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Home My WebLink About2199 RALEIGH AVE - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.cag. UILDING PERMIT n FAIR DRIVE, COSTA MESA, GA 92626 Job Address: 2199 RALEIGH AV Suite: Vicinity: Parcel Number: 42240301 npplicant: TUPIN, DAVID Address: Owner: KERSHAW, ELEANOR H Address 2199 RALIEGH AVE COSTA MESA, CA Contracror: R R R ROOFING Address: 1803 CALIFORNIA ST HUNTINGTON BEACH, CA Zip: 92648 Arch : Address: Zoning: Phone: 714-536-6890 Zip: Phone: Zip: 92627 Phone: 714-536-6890 License: 709223 Eng: Address: ISSUED BY: Status: ISSUED Applied: 10/13/2000 Issued: 10/73/2000 Phone: Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF SHAKE. SHEATH, COVER WITH COMP. - Plan Check: $0.00 Permit: $12525 SMIP Res: $0.51 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $125.76 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0-0 PARKING Exi� stinq: o NOTES: Rear 0-0 Rear 0- 0 Required: 0 FEE SUMMARY PLANNING & ZONING LeR 0- 0 LeR 0- 0 Proposed: 0 Calc Valuation: Claim Valuation: Right 0-0 Right 0- 0 $5,100.00 ss,�oo.00 NO710E: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-29, § 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 1 BO days. . � INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply vnth all applicable codes, and all requlred InspeClions and f�nal approval must be obtained. Failure to obtain inspections and tinal approval will result in the expiration of this permit. FOR INSPECTIONS CALL; (714) 7545626 ta4s-as(voo) WORKERS' COMPENSATION DECLAfiATION: - ' 1 hereby aHirm under panalry ol perjury one of Ihe fotlowing tleclerations: � ❑ I have and will melntain e cenificate of consent to seli-Insure for workers' compensation, es provitletl tor by section 3700 of the Labor Cotle, for ihe pertormance of tha work for which this parmil IS issued. � I have antl wlll meintein workers' canpen tipn Insurance, as required by section 3700 0l Ihe labor Code, for ihe peAortnance of ihe work for which t is permit Is issuea. My workers' compensatlon � 6p urenc� ner d licy number ere: `� Cerrier: 4�� PolicyNumber. V (fhis section need not be complB�ed il fhe if is ve/ued ef one hundred tlollars ($100) or less.) ❑ I cenify that in the pertormance ol th ork for which this permit is issuetl, I s�all not employ any person in any menner so as to become s ect to ihe workers' compensetion laws oi Celifor e, e agr that If I should become subject to Ihe workers' compensation pmvisions of S ction 3700 oi the Labor Cotla, 1 shall foRhwith comply_wiN�these provisi � t O 2 �\ ` plicam SignatJ: '_ � Date: I,%I �v WARMNG-FA7CGRE TO SECURE WORKERS'COMPENSATION COVEFAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CFIMINAL PENA TIE$ AND CIVIL FINES UP TOONE HUNDRED TKKISAND DIX.LARE (E100,000�, IN ADDITION TO THE COST OF COMPENSATION, OAMAGES AS PROVIDEO FOR IN SECTION 3%O60F THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRAC70RS DECLARATION: I hereby aflirm that I am licensed under rovisions of Chapter 9(commencing with Section 7000) ot Division 3 of the Business and ro ns Cotle, and my license is in full taca�e�M�eHect'lic'#—� � �U�/Z2 � Classa—� �- ��TT 1 CoMrectors�Signature Y, __ � _ Date: 1 l JI 1 til LONS7RUCTION LENDING AGENCY: ❑ I hereby aHirtn �hat ihere is a consiruction lending agency for the peAormance of ihe work For which Ihis permit is issued. (Sec. 3097, Civil Cotle). Lenders Name: Lentlefs Adtlress: Signature: Date: OWNEFi-BUILDER DECLARATONS: I hereby atlirtn that untler penelty of periury lhet I em E%EMPT FROM THE CONTRACTORS LICENSE LAW lor the tollowing reason (Sec. 7031.5, Business antl Protessions Code: Any ciry or coumy which r0quires e permit to construct, alter, improve, demolish, or repair any strucWre, pnor to its issuance, elso requires the applicant for such permit b tile a signed SWtement that ha or she is licensed pursuant to the pmWsions ot the Contradors License Law (Chapter 9(commencing with Section 7000) ot DlNslon 3 oi the Business antl Professions Code) or that �e or s�e Is exempt cherefrom and ihe basis for the elleged ezemption. Any violation ot Saction 7031.5 by eny applicant tor a pertnit subjects the applicant to a civil penalty of not more than tive �undred dollars ($500).): ❑ I, as owner ot the propeny, or my employees wlih weges es iheir sole compensetion, WILL DO TME WORK, and the siructure is not intentlea ar oHered for sale (Sec. 7044, Business antl Profe551ons Code: The Coniractors Licensa Lew dces not apply to an owner of propeny who builds or improves ihereon, antl who tloes such work himself or herself or through his or her own employees, providea that such improvements are not Intended or oNerad �or sala. If, however, the builtling or improvement is sold wit�in one yeer ot completion, iha owner-builtler will have ihe burtlen of proving thet he or she did not builtl or improve for purpose of sale.). ❑ I, as owner of the pmperty, am E%CLUSIVELV CONTRACTING WITH LILENSED CONTRACTORS to construct the pmject (Sec. 7044, Business enC Pmtessions Cotle: 7he conirectors License Law tloes not epply to an owner of property who builtls or impmves Ihereon, antl who contracts for such project wIN a comrector(s) license pursuant to the Con��ectors License Laws.). ❑ I am exempt under sec. Signalure: Owner ID varifietl 6y tlnvefs license. ❑ Ves ❑ No Business end Prolessions Code for ihis reason: Venticetian of Ownership 6y (type o� dacument, i.e. - pmperty ta: bill or deatl): DIVISION OF INDUSTRIAL SAFETY PERMIT CER7IFICATION: Driver's License No. Deta: Expires: ❑ I �ereby certiy ihat no axca�ation live (5) or more feet in depth imo w�ich a person is requiretl to descend, will De matle in wnnection with work euthorizetl by Ihis pertnit, antl Iha� no building siructure, scaffolding, falsework, or demolition or tlismaniling thereol, will be more ihan ihirty-six (38) leet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Ttle B, Califomia Atlministra�ive Code). ❑ As owner-builder, I will not employ enyrone to tlo work w�ich would require a pertnit from the Division ol Intlustnal Safery, as noted ebove, unless such person �es a permit to do such wark trom the tlivision. Signature: Date: Division of Indusirial Salery Pertni� Number: CERTIFlCATE OF COMPLIANCE AND AIJTTfORIZATION OF ENTAY: I certify under penalry ot perjury that I have reatl this epplication antl state Ihat the intorma�ion given is conect. I agree to compty with ell siate laws entl city orCinances relating to builtling conswction, and authorize representatives of the Ciry ot Costa Mesa lo entar upon the above-described property for ins0ection purpases. I egree not to occupy or allow occupancy ot any building authonzad by this permit until tinel inspeciion. Lagal Owner(s) �l'1 1 �L��e ^ lJ � � �� rizcd.n.,..n��e� ate CODE �. INSVECTON TYVE 1616 Fixetl Sys�em Final Fire P�evention 1266 200 201 202 203 Pool Spa Final Final Re-Roof Final BIocWRetaining Wa�� Final Factory Fire Place Final Sign 204 Final Demolition o�re It� CODE I INSPECfION TYPE 206 FinelMeCheniWl 20B Final PlumDing 270 Final Elecirical 212 Final Fire Preventlon 220 Final Planning Appro�al 222 Final Site 250 Final Builtlinq/Occupancy PAg 1[�4fl Applicant to �ili in ali spaces exceot lhose witnin heavy borGer lines antl sign all approoriate Aeclarations. CITY OF-COSTA MESA- CONSTRUCTION PERUIIT Project Address 2199 R811Cgh AVQ. Applicant's Mailing Address 1!42� 30. BI'09f'�MFl, Owner's Name blil li wm Kwrehnw Phone �?3 Address' —�� Q.9 Ral iegh Ave_ � � � ArchJEng. �icenu No. Address CoMracror's�j�jp � �gqe 15 5-0 Addresslmailing) 1%�4� $O �TOHdY83t ��+wrdwna_ Qn?AR City License No. 28�9 LICENSE� CONTRACTOR DECIARATION 1 hereby affirm that I am licensetl untler provisions of Charler 9(commencin9 with section �000) of Dlvision 3 of tne Business antl Professionz Cotle, antl my license is in tull forte ana effect. ' License Clais �icense r�o.2,50005 oate - - Slgnature RMO WORKERS' COMPENSATION DECIARATION ' ' hereGy attirm Ihat I have a certificate ot consent to self-insure or a certificate ' ,' Wo�kers' Comp¢n5ation insu�ance, o�'a certitietl�'Copy thereOf (Sectlon e800, 12b. C.y � � vonoy rvo htPi5.�i11?814 � comaaoy Fremont Tndemnitv . �Gertifietl mpy is �ereby fumishetl. , Certitietl copy is filetl with the cit Builtling Division oace ��3___ naoi�can QA � o.�rroved Pl�g„ 1G Hta. -EXEMPTION FROM WORKERS' COMPENSATION DECLARATION � (Thiz section neetl not be complete0 if the permit is for one huntlreC ($100) or less). . i . � 1 certity that In the pertormdnce ot [ne wo�k ior whiGh this pe�m�t is Issuetl, 1� shall not employ any person in any nn so'az to becoma subject to �the � Workers' Compe sation LawS ot Cdlito a . ' Date 1 7�_Si9nature C��r.O.p•Y��i� � NOTICE: 1, fte� making Ihis tlecla�atiOn, you shoultl beGOme subject [o tbe Workers' Compenwtion provisions of the Cabor Cotle; you must forthwkh comply iwith such provisions or �Ihis. permit sha11 be tleemetl revoketl. CONSTRUGTION LENDING AGENCV,' � ' I hereby affirm [hat there is a construttion lentling agency for the pertormance of the work 'for which this permit, Is Issuetl" (Section .3097 Civ. CJ , Lender's Name _ . Lender's AtlCress � � OWNER BUILDER DECLARATION ' ' 1 hereby afTirm that I am exempt trom the ContraGtor'S LlcenSe Law for the following reason (Section.7031:5 Business antl Protessional Cotle: Any city or county which requires a permit to construct, alter, Improve, tlemoiish or repalr �any st�ucture, p�io� to its Issuance, also �equires the applicant fOr such pe�mlt to file a'signetl statement that he/she is licensetl pursuant to tM1e provisions ot t„}�e Contractor's.License Law (Chapier 9(mmmencing with'Section ]000) of z,, vision 3 of the Business antl Professions Cotle)-or that he/she is exempt �;`.«s;refrom antl the basis for roe allegetl exemption. Any violation,ot Sectlon ' ��'�=�31.5 Gy any applicant for a permit'Subject5_the applicant to�a civil - enalty of not more than tive huntlretl tlollars ($500). I, as owner ot the properry or my employees with wa9e5 as their 5ole compensation will tlo the work, antl the structure is not intentletl or offeretl for sale (Secfion 7044, Business and Professional Cotle: The Contractor'S ' License Law does not apply to an owner ot a property who builtls or improves thereon; antl�who tloes such workTimself/herselt or through his or her own employees, provitletl that such improvem¢nts are not intendetl or otteretl for sale. Ii, however, the builtling or Improvement is soltl within one year ot com- pletion, tne owner wlll have the burtlen of proving he/she tlitl not builtl or im- � etove torthe purpose oisalej. ' LI I az bwner ot the property, am exclusively contracting. wltM1 licensetl con- ' trac{orsto consVuct the project (Section �044, Business and Professlons Code: TM1e Contractor•s License� Law tloes not apply to an owner of property who builtls or improves thereon, antl who contracts for such projects with a con- , tractor(s) license pursuant to the Contractor's License Ldw�. '� ❑�Pam exempt untler Section 8. & P. C. (or this reason Date Owner � I nereby certify that I have reatl this applicatlon antl state that the above iniormation ii correct: I agree to comply with all clty antl county ortlinances antl.state laws relatinq to builtling constru<tion, antl hereby authorize repre- sentatives of this city to enter upon the above-meniionetl property for inspection u os 5� nature �Q Date l?-15-8�i �'I —/O1�5 I . � . , �, I TYPEOFCONSTRUCTION NEW A�� ALTERATION REPAIR. ❑ CONVERSION ❑ DEMOLISH ❑ OTHER -DESCRIPTION OF WORK TVPE OF PERMIT LJ GRADING LJ FOUNDATION LJ STRUCTURAI O TENANT ❑ ELECTRIGAL ❑ PLUMBING ❑ MECHANICAL - ❑ �OTHER � � � � PROJECT DESCRIPTION SQ. FT. - OCCUPANCY— GONSTRUCTIONTVPE " VALUATION$ 20NE � GRADINGCU.YDS. ACRES Bar Sink Backflow Preventer � Backflow Irrigation Bathtubs Clarifiers � � Dishwasher-- ' -�" ' � Drinking Fountains ' Floor Drains FloorSinks � � Gas Service -Outlets Lavatories .A - ' . P-Trep _ ' Roof Drains - Reinspec[ian Fee'- $25 Boiler Duct- UnderGround Duct - SVuctural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO # Heating System & Ducting jE70�100,000 BTU 0100,OOOBT 9 Drivers' License or 55 � � � I I Reinspection Fee I �$25 CMF0865�46rev.1/83 White-Builtlin9tCanary-ApplicanqPink-Accountin9;Goltlenrod-Assessor Sewer Cap Sewer Connection Solar Collectors � SolaF Piping "-' �- Solar Tenk ' Swimmin9 Pool w/Spa Urinal ' Water Closet� . Water Heater Water Service ' ' FEES A.P. # S Main Build E T Front ' B Rear A C RigAt K Left S Ping. Ref. # Parking Req./Pr Use of Building Planning Notes: ` I116 Ic/:t/,� Zone Accessory Building:-� Park.Fees $ I � Auromatic Washer ' • ! ConstructionPoleSub. � ' '- i :Cdoking Unit"' ' - - Dis6washer � � . . ..�'Drvers ❑Gas ❑Elecvic � Issue Fee , Hood or TYPeI ❑ _ . Canopy Type I I ❑ _ Refrigeration System � ❑0-100,000 BTU O 100,000 B" System Repair/Alteration S Issue Fee $ 3 FEES $ 3 F.A,U. Fixtures Device Boxes Outlets Switches Garbage Disposal . Generator �0-5 KW �5 ELECTRICAL Transformer ❑ 15�50 KW ❑ 50+KW ' Meter ❑up to 100amps Meter �over 100 amps Sub Panel Motors � 0-1 HP � 1 Y� ��B � 'Inc.Solar,09�15 HP �i6-1 Microwave Pole Light Range Sign Standing'Sections � 5 KW Trash Comoacmr . I Reinspectian Fee I$25 I Issua Fee PUBLICSERVICESREOUIREMENTS: � Zoning Appraved By Applica;ion Approved By � io'::_' t'. ' = 2 O . N N G E $ 3 ' i SUMMARV OF FEES � � BUILDINGPERMIT�$ SMIP $ � � PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ ��-� PLAN CHECK $ ENERGV P.C. $ ELECTRICAL $ GRADING $ � PLAN CHECK $ MICROFILM $ MECHANICAL $ •�� TOTALFEE $ `f.00 PLAN CHECK $ x ' CONSTRUCTION AND PLANNING >{ '�_ � POO SPA APPROVALS Permit # ' 0��'-f - � Date � Inspecto{ qppROVALS Permit # Date Inspector ' 1., Temporary Electrical Service or Pole� � � "� � � y �� i y. 52. Pool & Equipment Location , 2. Soil PipefUndrgrnif7 �- - m � w �i W .53. Steel Reinforcement "3. �Electriqal Conduit'Utility,-Undrgrnd. '', N '~� 54. Forms � 4.�Electrical�'Conduit-Unii grnd. ' -.y 55. Electrical,Bonding � .5 ,'Steel f�einforcertient �, ^ � - . ' � . 56. Rough Plumbing & Pressure Test R� � 6.'�EI`ectricaLUFER°,G�nd. - �i � . 57. APPROVALTOCOVER-GUNITE �� ti 7. Footings�' ,y`'� � '� ; 58. Electrical Conduit-Undrgrnd. � n� 8..� €oundation ' �v � - ' . - 5: . „ 59. Gas Pipe, O Undrgrnd.; Test � �`i �.;<n 9. Wa�er Pipe-Undrgrncl" - m y � 60.' Backwash�Lines, P-Trap, � Undrgrnd. ' 10. Str.uctural Floor�ystem ii 'u . 61. APPROVALTO DECK � 11 : Property Sewer Lirig & House Corr�nection F� :� 62. Backwash & ReceptorFinal ' 12. Sewer�Cap y ` C `� . � 63. Heater & Vent-Final <,� 13. Roof,Drains ;�� ^ �' �" ;i � � 64. PlumbingSystem--FinaL i i 14: Rough;Plumbing� ' " ": p 65. Electrical-Final � ki � 15. Rough Electrical-Conduit ' - 66. Solar System-Pinai _ 16. Rough Electric Wiring � � 67. Fencing & Access Approval � 77. Rough Wiring Sign ' 68. `APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling , � . 69. POOL/SPA SYSTEMS FINAL Yj f 19. RougFi Heating & Air,Conditioning : FIRE DEPT. REQUIREMENT r ai 20. Rough Factory Fireplace , ' . APPROVALS Permit# � r 21. Ducts, in Structure . � 70. Underground Hydro ��' � 22. Ducts, Ventilating � �� 71. Product Piping �Gas ❑Oil �'-1 23. Gas Pipe-Rough & Test � - 72. Underground Flush �4. Roof Framing �. ; ' . 73. Undergrnd.StorageTank OGas ❑Oil 25, Roof Sheathing ,' . ' 74, Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat ' 75. Dry Chemical � 27. Frame and Flashing. 76. DrY Standpipe 28l Lathing & Siding '- , - 77. FIXED SYSTEM FINAL 29. Insulation f 78. FIRE PREV. FINAL ' 30. Drywall Nailing �' HEALTH DEPT. REQUIREMENT 37. Plaster Brown Coat 79. FINAL INSPECTION " 32. Electrical PowerMeterFinal ' � 80. FOOD CERTIFICATE ISSUED 33: Final Electric ' � ' Notes: ' 34. Final Heating & Air Conditioning � �a 35. Final Gas Pipe�Test � - � � 36. Hood or Canopy _ , 37. Final Factory Fireplace . - � 38. Final Plumbing � � � 39. Water Service-Final , � . , � 40. Gas Service�Final � , � � 41. Solar pomestic-Final � � . _ , � . . � 42. Backflow Preventer ' � ' 43. Backflow Irrigation _ � ', . ' , �� , � - 44. ,Landscape Irrigation System � ' � � 45. Sound Attenuation , � � � _ 46. Handicap Regulations � , � 47. FINALSTRUCTURE&BUILDING 48. Special Requirements Completed ' . 49. Electric Release to Edison _ . - � � - - � 50. Gas Release to Southern California Gas Co � , • i; � �. 51. CERTIFICATE Of OCCUPANCY.' __ . �� c No. ' Date' - � . . � • , � � .:�y OWNER MRSA MANOR: INC. , oATE 3—S—S� " JOBADDRESS 2199�Raleigh Ave. BUILDINGPERMITNO. f%IyI131 GENERAL CONTRACTOR R1Ch2Td H3Tt VALUE $ 9,961�.00 LOT �� ' BLOCK TRACT 'Z9(1% Sin�le TBS. W�Btt. p3T. GROUP I& J TYPE' �.J V ZONE FIRE DISTRICT LL32J INSPECTIONS —y�q�'�},��I'/U'�TE�I SUBCONTRACTOR PIRMITSISSUED _ I7`'�-S� DATE NUMBER Foundation Forms and Grade to Rough Framing � Plumbing, Rough to Slab WJ.4 Plumbing, Rough Complete Temporary Pole Wiring, Rough Heating, Rough Heating, Final Lathing, In �� Out Plastering Plumbing, Fin�al, Fixtures Coi Plumbing, Fin,al Gas Test/� Wiring, Final Occupancy FOHM 210 3M 10�'JS y /( ii � //- �f-.0 Costa Mesa Bnilding Department APPI,ICATION FOR PERIVIIT •• P.O.Boz3�� 4329 BUiLDING ' sj , COSTA MESA, CALIf-0RNIA FOR OFFICE USE ONLY •• FOYi� APPLICANT TO FII.L IN Receipf No. Permit No. Building A ��D nddress 2 99 alei h�ve �' �� Costa Mesa, California Recetved by nate eec'd. noate Issued Nearest –"' 0 '� �3' S ', c�o5gsc. Victoria Building Address owner Tgesa Manor c Mail Costa Mesa, California naaress 17639 Vanowen St Nearest � Tel. Cross St. city Van Nu s Cali£ No. DI 6606 Zone I No. of I ryPe // Group Architect or Lic. Plans !/ Engineer A s& Fie e No. C314 Approved p b Dale Address 4253 Coldtivater Canvon, Hollvwo CORRECTIONS c�ty �15286 contractor ichard Hart No. Address 17639 Vanowen De cr ption I No. 35 I Block I Tract �(�% (Attach Metesand 8ounds) No. of Bldg Size of Lot 137x56 Now on LOLfdone l�seof No.of No.of Existing Bldg. Families Ro s� Setback Line irom Rear Vard Center of Street � Sida Vard � DESCRIPTION OF WORH New I X I plteration � I Addition I Repair I I Moving I I Demolish I Buiiding No. of Size 1150 Sa F�iooms rg ( Stories 1 Exterior Wall Roof Covering Plaster Covering Vfood Shln�l ApP$�V:u..S Use of New Foundation Location Inspector � Date Building Single Family INrelling � Forms, Materials, Under-Pinning � Frame: Fire Stops, Bracing, Bolts I hereby acknowledge that I have read this Application and state that the ahme is correct and agree to comply Lath. Int. with all City Ordinances and State Iaws regulating building construction. Lath. Ext. Signatureof Me53 Tdanor Permittee Plaster, Int. Authorfzed Agt. plaster, Ext. Valuatlon Permlt Fee $ pZ �— Masonry Reiniorced $ 9� Plan Check $ SZ �" gond Beam � � �' To�� / Fee $ 3�0 — FINAL O � � 2 D r ' C � 2 4 .� ' ' IStreef PLOTPLAN Show Iocation and Cistances from _� - property Iine and between bufidinga G � W Q I lt ti 0 r� � , . • f e � � ' l � 0 _ , �