrig Sys >100 k BTU
$0.00
0
Compressors / Absorption Systems
Gas Piping
$0.00
0
Up to 3 hp / 100 k BTU
$0.00
0
Factory Fireplace
$0.00
0
3 To 15 hp / 500 k BTU
$0.00
0
Hood w/Mech Exhaust
$0.00
0
15 To 30 hp / 1,000 k BTU
$0.00
0
VAV Box
$0.00
0
30 To 50 hp / 1,750 k BTU
$0.00
0
Vent Fan / Single Duct
$0.00
0
Over 50 hp / Over 1,750 BTU
$0.00
0
Appliance
$0.00
0
Boilers
Fire Dampers
$0.00
0
Up to 3 hp
$0.00
0
Smoke Dampers
$0.00
0
3 To 15 hp
$0.00
0
Inst or Relocate Appl Vent
$0.00
0
15 to 30 hp
$0.00
0
Air Handlers < 10000cfm
$0.00
0
30 to 50 hp
$0.00
0
Air Handlers > 10000cfm
$0.00
0
Over 50 hp
$0.00
0
Floor Furnace
$0.00
0
Other Mechanical Fee
Floor or Suspend Heater
$0.00
0
_
Investigation Fee
$0.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754-5626
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 i/ the permit is valued at one hundred dollars ($100) or less.)
❑ 1 certify that in the performance of the rtl{k Jervr ich this permit is Issued, 1 shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and gree t if I hould become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with these routs' ns. -
Applicant Signature.
Date: ;� '—(— �i'�f
WARNING: FAILURE TO SECUR RKERS' COMPEN TI COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIE AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(SI 00, ,IN ADDITION TO THE OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3106 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensednder provisions of hapter 9 (commencing with Section 7000) of Division 3 of the Business and otessions Cade, and my license is in full
force and effect. Lic. # Class # —
Contractor's Signatur . Date:IF
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:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions
Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec.
7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work
himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is
sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions
Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractors)
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 driver's license. ❑ Yes ❑ 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) teat high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title 6, California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons,
or 200 cubic 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 feel 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? ❑ Yes ❑ No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication aaermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Ves 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 WIII 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? ❑ 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.
ig tura Of L 1 Owner(s) Date
C
And/Or Authorized A licant Date
CODE INSPECTION TYPE DATE INTFIALS CODE INSPECTION TYPE DATE NTRI LS
1616 Fixed System Final Fire Prevention 206 Final Mechanical a b
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
2446-46
M
a� 5tp Mg q , CITY OF COSTA MESA
BUILDING DIVISION PERMIT NUMBER
f DEVELOPMENT SERVICES DEPARTMENT
"•,� fi; PERMIT B00-00300
(714) 754-5273 • Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job Address: 1705 PALAU PL Status: ISSUED
Suite: Applied: 03/09/2000
Vicinity: Issued: 03/09/2000
Parcel Number:
13927113
Zoning:
R1 R1
Applicant:
HARRY DARTER
ISSUED BY: V
Address:
8372 KILLARNEY
Claim Valuation: $0.00
SMIP Res:
$1.83
Phone:
714-636-8091
SMIP Com:
GG, CA
Zip:
92841
Owner:
GRIFFEN, CHARLES D
Address
1705 PALAU PL
Total:
$508.79
Phone:
COSTA MESA, CA
Zip:
92626
Contractor:
HARRY DARTER CONSTRUCTION
Address:
8372 KILLARNEY
Right 0-0
ACCESSORY
Front 0-0
Rear 0-0 Left 0-0
Phone:
714-636.8091
Existing: 0
GG, CA
Zip:
92841
License:
473166
Arch - Eng:
Address: - Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
CONSTRUCT 214SF FAMILLY ROOM.
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
FEE SUMMARY
Plan Check:
$199.71
Calc Valuation: $18,297.00
Permit:
$307.25
Claim Valuation: $0.00
SMIP Res:
$1.83
SMIP Com:
$0.00
Other:
$0.00
Inspection:
$0.00
Total:
$508.79
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
DECLARATIONS
WORKERS' COMPENSATION DECLARATION:
I hereby allirn under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the
/work for 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 sect/on need not be completed it the permit is valued at one hundred dollars ($100) or less.)
❑ 1 certify that In the performance of the work hich 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, an a 11 t if I sh uld become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
Comply with these i . ns J3 ' C -
Applicant Signature: Date: ^ r/ `G C-%
WARNING: FAILURE TO SECU E \J' ORKERS' COMPENS ilON COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE ($100. NfJ ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3705 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
hereby affirm that Iam licensed u der provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and P ofessions Cotle, antl my license is in full
force and effect. Lic. # Class # Te
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ 1 hereby aHirrn 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 ($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.).
❑ 1, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions
Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ 1 am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by 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 Code).
❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building Occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑ No
(Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the 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? ❑ Yes ❑ No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of thisa plication eppermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control tlistrict or agency? a Yes L -I No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any pan of the facility to 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 It a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8 (If "yes", attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and 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-descnbed property for inspection purposes. I agree not to Occupy or allow occupancy of any building authorized by this permit until final inspection.
�1
Signature Of Legal Cwner(s)Date
n Or Authorized Applicant Date
CODE I. INSPELTIONTYPE pAjf INTRIAL CODE N INSPECTION TYPE Dmf INTMALS
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 -2 A/ Ori
2"6&46
11��ei<
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 317 COSTA MESA. CALIFORNIA
fOR APPLICANT M f/ll /N COMPLETELY
TYPE OR PRINT
ADDREISS 1705 Palau Place
COSTA MESA, CALIFORNIA
S=EE RECL JED
JAN 211960 v
FINANCE DEPT.
APhkAfi6'9Tl+(5iRS11PERMIT
BUILDING
foR offla USE My
OWNER Kenkol Development Co . , Inc .
RECEIPT, NO. I pC "F.RM I",/I .
t
ADAILDRESS 1555^Placentia
RECEIVED BY
DATE RECEIVED TES BBUED
/_d n I .IIV 1 1960
f-�
Newport Beach TEL' 6-3'0'27
BUILDING
CITY
ADDRESS
ARCHITECT Ll.
OR ENGINEER NO.
COSTA MESA, CALIFORNIA
ADDRESS
FIRE
ZONE
TYPE GROUP
K.W. K011 STATE 61195
CONTRACTOR LIC. NO.
APPROVED
BY
DATE
Ibbb acen is
ADDRESSNewport Beach
ZONING
LEGAL LOT
32
335522
ZONE
(PLANS
NO. OF
USE OF NEW
I"BUILDING
DESCRIPTION NO. BLOCK
TKALT9
A
A. P. NO.
APPROVED
BY
/
/ 1 !�' ' DD/ATE /'�'� -4-VSIZE
75x100 - I
NO. OF BLDGS. 0
YARDS
VES
OF LOT
NOW ON LOT
REQUIRED
ALLOWED
USE OF
none
(CENTER LINE ST-)
EXISTING BLDG.
FRONT
FT. IN.
SETBACK LINE FROM( I
50
CENTER OF STREET REAR YARD
R. SIDE
FT. IN.
71
I
8-
I
SIDE YARD LEFT
RIGHT
L. SIDE
FT. IN.
DESCRIPTION OF WORK
REAR
n
1 rf-O FT. IN.
XII
I II
NEW
ALTERATION ADDITION
REPAIR I
II MOVING II DEMOLISH
DING 1800 Sf 6 1
SIZE ROOMS STORIES
EXTERIOR WAL4StuL.`.O
JJ
ROOF WoodShingles
COVERING
COVERING
USE OF BUILDING AND WORISO BE PERFQ ED
Single-Fami�y Resi.�ence
and Attached Garage
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
ANDSTATE TH T ABOVE I CORRECT AN AGREE TO CO..
THE AMOUNT SHOWN UNDER VALUATION 18 FOR THE
PLY WITH AL CITY RDINANC 8 AN REGULATING
PURPOSE OF
ESTABLISHING A PERMIT FEE ONLY.
BuaD1rvG CO STRU ION.
SIGNATURE O
VALUATION
PERMIT FEE S 39�
PERMITTEE _
X/J
I v�jD
Q
S
PLAN CHECK $
TOTAL FEE $
AUTHORIZED AGENT