HomeMy WebLinkAbout939 DOGWOOD ST - Building PermitsJobAddress: 9$9 DOGWOOD ST
Suite:
Vicinity:
Primary Occ: R3 Type of Consiruction: V-N
Parcel Number: 42252208 Zoning:
Applicant: CAMBEROS, MARIA
Address: 22581 TINDAYA
Owner:
Address
Contractor:
Address:
Zip:
Arch :
Address:
MISSION VIEJO, CA .
CAMBEROS,MARIA A
939 DOGWOOD ST
COSTA MESA, CA
OWNER-BUILDER
Phone:
Phone: 71a-713-5403
2ip: 92692 ISSUEO BY:
�
Phone: 774-713-5403
Zip: 92627
Phone:
Status: ISSUED
Applied: 10/102006
Issued: 03/21/2007
/
License: 000000
DATE�
Eng: COOKE AND ASSOCIATES
Address: 400 E COMPTON
Phone: 310-608-5408
� COMPTON,CA
Zip: License: � 90221 License: 1597
SCOPE OF PERMIT
ADD 755SF, A 50SF ENTRY PORCH AND INTERIOR REMODEL TO A 1-STORY SFD. WORK TO INCLUDE: A NEW MASTER BEDROOM W/WALK-I�
MASTER BATHROOM, EXTENSION OF (E) BEDROOM 1, EXTENSION OF (E) BEDROOM 2 AND CONVERT INTO A FAMILY ROOM WMUNDRY RC
EXTENSION OF (E) BEDROOM 3 IN ORDER TO ADD A WALK-IN CLOSET. '
REF:C07-00004 . .- ,
EXISTING 3 BEDROOM, 1 BATHROOM SFD TO BE CONVERTED INTO A 3 BEDROOM, 2 BATHROOM SFD.
FEE SUMMARY
Plan Check: $736.94
Permit: $1,133.75
SMIP Res: $12.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $1,883.19
PLANNING & ZONING
SETBACKS
MAINSTRUCTURE Front 0-0
ACCESSORY Front 0- 0
PARKING Existina': o
Calc Valuation: sizs,000.00
Claim Valuation: Si25,000.00
Rear 0- 0 LeR 0- 0 Right 0- 0
Rear 0- 0 Left - 0- 0 Right 0- 0
Reauired: 0 ,�Pr000sed: 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, 72-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 780 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order tor the work authonzed under this permit to be considered legal, such work must comply with all applicable codes, antl all
required inspectlons and flnal approval must be obtained. Failure to obtain inspections and tinal approval will result in the expiration of this permi�
FOR INSPECTIONS CALL: (714) 7545626
241&48I8�00)
WORKERS' COMPENSATION DECLAHATION:
I hereby aHirtn under panalry of perjury one oi the following tleGarations:
❑ I have end will melntain a cenilicate ot consent b sel�-Insure tor workers' compensation, es provl0etl for by section 3700 of ihe Lebor Code, For the pedormance of the
work for which this permit is Issued.
❑ 1 have antl will melntain workers' compen5ation Insurence, as reduiretl by sectlon 3700 0l Ne Labor Code, for tha peRormance oi Ne work ta which Ihis pertnit is issuetl.
My workers' compensation Insurance cerner and policy number ere:
Carner: Policy Number:
(This section need nof be completed if the permif fs valued et ane hundred dollers (5100) or IessJ
� 1 certity Ihat in the pertormance of the work for which Ihis pertnit is issue0, 1 shall not employ eny person in any manner so as to become sublect to the workers'
compensetion laws of Callfomle, en0 egree thet If I shoWA become sub�ect to the workers' compensatlon provisions of Section 3700 of the Labor Code, I shall forthwith
comply wit� these Orovisions. �'i i
ApPlicant Signature: 'l,�l ..iw �i� . i q. �,l..t��,(.�. Date: L�z��� �
WARNING: FAILURE TO $ECURE WORKERS' COMPENSATION COVEiiAGE IS UNUWFUL ANO SHALL SUBJECT AN EMPLOYER TO CRIMINAL P NALTIES AND CIVIL FINES UP TOONE HUNDRED
THOUSAN� DOI.LARE (5100.000), IN A�DITION TO THE COST OF COMPENSATION, DAMAGES AS P(iOVIOED WR IN SECTIIXJ 3'1O80F TME LABOR CODE, IMEREST, AND ATfORNE1^S FEES.
IICENSED CONTRACTORS DECLARATION:
I hereby aflirtn Ihat I em licensetl untler provlslons ot Chepter 9(wmmenring with Section 7000) of Divisian 3 ot the Business end Professions Code, antl my license is in full
fOrCB end BRBC1. LIC. M C1355 #
Contractors Signeture: Dete:
CONSTRUCTION LENOING AGENCY:
❑ I hereby aflirtn that there is e cons�ruction lending egency lor the peAormance of Ihe work tor which ihis permit is issued. (Sec. 3097, Givil Code).
Lentlers Name:� Lendefs Atltlress:
Signature: Date:
OWNER-BUILDER DECLAfiAT10NS:
I herehy aNirtn Ihat untler,penalry of perjury thet I em EXEMP7 FROM TME CONTHACTORS LICENSE LAW for ihe tollowing reason (Sea 7031.5, Business antl Professlons
Cotle: Any ciry or county' ahich�re0uires e�parmiLlo,construct, elter, improve, demolish, or repeir eny strucWre, pnor to its iuuance, elso requires the applicant tor such pertnit
to file a signed statemant that he or she is Ilcensed pursuent Io the praWsions oi Ihe Contractors License Law (ChaOjer 9(cammendng with Section 7000) ot Division 3 ai the
Business end Protessions Cotle) or ihal he or she is exempt therafrom entl the �esis for ihe elleged eaemption. Any violatlon of Section 7031.5 by any applicant for a pertnit
subj s ihe epplicant to a civil penelry oi not more ihan five hundred dollers (5500).):
, I, as owner oi Ihe propeny, or my employaes wlth wa9es as their sole compensation, WILL DO TME WORK, end the swcture Is not intentletl or ottered tor sale (Sec.
7044, Business and Professions Code: The�Coniractors LJcense Lew does not epply �o an owner of properry who builds or improvas thereon, and who does such work
himself or herself or thraugh his or her awn employees, provitled �het such improvaments ere noI Intended or oflered lor sale. If, however, lhe building or improvement is
sold within one year ot complalion, the owner-builtler will �eve ihe burden of proving that he or sho tlid not build or improve for purpose of sale.). ' �
❑ I, as owner of the property, am El(CLUSIVELY CONTRACTING WI7H LICENSED CONTRAC70fiS to consWct Ihe projea (Sec. 7040, Business and Protessions
Code: The contractors License Law does not apply ro en owner ol property who builds or Improves thereon, entl w�o wntraas for such pmject with a conirecior(s)
license Oursuant to ihe Coniredors Licensa Lews.).
❑ I am e mpt under sec. Business antl Professions Cotle for ihis reeson:
Signature: � fln .<n.� l.. -- _Ll�'w Date: 1� J
Owner ID venfietl by tldvefs license. ❑ Ves ❑ Na Ddver's License No. "� 'Expires:
Verification oi Ownership by (rype ot document, I.e. - property tas �ill or tleetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby cartity ihat no excavation live (5) or more feet in deplh Into which a person is requirad to descend, will be metle in connection with wark authanzad by t�is
permil, and �hat no building siructure, scaffolding, falsework, or demolition or dismantling t�ereol, wltl be more Ihan thirry-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title B, Calibmia Atlminisiretive Cotle).
❑ As owner-bullder, I will not omploy anyone to do work which would require a permit irom the Division of Intlusinel Setety, as notetl abave, unless such person has e
pertnit co do such work irom �he division.
Signe�ure: Dele:
Division of Intlustrial Selety Permit Number:
CERi1FlCATE OF COMVLIANCE AND AUTHOBVATION OF ENTRY: I ceni�y under penalry of perjury that I hava read this epplication and state that the informatlon given is
correct. I agrea to compy wiih ell stata lews end ciry ortlinances relating to building consiruction, end au�horize reD�eseniaiives ot I�e Ciry ot Costa Mesa to enter upon the
above-descnbetl property tor inspection purposes. I egree not to occupY or ellow occu0ancy of eny building authonzed by Ihis pertnit until final inspection.
r'1 —� — �.�,tic, /LL� � —a/— D %
Signature OI Legal Owner(s) �Date
And/Or Authorized Applicant
COOE 6 INSPECTIONTYVE
1616 Fized System Finel Fire Prevention
12fi6 Pool Spe Flnel
200 Final Re-Rool
201 Final BIocWRetelning Well
202 Flnel Factory Flre Place
203 Final Slgn
204 4 Final Demolition
PAg It�lA64
COOE I INSPECTION TYPE
206 Final Mechenical
208 Final Plumbing .
210 Finel Elecincal
272 Final Fire Prevention
220 Final Planning Approvel
222 Final Site
250 Final Building/Occupency
PAg UIIIDELS
CITY OF COSTA MESA �.
BYILD/NG DIVIS/ON
77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (774) 754-4856 • v+ww.ci.costa-mesa.ca.us
. FOR INSPECTIONS CALL: (714) 754-5626 ,
PERMIT NUMBER: M07-00373
PERMIT TYPE MECH STATUS: ISSUED
DATE ISSUED: 06/0712007
` ' '" `�-'ISSUED BY: RMD
JOB ADDRESS: 939 DOGWOOD:ST CM• '= Suite/Umt: _-
-. .
Vicinity: . - . , - . . _ _ , ..,. - . ,
SQ. FT: 0 -
SCOPE OF WORK: MECHANICAL PERMIT TO ADD 755SF, ENTRY PORCH AND REMODEL TO A_1-STORY SFD. 1 INST FAU
<i p0 K BTU, 1 REPAIR/ALT COOLWGMEAT, 1 HOOD W/MECH.EXHAUST, 7 VENT FANS; 6 SMOKEDAMPERS, 1
COMPRESSOR UP TO 3HP:REF: 606-01717
OWNER: CAMBEROS,MARIAA-�-- ' Address: �� 939DOGWOOD�ST Unit:
PHONE: 7144-713-5403 -_ -- � �� CitylState2ip: COSTA MESA, CA �"
APPLICANT: CAMBEROS,MARIAA . � Address: 939 DOGWOOD ST Unit. .
PHONE: 7144-7735403 ' � -- � � • � �- - City/State/zZip: � COSTA MESA, CA - _ -
CONTRACTOR: OWNER-BUILDER ' . License�No. 000000 -
Address: Unit: - � � �� PHONE:... . -. .. � � . . �
City/State: . - �ZipCode: " - -
MECHANICAL PERMIT FEE SUMMARY . ,
MECH ITEM FEE: - $184:05'':'
PLAN CHECK FEE: $0.00 -
INVESTIGATIONFEE: - � -� `�. $0.00 --`
REINSPECTION FEE: � � � �'�50.00 ' �
TOTAL FEES: _ $184.05 � �
CELL: - _
NOTICE: The vrork authorized by this permit shall wmply with all applicable handicap access requirements under Califomia s�atutes and related
regulations. (Ord. No. 92-28. § 1, 12-21-92) .
EXPIRATION: PERMIT EXPIRES 160 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In oMer for the vrork authorized under this permit to be considered legal, such work must comply with all applipble codes, and all
required inspections and final approval musl be obtained. FaiWre to obNain inspectlons and finai approval wiil result in Ihe expiration of this permit.
COpEI. INSPEL710N7YPE p� IlRlilAl CODEi INSPECTIONT'PE . - �� �
1618 Fixed System Final Fire Prevenlion 206 Final Mechanical
1286 Pool Spa Final
200 Final Re-Roof
201 Final BIOWRetaining Wall
202 Final Factory Fira Place
203 Final Sign
204 Final Demolition
208
210
212
220
Final Plum6ing
Final ElecVipl
Final Fire Prevention
Fnal Ptanning Appioval
222 FinalSi�e
250 FinalBuiltling/OccuOancy
• CITY OF COSTA MESA -J '•
.
BYILpING pIVISION
F � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www d.costa-mesa.ca.us
°. FOR INSPECTIONS CALL: (774) 754-5626
��fi
PERMIT TYPE ELEC
JOB ADDRESS: 939 DOGWOOD ST CM
PERMIT NUMBER: E07-00568
STATUS:
DATE ISSUED:
dSSUED BY:
SuitelUnit: .
ISSUED
06/07/2007
RMD
Viamty: ADDITON _ - � � � � - . .
SCOPE OF WORK: ELECTRICAL PERMIT.FOR-A 755SF ADD, A SOSF ENTRY FORCH AND REMODEL TO A 1-STORY SFD. 1 RES AIC
PACKAGE, 17 LIGHT FIXTS, 37 OUTlETS, 10 SWITCHES. REF: 606-07717 �-
OWNER: CAMBEROS,MARIAA . �
PHONE: 7144-7135403 � �
APPLICANT: CAMBEROS,MARIA A '
PHONE: 7744-713=5403 � .
CO NTRACT4R: O W N ER-BU ILD ER
Address: Unit: .PHONE:
City/State: � , .ZipCode:
- :�"-Address: 939DOGWOODST Unit:
. . - CitylState/Zip: , COSTA MESA, CA �
Address: 939 DOGWOOD ST Unit
CirylStatehZip: COSTA MESA, CA
.. � � License No. 000000 �
ELECTRICAL PERMIT FEES
Electrical Plan Check Fee: . �' $0.00
Efectricat Permit Fee: $142.11 .
Reinspection Fee 80.00
TOTAL F�ES � $442.11 ` . , ,
C9��4!
NOTiCE: 7h@ wprk authorized by Nis permit s�all comply with all applicable handipp access requiremenis under Caiifomia sfatutes and related
regulations. (Ord. No. 92-28. § 1, 12-21-92) .
EXPIRATION: PERMR 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 vrork must compry with all applipble codes, and all
required inspections and Bnal approval must be obtained. Failure to obtain inspecdons and final approval will result in the e�iration of this pertnit.
CO�E t. IxSPEcnuxrrvE
1616 Ficed System Firel Frc Prevenfion
7268 Pool Spa Final '
2W Flnal RSRoof
207 Final BbdJRetairrinp Wall
202 Final Factory Fre Place
203 FinalSign
204 Final Demolition
P9LF 1�� � F�SPECl10NlYPE '
206 Final Mechanical
208 Final Plumbing
210 Fnal Elecuical
212 Final Fiie Praventian
220 FirelPianningApproval
222 FinalSite
250 Final BuildirnyOccupancy
� L IW:
I ��
PERMIT TYPE
,
. � CITY OF COSTA MESA ' .
BUILD/NG DMSION
77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-0856 • www.ci.costa-mesa.ca.us
FOR INSPECTIONS CAIL: (714) 754-5626
PLUM
PERMIT NUMBER: P07-00399
STATUS:
DATE ISSUED:
iSSUED BY:
ISSUED
06107/2007
RMD
JOB ADDRESS: 939 DOGWOOD ST CM : SuiteNnit:
viciniry: - , . . - - -. ' . -
SCOPE OF WORK: PLUMBING PERMMIT TO ADD 755SF, ENTRY PORCH AND REMODEL TO A 1-STORY SFD. 2 BATHTUB, 8
FLOOR DRAIN, 1 GAS (1-4 OUTLETS), 1 GAS SERVICE, 1 LAUNDRY TUBM/ASHER, 2 SHOWERS, 1.KITCHEN SINK, 2
WASTENENT, 2 WATER CLOSETS, 2 WASH BASINS, t WATER PIPING, 1 WATER REPIPE.REF; BO6-01717
OWNER: CAMBEROS,MARIAA� �
PHONE: 7'144-713-5403 .
APPLICANT: CAMBEROS,MARIA A :
P H O N E: 7144-713-5403 .
CONTRACTOR: OW NER-gUILDER
AddBss:
City/Slale:
� -� . Address:
- City/State/Zip:
Address:
_ _ _ _ . . �_ , City/StatehZip:
ZipCode: � - - - . . ..
PLUMBING PERMIT FEE SUMMARY
PLAN CHECK FEE:
PERMIT FEE: $255.05
TOTAL FEES: $255.05
50.00
939 DOGWOOD ST
COSTA MESA, CA
939 DOGWOOD ST : .
COSTA MESA, CA � �
License No. 000000
PHONE:
CELL:
NOTiCE: The work authorized by this permit shall comply with all appliwble handiwp access requirements under Califomia statutes and related
regula6ons. (Ord. No. 92•28, § 1, 12-21-92)
EXPIRATION: PERMR EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permil to be considered legal, such work must comply with ail applipble codes, and all
requlred inspeetions and finel approval must be obtained. Failure to obtain inspections and final approval will result in the eupi2tion of this permit.
OC pEt, MSPEL110N7YPE D�7F IXifMLS �QOEf p{SpEC710NTYPE �� �NRIip�$
1818 Fixed System Final Rre Prgventipn 2f16 Fnal Mec�anical
1268 Pool Spa Final ' 208 Final Plumbing IZ�I� �
200 Final Re-Rool 210 Final Elettrifal
201 . Final BIOWRetaining Wall 212 Fnal F"ve Preventbn
202 Final Faaory Fre Place 220 Fnal PWnning Appfoval
203 Final Sign 222 Final Site
204 Final Dertrolilion 250 Final BuiWinglOccupancy
. —_. . . —� .—�vaa�OV'�J�Y'
NEWPORT-MESA UNIFIED SCHOOL DISTRICT
CER7IFlCATE OF COMPWINCE OF DEVELOPMENT FEES
PURSUANT TO AB 1600 AND AB 181
�° 6589
To: � Ciry of Cosfa Mesa ' Distriet Receipt No.
( ) City oi Newport Beach �D `�`�1/
, ( ) Counly of Orange Plan Check N
ApPlicant: �+, =`- L2 �i rE �� -� o� �t.��f, tP �
Address: � � � � / —�" i`a� ct�./ !.ti l � S � , �; il i� i �'l-C �sA �l2 G:� r1 Z
Telephone Number:
TracUParcel and Lot
Location of Project:
Number ot Square Feet of:
Residential Space
Commercial and
Industrial Space
CommerciaUlndustrial Projed is: (Check One)
_ Warehouse
R8D
_ Movie Theater
Mini-storage
_ Heavy Industrial
_ Regional Shops
, Light Industrial
_ This projed is exempt because
�7 /
I �j x S1.B4
z S .30
_ Motel
Bank
_ Neighbarfiood Shops
_ RacqueVHealth
_ HMeI
Mediwl O(6ce
Otlice Park
Tofal
Presehool
Auto Repair
Hospital
large Olfice
OKtce BWg.
Restaurant
Fast Food
This certifies that the above-named DevelopedAppficant has paid school IaaYly fees in compiance with Govemment Code sections
5�080 and 65995. The Binlding Pertrits tur this square (ootage in tlris p►oposed devebprt�ent may now be issued by your jurisdicEon.
Checks are to be made payable to NewpoA-Mesa Uni6ed�School DistricL
The above representation as to square tootage is We. Appicant aprees fAat i( it is �ter detetmined that such rep►esentations are not
true, then this certificate sha0 automatiqUy temrnate and ihe appropriate City/Counry shap be noti6ed.
Date: J �� � — G � �L\cZ1��.�. �i� . �I�GLLl�G�i.f�`5
��
March 19, 2008
Maria Camberos &
Kickn-Back Properties LLC
3403 Cerritos Av
Los Alamitos CA 90720
PERMIT NUMBERS:
FOR:
PROJECT ADDRESS:
BUILDING DIVISION
EXTENSION NOTIFICATION
B06-01717, E07-00568, M07-00373, P07-00399
Addition
939 Dogwood St., Costa Mesa
This is to advise you that an extension on the above permits has been approved by Ed
Petros, Chief of inspections. The extension is valid for 90 days. The new expiration date is
June 17, 2008. You must call 714-754-5626 for inspection at any time prior to this date or
the permits will expire. Additiona� fees will be required to reinstate expired permits.
lf you have any questions, please contact the Building Division at 714-754-5273, between
8:00 a.m. and 4:30 p.m., and a staff member will assist you. We appreciate your working
with us to resolve this matter.
Sincerely,
Mary Jane Weidenkeller
Office Specialist II
MARIA CAMBEROS
AND
KICKN-BACK PROPERTIES LLC
3403 CERR[TOS AVENUE
LOS ALAM[TOS CA. 90720
(818) Z 16-3563
3/12/08
MR. ED P6TROS
c/o CITY OF COSTA MESA
77 FAIR DRIVE 2ND FLOOR
COSTA MEAS , CA. 92628-1200
RE: 939 DOGWOOD STREET
DEAR ED PETROS,
1 AM WRITING YOU THIS LETTER PER OUR TELEPHONE CONVERSATION
ON MARCH 11, 2008. I MENTIONED TO YOU THAT THE ABOVE MENTIONED
OWNERS MARIA CAMBREROS AND KICKN- BACK PROPERTIES HAVE
TEAMED TOGETHER TO FINANCE THE ADDITION AND ALTERATIONS TO
939 DOGWOOD STREET. THE HOUSE WAS PURCHASED DURING THE REAL
ESTATE DECLINE AND WE WERE HAVING PROBLEMS SECURING THE
NECESSARY FINANCING TO PROPERLY PREFORM THE ALTERATIONS AND
REMODEL OF THE ABOVE MENTIQNED PROPERTY. WE HAVE SINCE
RESOLVED THE FINANCIAL ISSUES AND WOULD LIKE TO REACTNATE THE
PLANS AND PERMITS FOR THIS PROPERTY. THE PERMITS # ARE AS
FOLLOWS BUILDING B06-017i7, PLUMBING P07-00399, ELECTRICAL E07-
00568, MECHANlCAL M07-00373. ALL SCHOOL FEES HAVE BEEN PAID
RECIEPT # 6589.
PLEASE CONTACT US ABOUT REACTNATING THESE PERMITS AS ALL
OF THE NECESSARY CITY LEGWORK, AND PAPERWORK WAS ALREADY
COMPLETED. IF NECESSARY WE ARE WILLING TO PAY ANY
RESTABLISHMENT FEES ASSOCIATED..
I HAVE ENCLOSED COPIES OF THE PERMIT CARD, RECIEPTS FOR
SCHOOL, AND ASSOCIATED PERMITS, FOR YOUR REVIEW.
WE WOULD LIKE TO THANK YOU IN ADVANCE FOR YOUR
CONSIDERATION IN THIS MATTER OUR CONTACT IS ANDREW TYLER HIS
PHONE NUMBER IS (818) 216-3563 . THE NEIGHBORHOOD WOULD REALLY
BENEFIT FROM THIS WORK AS THE HOUSE HAS BEEN IN A STATE OF
DISREPAIR FOR OVER 25 YEARS AND AT ONE TIME SOLD BY YOUR CITY
TO MARIA CAMBEROS AT A CITY LEIN SALE IN 2006.
REGARDS,
�
03-�1-r��
ANNA BUDA-TYLER I.LC MANAGER
CITY" '�COSTA MESA, BUILDING SAFETY""`'�IISION
POST IN CONSPICUOUS PLACE ON THE JOB
NOTICE � .
Schedule inspection one workday in advance. To schedule inspections, call (714) 754-5626. Provide the following information:
1) Permit number, 2) Job address, 3) Inspection item number.
- (� (� 5(o i� � c�azaoc
MeehanlwlPermilY: b —170�j'/PluinbingPermitf:I-O-I—bU?� -1—I � JobDes�xiption � [���
NEW ADO ALTEH REPARi MOVWG OEMOl15H ISSUEgn TE ���
/ 3/ z1/?) %' c� .� i'o �.�r.
PERMITS EXPIRE 780 DAYS (6 MONTHS) FROM ISSUANCE OR LAST INSPECTION
. . -.
�tem ♦ STRUCTURAL Date Inspxror �tem B POOL & SPA Date �nspeeror
3 Job Site Consult 94 Pool & Equipmenl Location
4 Footings 1 Ufer Ground 96 Steel Reiniorcement
6 Slab 100' Elec[rical Bonding
8 Structural Floor 702 Rough Plumb & Pressure Tesl
17 Pre-Inspect Roof 1D4 Approval to Cover - Gunde
12 Rooi Sheathing 1 Building Height 106 Elec Conduit - Underground
14 T-Bar Ceiling-SWctural 108 Gas Pipe 1 Underground Test
i6 Shear Panel 110 Backwash Lines, P-Trap,
78 Frame & Flashing Underground
20 Lathing 8 Siding 112 Approval to Deck
22 Insulation 116 Pool Plumbing System - Final
24 Drywall Nailing 118 Pool Electrical - Final
26 Plaster Brown Coat 122 Fencing 1 Access I Alarms Approval
30 Pre-Grout 124 Approval for Plastering
31 NPDESIBMP 126 Pool � Spa Systems - Final
33 Disabled Access
� •
1610 Overhd Hydro I Overhd Rough
7672 Dry Ghemical
ELECTRICAL 1614 Dry Standpipe
36 Ufer Ground 1616 Final - Fixed System
38 Eiec Conduit - Underground
44 Raugh Elec - Wiring �
46 Rough Elec. Conduit • ' � � � � � � �
48 Elec T•Bar Ceiling Call (714) 754-5626 for the following: Date Inspeemr
50 Elec Power Final 1 Meter Release 200 Finai Re-Roof
51 Temp Power Final 20t Final Block � Retaining Wall
203 - final Sign
204 Final Demolition
206 Final Mechanical
PLUMBING & MECNANICAL 206 Fnal P�umhing
52 Soil Pipe - Underground 210 Final Electrical
53 Shower Pan Call (714� 327-7400 tor the following: oate mapeetor
_ . ... . _. - � - -
CITY OF COSTA MESA
BYILDING DIVIS/ON
77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Faz (714) 754-0856 • www.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER: E07-00568
PERMIT TYPE ELEC STATUS: ISSUED
DATE ISSUED: 06/0712007
� ISSUED BY: RMD
`�� ��.,�.
JOB ADDRESS: 939 DOGWOOD ST CM ` Suite/Unit
Vicinity: ADDITON
, .. _
SCOPE OF WORK: ELECTRICAL PERMIT FOR�A 755SF ADD, A 50SF ENTRY PORCH AND�REMODEL�TO A 1-STORY SFD. 1 RES A/C
PACKAGE, 17 LIGHT FIXTS, 37 OUTLETS, tO�SWITCHES. REF: 806-01717 '�i`. ;� ' �
t;r. -
OWNER: CAMBEROS,MARIA A-� ' , -- Address: 939 DOGWOOD ST ,. Unit: . ,
PHONE: 7144-713-5403 � - � i� `�� � " , � .. � � .�.. City/State/Zip:. � ' COSTA MESA, CA �' � -
r " -
APPLICANT: CAMBEROS,MARIA A�� ,� � Address: 939�DOGWOOD ST Unit
PHONE: 7144-713-5403 -� .� City/State/zZip: COSTA MESA, CA
� . � i .�. . ...,._ . .,. . . . : .
, �i,�:... ... .. , `- .' . .
CONTRACTOR: OWNER-BUILDER License No. 000000
Address: UniY.;- -� ' .-PHONE:. �� � � -� � ., � � � �
City/State: � , � � ZipCode:__ , . - , - CELL: _ ,
. - � ,,.. '.� - . s , � ' �
ELECTRICAL PERMIT�FEES :: � -
Electrical Plan Check Fee:. ?'. $0.00 =
Electrical Permit Fee: '$142 11 . :'• . _
Reinspection Fee $0.00
TOTAL FEES • ` $142 11 � ` '[��� � �
L
.. � . _ ' . , DATi l0 �7 b.
NOTICE: The work authonzed by this permit shall comply vdth all applicable handicap access requirements under Califomia 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
requi�ed inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
GODE/. INSPECTIONTYPE DRTE IN7ITIAlS GODEI INSPEGTIONTYPE ' ORTE IN77M15
i616 Fized System Final Fire Prevention 206 Pinal Mechanical �
1266 Pool Spa Final � 208 Final Plum6inq
200 Final Re-Roof - 210 Final Electrical
207 Final B�ock/Retaining Wall 212 Final Fire Prevention -
202 Final Factory Fire Place - 220 Final Planning Approval � ./�r
203 Final Sign � 222 Final Site �
204 Final Demolition 250 Final Building/OccuOancy
WORKERS' COMPENSATION DECLARATION:
I hereby aKrm under penalty of perjury one of Ihe f��.�.�ng declaralions: -
❑ I have and will maintain a certifca[e of consent to self-Insure for xrorkers'=
I� compensation, as provided for by section 3700 of lhe Labor Code, for the
� performance of the work for which Ihis permit is issued. . �
�❑ I have antl will maintain workers' compensalion insurance, as requiretl by
section 3700 of Ihe Labor Code, for the peAortnance o( the vrork for which this
pertnit is issued. My workers' compensation Insurance carrier and policy
number are:
Rie�"
rs nee plet '(he permrt is valuetl af one bundred t,bllars (5100) a less J
Policy Number:
❑ I ceAity that in the peAormance of the vrork for which this pertnit is
issued, I shall not employ any person in any manner so as to become subject
to the workers' compensation laws of Cali(omia, and agree that if I should
hecome subject to the vrorkers' compensation provisions of Section 3700 of
the Labor Code, I shall forthwith comply with these provisions.
�rin ti_. cti �_ Cer �(-tic� r� — 7—z� 7
CApplitanfs Signature' Dele--��
1�,.�J
WARNIN(`i. FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHAII 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, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm that I am licensed under provisions ot Chapter 9(commencing
with Section 7000) of Division 3 of the Business and Professions Cotle, antl
my license is in full force and effect.
Lic. # Class #
Camractor's Signature Da�e
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirtn lhat there is a constructbn lending agency for the
performance o( the v.ork fa which this pertni[ is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
Signature
OW NER•BUILDER DECLARATIONS:
I hereby affirm that under penalry 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
consUuct, alter, improve, tlemolish, or repair any structure, prior to its
issuance, also requires the applicant for such permit to fle a signed statement
[hat he or she is licensetl pursuant to �he provisions of Ihe� Contractors
License Law (Chapter 9(commencing with Section 1000) of Division 3 of the
Business and Pmfessions Code) or that he or she is exemp[ therefrom and
the basis (or [he alleged exemption. Any viola[ion of Sec[ion 7037.5 by any
applicant for a permil subjects the applicant to a civil penalty of not more than
fve huntlretl dollars ($500).):
❑ I, as owner o( [he property, or my employees with wages as [heir sole
compensalion, WILL DO THE WORK, and [he 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
Ihereon, and who does such vrork himself or herself or through his or her ovm
employees, provided that such improvements are not intended or oNered (or
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 nol build or improve for purpose of sale.).
���1^as ovmer�of the property, am EXCWSIVELY CONTRACTING WITH
LICENSED CON7RAC70RS to construct the project (Sec. 7044, Business and
Pmfessbns Code: The-cont2ctors License Law dces not apply to an owner of
property who builds or improves thereon, and who contrdcts for such project with
a cmlracta(s) license pursuant to the Cont2ctars License Laws.).
❑ I am exempt under sec.
Business and Pro(essions Code for �his reason:
i'�,1.,��- � _ � u. C�- � - 7 � � ? .
J—"—Signature ' LDate +—.r��
305]-a6(3I0�) —
Owner ID verified by drive ise. Ves ❑ No
D`er�s�Li—ceo5e'No� . Exp��ires_:_..— ,�% � �
Verifcation of Ovmership - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICA710N:
❑ I hereby certdy that no excavation (rve (5) or more feet in depth into which a
person is required to tlescentl, will be made in connection with work authonzed
by this pertnit, antl that no 6uilding structure, scaffdding, falsev.ark, a demolition
or dismantling thereof, will be more than Ihirty-six (36) feet high. (Chap. 3.2, Gry
2. Art 2. Sec. 341. Ttle 8, Cali(omia Atlminist2tive Code).
❑ As owner-builder, I will not employ anyone to do work which would
require a permit from the Division ot IndusMal Safety, as noted above, unless
such person has a permit to tlo such work from the division.
FpPliwnfs SgnaWre �ate
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or fuWre builtling occupant neetl to fle antl
certify a Business Plan for emergency response to release or threatenetl
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 ot the California Health and Safery Code requires, with some
exceplions, that a Business Plan be filed wi[h the Costa Mesa Fire
Department hy every business which has at any one time dudng a reponed
year a quantity ot hazardous materials equal to or greater than a weight of
500 pounds, or a volume o� 55 gallons, or 200 cubic (eet of compressed gas
at standard temperature and pressure).
2. Ooes or will the applicant or preseM or tuture building ocwpant need to fle
a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 0( the Califomia Health and Safety Code, with some
ezceptions, requires registration with the Costa Mesa Fire Depariment by
each business which at any one time has on hana a quantiry of acutely
hazardous materials equal to or greater than a weight o! 500 pounds, or a
volume of 55 gallons, or 200 cubic �eet of compressed gas at standard
tempereWre and pressure).
3. Does or will the applicant or present or fuNre building occupant need to
prepare an RMPP (Risk Management and Prevention Program (or acWety
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the Calitomia Heallh and Safety Code provides that the
Costa Mesa Fire Department may require the preparation, certifcation and
filing wi[h [he Fire Department of an RMPP by businesses which are required
to register aculely hazar0ous materials with the Fire Department.
4. If an RMPP is presently required, has Section 25534 of [he Califomia
Health and Sa(ety Code been fully complied with? ❑ Yes ❑ No
5. Does or will the applicant or presenl or future builtlinq occupant require for
the vrork which is the subject ot this apPlication a permit for such constmction
or motlifcation fmm the South Coast Air Qualiry Managemenl District or from
any other air pollution conirol district or agency? ❑ Yes ❑ No
(SecCron 65850.2 of the Califomia Govemment Code requires that the requesletl
infortnation be fumished on applications for non-residential building permits).
6. Will any part of the facility to be constructed under this permit be within
1000 leet from the outer boundanes of a school? ❑ Yes ❑ No
Qf yes", the facility must meet the requiremen[ of Sec[ions 25534 and 42303
of the California Health and Safety Code).
7. If a permit from the South Coast Air �uality Management Distnc[ or other
air polNtion contml district or agency is required (or the work which is the
subject of this application, have all of the disclosures prescribed by Califomia
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. , Qf 'yes", attach ceAifcate of compliance from the appropnate air polWtion
conVol oKcer). . � � . . .
CERT�FICATE OF, COMPLIANCE:J certify Ihat under penalty of perjury the
information given above is correcf. I agree to comply with all state laws and
ciry ordinances regarding Hazardous Materials and Emissions. � �
SignaWre Dale
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF�ENTRY: I
certify under penalry of perjury that I have read this applica[ion and state that
the information given is correct I agree to comply with all state laws and ciry
ordinances relating ro building construction, and authorize representatives o(
ihe Ciry of Costa Mesa to enter upon the above-descnbed property for
inspection purposes..l agree not to occupy or allow occupancy of any building
authorized by �his permit until final inspection.
1 �� � _ ��u�� �O ' � `d 7
� . SiB�aWreW.LegalOwner(s)'2;�+'�'a�-� Date�_�„�
Antl/or Aul�onzed Ap0licanl
>
CITY OF COSTA MESA
.
BUILD/NG D/VISION
i � 77 FAIR DRIVE, COSTq MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ra.us
t
". - FOR INSPECTIONS CALL: (714) 754•5626
R'O°^o.m�°"`� � , -
PERMIT NUMBER: M07-00373
PERMIT TYPE MECH STATUS: ISSUED
DATE ISSUED: 06/07/2007
` '' ISSUED BY: RMD
JOB ADDRESS: 939 DOGWOOD ST,CM �• , �$uite/Unit -
Vicinity:
SQ. FT: 0 '� ;
� �
SCOPE OF WORK: MECHANICAL PERMIT TO ADD 755SF, ENTRY PORCH AND REMODEL TO A 1-STORY SFD. 1 INST FAU
<100 K BTU, 1 REPAIR/ALT COOCING/HEAT, 1 HOOD W/MECH.EXHAUST, 7 VENT FANS-,¢ SMOKE DAMPERS, 1
COMPRESSOR UP TO 3HP'REF: BO6-01717 '
OWNER: CAMBERO,S,MARIA A; � - Address: � � 939�DOGWOOD ST Unit:
PHONE: 7144-713-5403 . - -�" ., City/State/Zip: COSTA MESA, CA
APPLICANT: CAMBEROS,MARIA A ,. � Address: 939 DOGWOOD ST Unit::
PHONE: 7144-7133403 � _ - - � � � : ..- City/State/zZip: -, COSTA MESA,�CA � '
. . . � - � � .- �_ .. -.
CONTRACTOR: OWNER-BUILDER - - License No. 000000 ''
Address: Unit: -,. ,� ...�. � --PHONE:__ ..�, ..- � � -: � - - ..
City/State: . - ,ZipCode: � CELL:. ,-
MECHANICAL PERMIT FEE SUMMARY . . -
MECH ITEM FEE: $184.05 . � Fj�,y, LRED
PLAN CHECK FEE: � r�' ".:$0 00 `' �':' � -
INVESTIGATION FEE: � $000 , DAT� �� �7 � �
REINSPECTION FEE: 50.00 "
TOTAL FEES: $184.05 '
NOTICE: The work authorized by this permit shall comply with all applicable handirap access requirements under Califomia slatutes and related
regulations. (Ord. No. 92-28, § 7, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. �
INSPECTIONS: In order for the work authonzed under this permit to be wnsidered 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 o( this permit.
COUE�. INSVEGTONTYGE OATE IN7171AL5 � INSPECTONTYPE 0� IN7171RL5
1816 Fixed System Final Fire Prevenlion 206 Final Mechanical �
1266 Pool SDa Final - 208 Final Plumbinq
200 Final Re-Root 270 Final Eleclncal ' �
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
WORKERS' COMPENSATION DECLARATION:
I hereby aKrm under penally of perjury one of Ihe fo,.,,mng declaralions:
❑ I have and will maintain a certifcate of consent to selhlnsure for vrorkers'�
compensation, as provided for by section 3700 of the Labor Code. for the
peAormance of the wurk for which this pertnit is issued.
❑ I have and will maintain workers' compensalion insurance, as required by
section 3700 of the Labor Code, for the peAortnance of Ihe work for which Ihis �
permit is issued. My vrorkers' compensalion Insurance carrier and policy
number are:
Carrier.
(Tnrs secGon need rro� ee camde(ed nlhe pemra is valued at we hundretl J�Ilars (St00) wiess )
Policy Number:
❑ I certify Ihal in the peAormance of the vrork for which this permil is
issued, I shall not employ any person in any manner so as to become subject
[o Ihe workers' compensalion laws of California, and agree thal if I should
become subject to the vrorkers' compensation provisions of Section 3700 of
thleILaboi Code, I shall forthwith comply with [hese provisions.
IM i:v�,.-- (� - �GLGwC�'" IO — % —f�7
�Apphmnl's�SpreWre..v.� Data
�.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLAF2S
($100,OW), 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 aKrm that I am licensed under provisions of Chapter 9(wmmencing
with Section 7000) of Division 3 of the Business and Professions Code, anC
my license is in lull lorce and eHect.
Lic. # Class #
Gom2ctor's SiBnalure Da�e
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm tliat there is a construclion lending a9ency for the
peAortnance of the work for v,fiich this permit is issued. (Sec. 3097, Civil Code�.
Lender's Name:
Lender's Address:
OWNER•BUILDER DECLARATIONS: •
I hereby aKrm that under penalty ot perjury thal I am EXEMPT FROM THE
CONTRnC70R5 LICENSE LAW (or the following reason (Sec. 7031.5,
Business and Professions Code: Any city or county which requires a permit to
construct, alter, improve, tlemolish, or repair any strucWre, prior to its
issuance, also requires the applicant for such permit to file a signed statement
Ihat he or she is licensetl pursuant lo Ihe pmvisions of the Contractors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business and Professions Cotle) or that he or she is exempt therefrom antl
the basis for the alleged exemption. My violation of Seclion 7031.5 by any
applicant for a permit subjects the applicant to a civil penalry o� not more than
five hundred dollars ($500).):
❑ I, as ovmer of the property, or my amployees vnth wages as their sole
compensation, WILL DO THE WORK, antl the strucWre is not in[ended or
oHered for sale (Sec. 7044, Business an0 Professions Coda: The Contractors
License Law does not apply to an owner of property who builds or improves
thereon, antl who does such vrork himself or hersel� or through his or her ovm
employees. provided Ihat such improvements are not intentled or oNered for
sale. If, however, the building or improvement is sold vnthin one year of
completion, the ovmer-builCer will have Ihe burden of proving ihat.he or she,
did not build or improve for purpose of sale.). �
❑_.I,-as�o�er of the property,-am E%CLUSIVELY CONTRACTING WITH
CLICENSED CONTRACTORS to construct the projeU (Sec. 7044, Business and
Professbns Code: The cont2ctqs License Law dces not apply to an owner of
property wiro builtls or improves thereon, antl who coniracts for such project vrith
a contracla(s) license pursuant to the Contractors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
`l.�-� � • ��� � - � -o�
$igewWreT � - [_Oate-_?�
905�-G6�3IO1)
.Ovmer ID veri(ed by drive ise. Yes ❑ No (�
Driver:s.Cicense No. �� CExpire's:; � !
Verification of Ownership by (t pe of tlocument, i.e. - property tax bill or deetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby cenify that no excavation five (5) or more feel in depth into wfiich a
person is required to descend, will be made in conneclbn with v,�rk authorized
by this pertnit, and Ihat no building structure, scaffddinq, falsework, a demolition
or tlismantling thereof, will be more Nan Ihirty-sa (36) feet high. (Chap. 3.2, Grp
2, M 2, Sec. 341, Ttle 8, Cal'rfomia Administrative Code).
❑ As owner-builtler, I will no[ employ anyone to do work which would
require a permit from the Division o( Industrial Safety, as no�etl above, unless
suGh person has a permit to tlo such work from the division.
Applicanfs Signature �ate
Division of Industnal Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or Wture building occupant need to file and
certify a Business Plan for emergency response to release or threatened
release of a hazardous maleria1l ❑ Yes ❑ No
(Section 25505 of the Califomia Heallh antl Safery Code requires, with some
exceptions, that a Business Plan be filed with the Costa Mesa Fire
Department by every business which has at any ona time dunng a reportetl
year a quantiry of hazardous matenals equal to or greater than a v+eight of
500 pounds, or a volume of 55 gallons, or 200 cubic leet ot compressed gas
at standard temperaNre and pressure).
2. Does or will the applicant or presant or fuWre building occupaN need to file
a registration form tor acutely hazartlous matenals? ❑ Yes ❑ No
(Section 25533 of the Califomia Health and Safery Cotle, with some
exceptions, requires registration with the Costa Mesa Fire Depariment by
each business which at any one lime has on hantl a quantily ol awtely
hazardous materials equal [o or greater than a weight o! 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
temperature antl pressure).
3. Does or will the applicant or present or future building occupant neetl lo
prepare an RMPP (Risk Management and Prevention Program (or acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 ot the Califomia Health and Safety Cotle provides thal the
Costa Mesa Fire Department may require the preparation, certification antl
�ling with Ihe Fire Department of an RMPP by businesses which are required
to register acutely hazardous ma[erials with lhe Fire Department.
4. If an RMPP is presently required, has Section 25534 of the California
Health and Salely Code been fully complied with? ❑ Yes ❑ No
5. Dces or will the applicant or present or (uture building occupant require for
[he work which is the subject of Ihis ap0licalion a permil for such wnstmction
or modifiwtion fmm Ihe South Coast Air Qualily Management DistfiCl or (rom
any other air pollution coMrol tlistrict or agency4 ❑ Yes ❑ No
(Section 65850.2 ot the Califomia Govemment Cotle requires that Ihe requested
infortnation be lumished on applications for nornresidential builtling permits).
6. Will any part of the facility to be constructed under Ihis permit be within
1000 feet from Ihe outer boundaries of a school7 ❑ Ves ❑ No
Qf "yes", the faciliry must meet the requirement o! Sections 25534 and 42303
of the California Health and Safety Code).
7. If a permit fmm the South Coast Air �ualiry Management District or other
air pollution control district or agency is required lor ihe work which is the
subject of this application, have all of Ihe disclosures prescribed by Califomia
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. Qf "yes", atlach certificate of compliance from the appropnate air polWtion
control officer). , ,
CERTIFICATE OF COMPUANCE: I certify that under penalty of pery'ury Ihe
infortnation given above is correci. I agree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
Signature Dale
CERTIFICATE OF. COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury Ihat I have read this application antl state �hat
the in(ortnation given is correct. I agree to comply vnth all state laws and city
ordinances relating to building wnstruclion, antl authorize representatives of
the Ciry of Costa Mesa to enter upon the above-0escnbetl pmperty for
inspection purposes. I agree not to occupy or allow occupancy of any building
a Itho,rized by this pertnit unti,(nal inspection.
`t�.� ��- G�r,. �O -?-0 7
Signa�olLegalOwneqs) '—Dale'"�
An�lor Aut�onzeE ApPI¢dnt Date
PERMIT TYPE
CITY OF COSTA MESA
BUILOIN6 DIVISION
77 FAIR DRIVE, COSTA MESA. CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714) 754-5626
PLUM
PERMIT NUMBER: P07-00399
STATUS:
DATE ISSUED:
ISSUED BY:
ISSUED
os�o��zoo�
RMD
JOB ADDRESS: 939.DOGWOOD ST CM Suite/Unit: �
vicinity: � , � , , .� � � � . .
SCOPE OF WORK: PLUMBING PERMMIT TO ADD 755SF, ENTRY PORCH AND REMODEL TO A 1-STORY SFD. 2 BATHTUB, 8
FLOOR DRAIN, 1 GAS (1-4 OUTLETS),.1 GAS SERVICE, 1 LAUNDRY TUB/WASHER, 2 SHOWERS, 1 KITCHEN SINK, 2
WASTENENT, 2 WATER CLOSETS, 2 WASH BASINS, 1 WATER PIPING, 1 WATER REPIPE.REF: 806-01717
OWNER: CAMBEROS,MARIAA
PHONE: 7144•713-5403
APPLICANT: CAMBEROS,MARIA A
PHONE: 7144-713-5403
CONTRACTOR: OWNER-BUILDER
Address:
CitylState: . . ZipCode:
PLUMBING PERMIT FEE SUMMARY
PLAN CHECK FEE: $0.00
PERMIT FE�: $255.05
TOTAL FEES: $255.05
Address: 939 DOGWOOD ST
CitylState/Zip: COSTA MESA, CA
Address: 939 DOGWOOD ST
.City/State/zZip: COSTA MESA, CA
License No.
PHONE:
CELL:
000000
EXPIRED
DATE � /, 7/� �S
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenfs under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 780 pAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for lhe work authorized under this permil to be wnsidered legal, such work must comply with all applicable codes, and all
required inspections and final approval musl be obtained. Failure lo obtain inspeclions and f nal approval will result in the expiration of this permit.
CODE/. INSPECTIONIYPE U� IN R LOQEt INSPEC110NTTE � 04T INTITIAL
7616 Fixed SyStem Final Fire Prevention 206 Final Mechanical
1268 Pool Spa Final � 208 Final Plumbing
200 Final Re�Roof � 210 Final Electncal �d
201 Final Blotg/ReWrnirrg Wall � 272 Final Fire Prevention //
202 Final FaG(ory Fire Place 220 Final Planning Approval �
20& Final Sign 222 Final Site
204 Final Deryqlilion 250 Final Building/Occupancy
WORKERS' COMPENSATION DECLARATION:
I hereby affrm under penalry ol perjury one o( the /ou.,wing declarations:
❑ I have and will maintain a certificate o( consent to self-Irisure �or vrorkers'
compensation, as provided tor by section 3700 of the labor Code, for the
peAormance of Ihe work for which this permit is issued.
❑ I have and vAll maintain workers' compensation insurance, as reguiretl by
sectbn 3700 0/ the Labor Code, /or ihe pedortnance of the work (or which this
pertnil is issued. My workers' compensation Insurance carrier and policy
number are:
Carrier
(Tlus setl.on neetl nd Ee mrtrpktetl ✓Ihe peimQ a vaNetl a1 one nu�MietlOdWrsl5100) a kss )
Policy Number:
❑�I,,,certify that in Ihe pertormance of the vrork for which this permit is
�jissued, I shall not employ any person in any manner so as to become subject
ro the workers' compensation laws o( Califomia, and agree tha[ if I should
become subject lo Ihe vrorkers' compensation provisions of Section 3700 of
the Labor Code, I shall foy�with comply with these provisions.
'il.�.� .,: G- - (-CL �.u.� �„- (� 7 .� 7---
App� fiwni's S�ign_a��ur.e= �Da�e'
`�..�.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SU&IECT 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 Chapler 9(commencing
with Section 7000) o! Division 3 of the Business antl Professions Cotle, and
my license is in full lorce anC eflect.
Lic. # qass #
Comraaor's SignaWre Da�e
CONSTRUCTION LENDING AGENCY:
❑ I hereby aKrtn that there is a construction lending agency for the
pedormance of lhe wurk fa wfiich this pertnit is issued. (Sec. 3097, Civil Code�.
Lentler's Name:
Lender's Atldress:
SignaWre Date
OW NER-BUILDER DECLARATIONS:
I hereby aKrm lhat under penalry of perjury that I am EXEMPT FROM THE
CONTRAC70RS LICENSE LAW for the following reason (Sec. 7031.5.
Business antl Professions Code: Any ciry or county which requires a permit to
construct, alter, impmve, demolish, or repair any sWcture, prior to its
issuance, also requires ihe applicant lor such permit to file a signed statement
that he or she is Iicense0 pursuant lo the provisions of the Contractors
License Law (Chapler 9(commencing with Section 7000) o( Division 3 of the
Business and Protessions Code) or that he or she is ezempt therefrom and
the basis for the alleged exemp[ion. Any violation of Section 7031.5 by any
applicant for a permit subjects the applican[ [o a civil penally of not more than
five hundred dollars ($500).):
❑ I, as owner o! the property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and the struclure 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
ihereon, and who does such vrork himself or herself or through his or her own
employees, provided that such improvements�are not intenCeG or oftered for
sale. If, however, the building or improvement is sold within one year of
completioq the owner-builder will have the burden of proving thathe or she
did not build or improve for purpose of sale.).
0�I;:as:owner of ihe property, am EXCLUSIVELY CON7RACTING WITH
GGCENSED CONTRACTORS to constmct the project (Sec. 7044, Business and
Professions Code: The contractors License Law dces not apply to an ovmer of
propeny who builds or impmves Ihereon, antl who contracts for such project with
a contracta(s) license pursuant to the Contractors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
).�cz...., CC < �CG/,�cl-� � - !�O7
� �SigiuWrec�^' DaleJ••.O
305]-a6 (3�09)
Ovmer ID verified by tlrive ise. Ves ❑ No
Dri e�sl'icense`No. E�cpires_�.' ��
Vedfication of Ovmership by (type o! documenl, i.e. - property tax bill or deetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby ceAify that no excavation (rve (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 ihereof, will be more lhan thirty-six (36) feel high (Chap. 32, Grp
2. M 2, Sec. 341, Title 8, Califomia Administrative Code).
❑ As ovmer-builtler, I will not employ anyone to do work which v.ould
require a permit from the Division o! Intlustrial Safety, as noted above, unless
such person has a permit to tlo such work from the division.
Appliranl's SignaWre
Division of Industrial Safety Permit Number.
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
i. Will the applicant or present or fWure buildinq occupant need b file antl
certify a Business Plan for emergency response to release or threatened
release of a �azardous material4 ❑ Yes ❑ No
(Seclion 25505 of the California Heallh and Salety Code requires, with some
exceptions, [hat a Business Plan be fled with the Costa Mesa Fire
Departmenl by every business which has al any one lime dunng a reported
year a quaMiry of hazardous malerials 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 temperalure and pressure).
2. Does or will the applicant or present or fulure building occupant need to file
a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Seclion 25533 of the California Health antl Safety Cotle, with some
ezceptions, requires regislration with the Costa Mesa Fire Department by
each business which al any one lime has on hantl a quanlity o( acutely
hazardous materials equal to or greater than a weight of 500 pountls, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at stantlard
temperaWre and pressure�.
3. Does or vnll the applicant or present or tuture builtling occupant need to
prepare an RMPP (Risk ManagemeN antl Prevention Program for acutely
hazardous ma[erials)? ❑ Ves ❑ No
(Section 25534 of the Cali(omia Health and Safety Code provides that the
Costa Mesa Fire Department may require the preparation, certification and
(ling with the Fire Department of an RMPP by businesses which are required
to register awtely hazardous malerials with the Fire Department.
4. I( an RMPP is presenlry required, has Section 25534 of the Califomia
Health and Safery Code been fully complied with7 ❑ Yes ❑ No
5. Does or will the applicant or present or future builtling occupanl require for
Ihe work which is the subject of Ihis application a permit for such construction
or modification from the South Coast Air Quality Management District or from
any other air pollution control tlistrict or agency? ❑ Yes ❑ No
(Section 65850.2 of lne Califwnia Govemment Code requires that the requested
information be tumished on applications for non-residential building pertnits).
6. Will any part of the facility to be wnSWcted under this permit be wilhin
1000 feet from the outer boundaries of a school? ❑ Ves ❑ No
(II yes", Ihe lacility must meet the requirement of Sections 25534 and 42303
o( Ihe California Health and Sa(ety Code).
7. If a permit from the South Coast Air Oualiry Management District or other
air pollution control disMct or agency is requiretl for ihe work which is the
subject of this application, have all of the disclosures prescribed by Califomia
Health and Safety Code Section 42303 been made7 ❑ Yes ❑ No
8. Qf'ves", attach certificate ot compliance from ihe appmpnale�air polWtion
control oKceQ. .
CERTIFICA7E OF COMPLIANCE: I cartify that under penalty of perjury the
information given above is correct. I agree to comply with�all state lavrs and
city ordinances regarding Hazardous Materials antl Emissions.
.. SignaWre Dale
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION� OF ENTRY: I
certify under penalty of perjury that I have read this appliwtion antl state thal
the in(ormation given is corcecL I agree to comply with all state laws and ciry
ortlinances relating to building constmction, and authonze representatives of
the City of Costa Mesa to enter upon lhe above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
��honzed by this per�nit until final inspection.
�-� Gc • ����r� � ` 7 `v Z
�Signa4ueN.LegelOwner(ij' 6ale--\ �
Analo� AulbOn2¢0 Nppli W nl
MAR 1�.195$
OWNER $j.1I`IN, $, M. dUL Q 1958 DATE j1�'j�5'j _
JOB ADDRESS 9j9 DOg5700d Sb. BUILDING PERMIT NO.. 5963
��v�i�CONTRACTOR OFrcter—Buildex� VAUiE S 8�.�
LOT
ZONE
OF
���SPECTIONS I DATE I SUBCONTRACTOR I DATE , NUMBER
I' 1inA Fi#ures, Final I
1 . Gas Test . _ .J� . �./' /
� r �
'�� _ � S�q
COSTA MESA BUILDING DEPARTMENT
P.O.BO% 31]
COSTA MESA, CALIFORNIA
FOR APPLICANT TO FILL IN
BUILDING
ADDRE55
OWNER �
MAIL
ADORE55
ar
ARC�'TECT
OR' NEER
ADORE55
� �ql..eo e � •
COSTA MESA. CALIFORNIA
TNO,� / A`OS�S!
LIC. .
NO.
CITV LIC.
OLl�N'P+'- NO.
Le�nl ILOT��
OESCRIPTION (.fQ,
A.P. NO. �_L_ V
SIZE �� �
OF LO�
USE OF '
E%ISTING BLDG NC
SETBwCK LINE FROM
CENTER OF STPEET ��J
N' _
REPAIR
BUILDING
SIZ�
EXTERIOR W.
COVERING
USE OF NEW
BUIL�ING
NO. � BLOGS.
I HOW ON LOT
RIGHT � LEFT (� /
DESCRIPTION OF WORK
XALTERATION I ADDITION
MOVING OEMOLISf
���� Rect�v�DG
,, ��-
FIR.1RCE DEPT.
n,,. f�F �'.QSTEi MtS�i
APPLICATI'ON FOR PERMIT
BUILDING
FOR OFFICE USE ONLY
FECEIPT NO. PERMIT N/O
� p
EIVEO BY �/�� R C�IVE /%=TE ISSUF
\ S � �
L�ING ��� YB �+, �,j a o D�
RE55
COSTA MESA. CALIFORNIA
APPROVED
BY DATE
'�%L CORRECTIONS
s �� .
e.
CITY OE STA MCSA
� �
SUBJECT TO DG. DEPT. REG.
/ � VO.OF
�G JC� O ROOMS � STORIES
�
�
a
i�
I HEREBY nCKNOWLEOGE TNST I HFVE REAO THIS iPPLIC�TION nNp
ST>TE TMiT TME �BOVE IS CORRECT hND AGNEE TO COMPLY WITH .�ll
CITY OROINANCES /NO ST1TE �4W5 REGUL4TING BUILOING CONSTRUC�
norv. VALUATION
SIGNATURE OF �i���,yy PERMiT FEE S 6.�
PERMITTEE �� —
PLAN CHECK S
�
� TOTAL FEE 8 '�' °'"`
AUTHORIZED AGENT � �
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ORANGE COUNTY BUILDING DEPARTMENT
! 636 North Broodway
� . � ' ' SANTA ANA, CALIFORNIA • � ' '
�
fOR APPLICANT TO FILL IN
Aoo E'S5 Q39 Dogwood St.
SCHOOL DIST. COBtA Meea
OR TOWN
NEAREST
cRoss sr. Renublia Aee.
^'^�� 93b3 w��sN�Re BLVD.
ADDRE55
V lY ILIS TEL. R•
QTY NO.
ENG NiEERTI.A�N R� MCKERRACHER NOL SY�C4U9
°oDRESSZ��O E, WAINUT ST.� PA9ADENA
TEL.
NTRAGTOR NEWPORT V�STA CO,No. CR. rj �
ADDRESS g363 w��sy�AE BLVD.� �EY.filll5
LEGAL
DESCRIPTION �OT NO. %Q� BLOCK � 7�'?
(ATTACH METES & BOUNDS)
TRACT
SIZE OF LOT
Q� JI � �O I NOW ON LOT O
USE OF I NO. OF I NO. OF
EXISTING BLDG. Famiues ROOMS
DESCRIPTION OF WORK
NEW I X I ALTERATION I I qDDITION I
IES
WALL � ROOF-
COVERING STIlffO COVEftING
��SE OF NEW
'L�ING o.-_..,�_._.. w�.� n
1 HEREBV ACKNOWLE7GE THAT I HAVE READ THIS
APPLIGATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLV WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING BUILDING CONSTRUCTION.
SIGNATURE OF NEWPORT V� ST
PERMITTE
AUTHOHIZED AGT J—
$ 30.00 P. c. S 2—
FEE 1� �
E
VALUATION J/
FEE �10 ��
APPLICATION FOR PERMIT
� . ��uo`���G 1
' FOR_OFFICE USE ONLY
' RECEIPT NO. PERMIT NO.
�� 1� S/ �'�'
RE EIVE� BY DATE OF APPL. DATE ISSVED '
��' I/✓y ��� NOV 5 i953'
I�DING i �
ADDRE55 �39 -
�
SCHOOL DIST. .
OR TOWN ii � �
NEAREST �
CRO55 ST. ��
ZON�-/ I O.,SF I TYP� I � OUP �
/f// � PLANS �
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REAR'YARDNEF��f� CENTSRDOF�ST.D�O�J�i�
APPROVED �.rl/L�Nnf� .! // )-�i
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