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Home My WebLink About2127 RALEIGH AVE - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 MECHANICAL PERMIT Job Address: 2127 RALEIGH AV Suite No Vicinity: Parcel Number: 42246217 Applicant: WILLIAMS, KIMBERLY Address: 1401 BAXTER ST ISSUED BY: Phone: (310)253-5229 ANAHEIM, CA Zip: 92806 Owner: ROFF, AURORA M TR Address: 2127 RALEIGH AVE Phone: COSTA MESA, CA- Zip: 92627 Contractor: ALASKA AIR Address: 1401 BAXTER ST Phone: (310)253-5229 ANAHEIM, CA Zip: 92806 License: 574615 FAU. < 100K BTU. SCOPE OF PERMIT FEE SUMMARY Repair / Alt Absorbtion Unit Repair/ Alt Refrigeration Unit Ventillation System Evaporative Cooler Commercial Incinerator Domestic Incinerator Compressors / Absamtion Svstems Up to 3 hp / 100k BTU 3 To 15 hp/500k BTU 15 To 30 hp / 1,000 k BTU 30 To 50 hp / 1,750 k BTU Over 50 hp / Over 1,750 BTU Bailers Up to 3 h 3 T 15 hp 15 to 30 hp 30 to 50 hp Over 50 hp Other Mechanical Fee Investigation Fee Plan Check Fee Reinspection Fee TOTAL CALCULATED FEES Status: ISSUED Applied: 11/05/2002 Issued: 11/05/2002 Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 $38.30 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 244646 (6/00) Quantity ISSUE FEE $23.50 Inst FAU <100 k BTU $14.80 1 Inst FAU >100 k BTU $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Inst / Rep. Recess Wall Htr $0.00 0 Refrig Sys <100 k BTU $0.00 0 Refrig Sys >100 k BTU $0.00 0 Gas Piping $0.00 0 Factory Fireplace $0.00 0 Hood w/Mech Exhaust $0.00 0 VAV Box $0.00 0 Vent Fan / Single Duct $0.00 0 Appliance $0.00 0 Fire Dampers $0.00 0 Smoke Dampers $0.00 - 0 Inst or Relocate Appl Vent -$0.00 0 Air Handlers < 10000cfm $0.00 0 Air Handlers> 10000cfm $0.00 0 Floor Furnace $0.00 0 Floor or Suspend Heater $0.00 0 SCOPE OF PERMIT FEE SUMMARY Repair / Alt Absorbtion Unit Repair/ Alt Refrigeration Unit Ventillation System Evaporative Cooler Commercial Incinerator Domestic Incinerator Compressors / Absamtion Svstems Up to 3 hp / 100k BTU 3 To 15 hp/500k BTU 15 To 30 hp / 1,000 k BTU 30 To 50 hp / 1,750 k BTU Over 50 hp / Over 1,750 BTU Bailers Up to 3 h 3 T 15 hp 15 to 30 hp 30 to 50 hp Over 50 hp Other Mechanical Fee Investigation Fee Plan Check Fee Reinspection Fee TOTAL CALCULATED FEES Status: ISSUED Applied: 11/05/2002 Issued: 11/05/2002 Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 $38.30 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 244646 (6/00) DECLARATIONS n'l 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. Mierl maintain worNeM' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. o ens/"ation In once carrier and policy number are: 1 17 ��trT7 l4Vl olicy bar: ('"1 ✓2 -7-0 ' 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 armor so as to become subject to the workers' tion laws of California,, and agree that if I should become subject to the workers' compensation provisions of Section 1700 f the Labor Code, I shall forthwith ply wit these provisions. ` `' / ' Ap Icant Slgn re: �" �DaTs:� J 1) WAR At TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBIECT AN EMP YER TO CRIMINA PENALTIES AND GVIL FINES UP TO ONE HUNDRED THOUSAND DOU ARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTI R CODE, INTEREST, AND ATTORNEYS FEES. LICENSED C RACTORS DECLARATION: I hereb ffirm that l am license under visi of C�apter 9 (commencing with Section 7000) of D Ision 3 of the Busi ss and Professions Code, and my license is in full force n -Lia a Class k Cra ature: CO 34STRUCTION 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: 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 10 verified by drivers 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) feet high. (Chap. 3.2, Grp 2, Art 2, Sac. 341, Title B, 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 his 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 luny complied with? ❑ Yes ❑ No .............................................. ............................................................................................................................................................... ......................................................................... .... ................................ ................................................ ....... 1111...... 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication aermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 8 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). .............................YP.....................................,.......I...... P........................................................................................................................................................................................................ fi Wiil an art of the facilityto be constructed under this ermit 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 ..............................................................-...................................................................................................................................................................................................................1111.............................11...............11.......... 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 slate 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. Sign Of Legal Owner(s) Or Authorized pplicant e CODE 0. INSPECTION TYPE PA7F IMIAL5 CODE I INSPECTION TYPE 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 Applicant to fill In all spaces within CITY OF COSTA MESA PERMIT NO. CONSTRUCTION PERMIT 10-,420,3/ 1 -Address , r s:In YI AL& ji M -- I Address Phone LICENSED CONTRACTOR DECLARATION I hereby affirm that I am Iicen sed untler provisions of Charter 9 (corn - men Clog with section 7000) of Ivi si on 3 of the Business and Professions Cotle, tl my Iicen a is in fullforce and lett. License Class Li ens. N _ Dateje� Signature WORKERS' COMPENSATION DECLA ATIO - - I hereby affirm that I have a certificat of co sent to self -Insure or a certificate of Workers" Compensation insurance, or a certified copy 'hereof (Section 3800, lab. C.). olicy No. Company *ertifleo copy is hereby furnished. - f - ertifled copy Is filed with the city Building Division. EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This Section need not be completed if the permit is for one hundred S$1110) er Ie55). ter lify that in the performance the work for which this, permit li issued, I shall not employ any pe in awsny man er so as to becom d tR tha/We subjarrkw' Compensati Laof Cali rnla. Date ll 11 5..... Wre NOTICE: If after making this tlectaratlon, iou shout become subject to the Workers' Compensation provisions o91the Labor Code, you must forthwith comply with Such provisions Or t4ls permit shall be deemed revoked. - CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the per- formance of the work for which this permit is issued (Section 3097 Civ. C.). Lender's Name Lender's Address OWNER BUILDER DECLARATION hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section7031.5-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 re- quires the apoicanl for such permit to file a signed statement that he Is licensed pursuant t0 the provisions of the Contractor's License Law (-Chapter 9 (commencing with Section 7000) of Division 3 of the y siness and Pro/esslons Code) or that he is exempt therefrom and the �:'E`s for the alleged exemption. Any violation of Section 7031.5 by applicant for a'permit subjects the 'applicant to a civil penalty not more than (i" hundred dollars ($500). El I, as owner of the property, or my employees with wages as their Sole Compensationwill do the work, and. the structure Is not Intended or offered for sale., (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of a property who builds or Improves thereon, and who does such work himself or through his Own employees, provided that.such improvements are not Intended or offered for sale. It, however, the building or improvement Is sold within one year of Completion, the owner will have the burtlen of proving he did not build or improve for the purpose of sale). ❑ 1, as owner of the property, -am exclusively contracting with licensed contractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of properly who builds or improves thereon, and who con. tracts from such projects with a contractor(s) licesned pursuant -to the Contractor's License Law). ❑ 1 am exempt under Section - B. & P. C. for this Date - Owner hereby 0 lify that 1 have read this application and state [hat the above infor matin is correct. I agone to comply with all City antl county ordinances O Stale laws tat in t construction, and hereby duthoriae re Peen tat s OI t is c y t 9nter upon the above mentioned property f Inspect o u,p z Signature _ Data Drivers' Lican Se Or border lines and sign all appropriate declarations TRACT NO. LOT NO.' I BLDG. NO. TYPE OF CONSTRUCTION - ,r' 9466 1 2/ 14/8 ❑ NEW 'El ADD'- ❑ ALTERATION -' ® REPAIR ❑ CONVERSION ❑DEMOLISH ❑ OTHER ZONING REGULATION DESCRIPTION OF WORK O A.P. -L ..n ra r ZONE PLNG. REF. =iP ❑ GRADING -'❑ FOUNDATION- ❑ STRUCTURAL ❑ TENANT ❑ ELECTRICAL-OPLUMBING OMECHANI ❑ OTHER PROJECT DESCRIPTION _. SQ. FT. OCCUPANCY_ CONSTRUCTION TYPE VALUATION ZONE GRADING CU. YDS. ACRES REMARKS: PLUMBING - PLAN CHECK BATHTUBS SHOWERS TOILETS. , URINALS - LAVATORIES DOUBLE LAVS' . KIT. SINKS DISHWASHERS SERVICESINKS SUMPS ' FLOOR SINKS FLOOR DRAINS DRINKING FOUNTAINS 'FIXTURES INTERCEPTORS CLARIFIERS SWIMMING POOL PTRAP REARYARD (TO P/L) PKC. SPACE REQ. PROVIDED - PARK ZONING APPROVED BY SPECIAL CONDITIONS: ELECTRICAL PLAN CHECK GENERATOR 0-1 KW_ 1-10 KW TRANSFORMER SUB - _ APPLIANCE 10-50 KW_50+KW MOTORS 0-1 HP --1-10 HP _ (INC. SOLAR) 10-50 HP_50+HPy 'FIXTURES OUTLETS SWITCHES GAS TUBE SIGNS ' POLE LIGHTS SOLAR TANK 500 'Tl WATER SERVICE ALTERATION - PANELS -MAIN SUB - ASSERVICE OUTLETSSERVICE - AMP ' WATER HEATERS BTU OUTPUT - SEWER CONNECTIONS SOLAR TANK COLLECTORS SOLAR PIPING SYS. - ISSUE FEE ISSUE FEE - — APPLICATION APPROVED BY DATE MECHANICAL PLAN CHECK SUMMARY OF FEES BUILDING - HEATING SYSTEM 0-100,000 BTU PERMIT $ SMIP $ AND DUCTING _ _ 100,000 «BTU PLAN CHECK $ PERMIT,' ISSUANCE $ REFRIGERATION 0-100,000BTU PLUMBING $ SYSTEM" GRADING $ 100,0001 BTU PLAN CHECK $ BOILERS BTU ELECTRICAL $$ PLAN CHECK $ MIC ROFILM'E SYSTEM REPAIR, ALTERATION TOTAL FEE $ MECHANICAL $ EXHAUST SYSTEM MULTIPLE , LESS AD - - - PLAN PLAN CHECK E - _ $_ - - ISSUEFEE CMF 0865-46 White -Building; Canary -Applicant: Pink -Accounting; Goldenrod -Assessor FINAL FEE $C,� CONSTRUCTION AND PLANNING APPROVALS Permit# - Date POOL & SPA •, InspectorgppROVALS Permit# ' Date Inspector •„ 1. Temporary Electrical Service or Pole _ 43. Pool & Equipment ILocatior 2. SoilPipe-Undrgrn _ 44. Steel Reinforcement- - - --�- ---- 3. Electrical Conduit Utility-Undrgrn - 45. Forms - - - 4. Electrical Conduit-Undrgrn 46- ..Electrical Bonding - - 5. Steel ein orce - 47. Rough Plumbing & Pressure'Test ' 6. Electrical UFER Grn 48. APPROVALTO COVER-GUNITE•- 7. Footings - 49. Electrical Conduit-Undr rn 8. Foundation - 50. Gas Pipe, ❑ Undr rn, Test 9. .Water Pipe-Undrgrn 51. Backwash Lines P -Trap,❑ Undrqrn '•- -- - 10. Structural Floor System 52. APPROVAL TO DECK 11. Property Sewer Line & House Connection 53. Backwash & Receptor -Final 12. Street Sewer Connection 54. Heater & Vent -Final 13. Rough Plumbing _ _ Final 14. Rough Electric -Conduit - - - - •56: Electrical -Final - 15. Rough Electric -Wiring - 57. Solar System -Final - 16. Rough Heating'& Air Conditioning b1J. Fencing & Access Approval 17. Ducts, in Structure 59. APPROVED FOR PLASTERING ' 18. 19. 20. Ducts, Ventilating Gas'Pipe-Rough & Test Roof Framing 60. POOL/SPA SYSTEMS FINAL ! 21. 22. Roof Sh'eathin Frame and Flashing__ NOTES: 23. Insulation 24. Lathing & Siding _ 25. Drywall Nailing ' 26. Plaster Brown Coat 27. Electrical Power Meter -Final 28. Final Electric 29. Final Heating & Air Conditioning 30. Final Gas Pipe -Test 31. Final Plumbing 32. Water Service -Final 33. Gas Service -Final 34. Solar Domestic -Final 35. Landscape Sprinkling System 36. Sound Attenuation 37. Handicap Regulations - - 38. FINAL STRUCTURE & BUILDING 39. Special Requirements Completed 40. Electric Release to Edison- - -- 41. Gas Release to Southern California Gas Co. 42. CERTIFICATE OF OCCUPANCY No. Date PROJECT ADDRESS: 2127 RALEIGH AV UNIT: OWNER'S NAME: ROFF, AURORA M ADDRESS: 2127 RALEIGH AVE COSTA MESA,CA 92627 ARCNIENGINEER: REG.NO.: ADDRESS: UNIT: PERMITTEE: ROFF[ AURORA (714)548-6209 ADDRESS: 212'), RALEIGH COSTA MESA CA 92627 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 at the Business and Professions Code. and my license is in full force and effect. CITY LIC.: STATE LIC.: CLASS: Date: Signature: WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell insure or a certificate of Workers' Compensation Insurance. or a certified copy thereof (Section 3800. Lab, C), POLICY NO.: EXP. DATE: COMPANY: ❑ Certified copy is hereby furnished. ❑ Cenilied copy is filed with the city Building Division. Dale: Applicant: EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This secti need not be completed if the permit is f ne undred ($lXh or less), I certify that in the performance of the work for which this permit is' a d. I shall not employ any person i n stirrer so as to become subject to Ih orkers' Compensation Laws of California. O Date: �— / 3 Signature: D' NOTICE: It, after making this declaration. you should be a subject to the Workers' Compensation p ns of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097. Civ. C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the fallowing reason ISection 7031.5 Business and Professional Code: Any city of 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/she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 at the Business and Professions Code) or that he/she is exempt therefrom and the basis lar the alleged exemption. Any violation of Section 7031.5 by any applicant lot a permit subjects the applicant to a civil penally of not more than five hundred dollars ($500). I, as owner of the progeny or my Can wild wages as their sale compensation, will do the work. and the ❑ structure is not intended or offered for sale Rection 7044, Business and Professional Code: The Contractors' State License Law does nor apply to an owner of a progeny who builds or improves thereon, and who does such work himself/hersell 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 01 completion, the owner will have the burden of proving he/she did not build or improve for the purpose of sale). I, as owner of the properly, am exclusively contracting with licensed Contractors to construct the project (Section 7D44, Business ® and Ptalessions Code: The Contractors' Slane License Law does not apply To an owner of property who builds or improves thereon and who contracts tar such projects with a contraclor(S) license pursuant to The Contractors' Slate License Law). I am aware that proof of their Worker'S Compensation insurance should be provided to me. ❑ I am exempt under Section: B. A P. C. for this reason: Date: & O — f3 Owner do hereby certify That I am aware of and understand the requirements of ed to co Health and Safely Codes and the 2e 33, and 25534 and Inas m any lunare building occupant will/will not (circle ane) t Dis to comply with said state codes and the requirements for a permit for construction or modification from the Air Oualny Management District. Residential tonslruction applications are exempt from these provisions. Date: Applicant: I hereby certily that I have read this application and state than the above i rmasion is correct. I agree to comply wish city and county ammdntes and stale lours relating to building construction and If '12 r e rapresennalives of this city to enter up 1 bave mentioned property for inspection purposes. purrpnppoos,se?ess. Date: �(J1✓ Signature: B� Driver's License ar Social Security .: 1641-46 White—Building: Green—Cade Enforcement; Canary—Applicant: Pink—Revenue; Goldemod—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERM NO; B 063868 PERMIT NO: B 063868 PLAN CHECK NO: N GOVT; N SUPP: N CONSTRUCTION TYPE; PERMIT TYPE: STR PURPOSE: ALT JOB DESCRIPTION ; T/O ROCK ROOF,REROOF W/ASPH SHING SQ FT; 3,800 CLAIM VALUE; 3,800,00 CALC—VALUE; 3,800.00 GROUP OCC; R-3 / q COMMENTS: HOT MOP ON FLAT SECTION IN REAR ***iFkkkif Bk**iE BE iE*RE iE iE 8E 8E*kRE BE kiE BF BE iE iE BEM kiE*****BEM**1E**iE BE iE iE**BE 8E iE 8E BE**iE iE iE�1��9E +Gr•+Fftl- 1E iF Z O N I N GSERT E B Q A U C I K R S E M E N T S� �ut��D ------------ MAIN BUILDING ------------------- ACCESSORY BU L ING--------- FRNT: FT IN REAR; FT IN FRNT: FT IN REAR; FT IN LEFT; FT IN RGHT: FT IN LEFT; FT IN RGHT: FT IN PARKING REO• PROV: PARCEL: 42246217 ZNE: REF NO: PLANNING N TES> > iE * iE iE iF iE BE BE BE if RE iE 8E 8E RF iE 8E iE RE RF BF iE * if BF * iE # iE 8E RF iE BE BF9E BF BE * BE 8F lE RE Rf iE k BE BE iE * iE iE BE 8E BF fE * RE BE iE BE iF RL• iE iE 1E RF BE rt *iE BF iE BE !F Bk * Bf BE RF D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N -T S ZONING APPROVED. BY DATE: BUILDING APPROVED BY DATE: APPLICATION ISSUED BY: DATE: if if iFk BE iE BE Rt Bf iE BE;>E BE BE �E iE RF iE****iE kBEit BE it*iE BE***iE*iE*BE if fe*iP***kiE JE***BEiEiE*it BE*iE BEBE*BE iE**iE'BEie ft BE BE RE iE ft*** LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 63.00 .50 SMIP/NON—RES PL ISSUE FEE BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL jy PAID DUE TOTALS ---- > 63.50 0.00 0.00 63.50 63.50 .00 REVENUE DIVISION TOTALS--> COLLECTED; 63.50 OVER/SHORT; 00 BLDG P00 PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOOT GRADING PLAN—CHECK **Bf iE iE BE Bfkk*rtk***RE*it*kBE iE ie kif*iE*iEkk*RE iE***it iE it RE kit*BE BE*if**BE*iE*iEiE BE iE**♦E iP iE 1E BF iE*BE***BE iE k iE***iE I N D I V I D U A L F E E B R E A K D.O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST SFR 3800 REROOF BY VALUE RESIDENTIAL NOZONE 1,00 3,800,00 END OF FEES a- 01 109r 6529-00146.;30 TOT 63.50 DATE: 09/08/93 TD1E: 11:42 CONSTRUCTION AND PLANNING APPROVALS Permit 5r Date Inspector POG SPA APPROVALS Permit;,`- Date Inspector 1. Temporary Electrical Serv!cz or Pole 52. Pool & Equ:pmant Local, of l 2. Soil Pipe-Undrgrnd. 53, Steel Reinforcement -I 3. Electrical Conduit Ut,lltv•Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Elactrical Bonding S. Steel Reinforcement 56. Rough Plumbing & Pr[ssurC Test ' 6. Eeetrpeal U F E R G, rd 57. APPROVAL TO CO\'ER-GU <ITE ! 58. Electrical Conduit-Und,grnd. j 7. Foot,ngs 8.: Foundation 59. Gas Roe, C Ur.di grad , Test 9. %Pater Pipe-Undrgrrd. E0. Bac!cvrash L rr--, P Tran,' ' "''drg-na 10. Structural Floor System 61. APPROVAL TO DECK_ 11. Property Sewer Lina & Ho sse Connection 62. 6:ckct;h & P•,•c-,.•c• Fr•.. 12. Sewer Cap _ 63. Hcatur & Vent•umal 13. Roof Dta!ns 64. Plumbing System - Final 65. Ele2trical-F,r3 -� 14. Rm,gl'Plumbmr 15. Rough Electrical -Conduct 66. Solar Systam-F.r.,' 67 Fer,cing & Acc •'v.r,o. 68. APPROVED FOR PLASTLRING 69, POOL/SPA SYSTEMS FINAL FIRE DEPT. REQUIREMENT 'APPROVALS i'ermit;<___�_� 70. Underg.ounu H�,:,o -. 16. Ro'..gh Electric VVicmg 17. Rough k%inng Sign 18. Rough Electrical -T Bar Ceding 19. ROLOh Heating & Air Cordit oning �j'' 20. Rot.gh Faetoty Fireplace 21. Ducts, in Structure •• j' 22. Ducts, Ventilatirig i ,71. Product P,Oi�c '-;Gas -'Oil ---� - 23..Ga5 Pipe Rough & Test .72. Undergroulid Flusty 73. 'Undcrgrnd. Storyc'T,n!c Gas :7''j 24 Roos Fram,ng 25. Rour Sheathing� �[ f1t3 6wi- 74. Oserhead Hydi o� 75. Dry Chermca! 76. Dry Standc: -, 77. FIXED SYSFEMI FINAL 711 FIRE PREV, F1'.A_ HEALTH DEPT. REQUIREMENT , 79. -FINAL I,'�SPECT'.- 30. FOOD CERT Ngtes: r - - T-- .- - -` ----- -- -- ---- - - - - - --- : -' - -- - --------'- - - - _-- 26. T -bar CeJing SSv acturaN & ,'orocoat 27. Frac= and Flashing 28. Lathing & Siding'. c- 29. Insulation 30. X31. Piaster Brown Coat , r. ,. I 32. Electr;ca!Poser'Ve;nr-F 33, Final Elgctric I -, 34. Final Heating & Air Cor. a,t-onion _ 35, F,rcl Gas Pigj-Test 36. Hood or Canopy - 37 j,r,al Factory Fireplace _-- 38. Fm31 Plumbing-- 39. Water Service=Final �- 40. Gas Sendce-Fina!-- 41. Solar Domestic-Firal I 42. SacKr!ow Fireventer 43. Backflow irrigation v� 44. Landscape trrigationSYste rr. J - ,--- - --_-- 45. Sound Attenuation,- •,s i- 46. Hardicap. RegulatAris ' r 47. FINAL STRUCTURE & BU!LDtNG 48. FINALPLANNING I 49. Electric Release to Edison ' - 50. Gas Release to Southern Cai,fornia Gas Co _ I 51. CERTIFICATE OF OCCUPANCY No. Dare OWNER ROLL, KENNETH W. DATE 3-9-56 JOBADDRESS 2127 Raleigh Ave. BUILDING PERMIT NO. GENERAL CONTRACTOR Owner SUBCONTRACTOR PERMITS ISSUED DATE VALUE $7np3?n-on _ Foundation Forms and Grade to Garage LOT L BLOCK TRACT 23u8 Rough Framing Residence & Gar - GROUP I & i TYPEy ZONE Rh FIRE DISTRICT 90n INSPECTIONS ATE SUBCONTRACTOR PERMITS ISSUED DATE NUMBER Footing Trench Foundation Forms and Grade to Garage Rough Framing - Plumbing,Roughto- Plumbing,RoughComplete .� �/� �'�a�y. .�-,� t1 c,l C�/�i ✓ Temporary Pole Wiring, Rough i�t� �.3-s�e ,G'!'J�2✓1� O�.�i p7 pi &3- 1� Heating, Rough Heating, Finala��..S.i�-y>>, Sewer, House O.L!,.0 Sewer, St. ha /.t)� -5(_ .SO �T' sr Septic Tank or Cesspool Lathing, In Out Plastering Plumbing, Final, Fixtures Plumbing, Final Gas Test 19.t' 7i,�- p-f{e Wiring, Final 2i/ft71,13-4-4 ✓,L,/�a( .✓.✓ �J�„i cf -S — is=.?/vim Occunancv /1?iA 7.9 2 4r FORM 210 3M 1055 Costa Mesa Building Department A y APPLICATION FOR PERMIT III EAST 20th STREET COSTA MESA CAL CALIFORNIA 24 0 BUILDING � FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY Receipt No. Permit No. , Building Address 2127 Raleigh Avenue Costa Mesa, California Received by Date Recd. Imo, _ —r6 / J It �AP Is V6 Nearest Cross St Building Address Owner Kenneth w Koll Costa Mesa, California Address 2626 Newport Blvd, Nearest Cross St. Tet. city NewDort Beach No. Hr. 5201 ZoneI No. of Plans I Typc Grou Architect or Lic. Engineer No. Approved b Date CORRECTIONS mress City Lic. Contractor No. Address LegalI Description Lot No. 4 I I Block I Tract2346 (Attach Metesand Bounds) No. of Bldgs. Size of Lot 60 X 100 I Now on Lot rMIR O Use ofI No.of Existing Bldg. Families No. of I Rooms 7e j Setback Line from Rear Yard 2 Center of Street 50 Side Yard DESCRIPTION OF WORK New I R I Alteration I I Addition CITY OF COSTA Repair I I Moving I I Demolish MESA Building No. of _ 1.200 Rooms 6 Stories 1 `'rior , Wali covering Stucco Roo I covef ring Como APPROVALS Use of New Building Residence –da� Foundation Location Forms, Materials, Under -Pinning Inspector Date Frame: Fire Stops, Bracing, Bolts I hereby acknowledge that I have read this Application and state that the above is correct and agree to comply with all City Ordinances and State Laws regulating building construction. Signature of PermitteePlaster, l'� C Authorized A t. ..�,,,, Lath. Int Lath. Ext Int Plaster, Ext. Valuation Permit Fee $ 26.00 Plan Check $ 13.00 $ 10.320 Total 39.00 Fee $ Masonry Reinforced gond Beam FINAL PLOT ELAN Show location and distances from property line and between buildings. cosrn IAR—9-56PDUr v d d � 0 4 a` Street PLOT ELAN Show location and distances from property line and between buildings. cosrn IAR—9-56PDUr PERMIT NUMBER: B18-00041 PERMIT TYPE B_ROOF2 STATUS: FINALED APN: 42246217 DATE ISSUED: 02/07/2018 Bldg Std Admin Fund ISSUED BY: CAC JOB ADDRESS: 2127 RALEIGH AV CM Suite/Unit: Vicinity: Squares: 0 Valuation: $12,300.00 SCOPE OF WORK: TEAR OFF INSTALL 2 L30 LB FELT A.D COMP SHINGLES ON THE SLOPED SECTION AND BUR /TORCHDOWN ON THE FLAT SECTION OF THE HOUSE NOTE: RESIDENTIAL RE -ROOF: For Proiects exceedina $1,000 in valuation final approval of permit shall not be aranted until access to dwelling unit(s) is provided for verification of the installation of smoke and carbon monoxide alarms by the City Inspector. See Attachment w/Inspection Card OWNER: ROFF, AURORA M TR Address:2127 RALEIGH AVE Unit: PHONE: City/State/Zip: COSTA MESA, CA APPLICANT: CARLOS TOME Address: 955 S MAGNOLIA AVE Unit: PHONE: 213.909.4879 City/State/Zip: LOS ANGELES CA CONTRACTOR: WESTCOAST QUALITY ROOFING COMPANY License No. 1034765 Address: 955 S MAGNOLIA AVEUnit: PHONE: 213.909-4879 City/State/Zip: LOS ANGELES CA 90006 CELL: ARCHITECT: ENGINEER: J4461111IM&F-137 Reroof Plan Check: $0.00 Reroof Permit Fee: $223.25 Reinspection Fee: $0.00 Bldg Std Admin Fund $1.00 Waste Hauling Per Project Fee: $160.00 License No. PHONE: License No. PHONE: 'OTAL FEES $384.25 HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279 Monday thru Friday - 7:00 am thru 7:00 pm. Saturdays - 9:00 am thru 6:00 pm. Prohibitied all hours - Sundays and the following Federal holiday: New Years Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day and Christmas Day PERMIT TYPE: B_COMBO Sub Type: RES_ALT JOB ADDRESS: 2127 RALEIGH AV CM APN: 42246217 Zoning: , Vicinity: Const Type: V -B SQ. FT: 0 PERMIT NUMBER: BC15-00758 STATUS: FINALED DATE ISSUED: 09/16/2015 ISSUED BY: CK Suite/Unit: Primary Occ: Valuation: $6,000.00 SCOPE OF WORK: REPLACE BATHTUB WITH JACUZZI/WALK IN TUB. MECH: 1 VENT FAN TO SINGLE DUCT, ELECTRICAL: 3 OUTLETS, 1 SWITCH. PLUMBING: 1 TUB, 1 WATER PIPING INS/REPAIR OWNER: ROFF, AURORA M TR AVE Unit: Phone: City/State/Zip: COSTA MESA, CA APPLICANT: GRANT HOFFMAN LOOP Unit: Phone: 714.544.3100 City/State/zZip: TUSTIN, CA CONTRACTOR: L J HAUSNER CONSTRUCTION CO License No. 326317 Phone: 714.544.3100 Address: 1541 PARKWAY LOOPUnit: Cell: City/State: TUSTIN, CA ARCHITECT: License No. ENGINEER: License No. COMBINATION PERMIT FEE SUMMARY Building Plan Check: $81.41 Building Fees: $125.25 Electrical Fees: $27.90 Mechanical Fees: $30.75 Plumbing Fees: $43.10 SMIP Residential: $0.78 SMIP Commercial: $0.00 Bldg Std Admin Fund $1.00 Waste Hauling Per Project Fees $0.00 TOTAL FEES: $310.19 '*Refer to fee receipts for all fees paid for project Address: 2127 RALEIGH Address: 1541 PARKWAY ZipCode 92780 PHONE: PHONE: HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279 Monday thru Friday -7:00 am thru 7:00 pm. Saturdays- 9:00 am thru 6:00 pm. Prohibited all hours -Sundays and the following Federal holidays: New Years Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day and Christmas Day