HomeMy WebLinkAbout2894 ELLESMERE AVE - Building PermitsO�a MFS
o q
e
> ;
: j'
J �
°���o �"
�
�
qTY OF COSTA MESA
B!/ILDING DIVISION , ,
77 FAIR DRNE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.costamesaca.00v
PERMIT TYPE: B COMBO
Sub Type: RES_ALT
FOR INSPECTIONS CALL: (714) 754-5626
�os aooRess: 2894 ELLESMERE AV CM
APN: 13927212
Zoning:R1, ,
PERMIT NUMBER: BC12-00272
STATUS: ISSUED
DATE'ISSU ED: 05101 /2012
ISSUED BY: ' KJB � -
�
Suite/Unit:
Vicinity: Primary Occ:;
Const Type: V-B , ' SQ. FT: � :- 0. � � - , Valuation: . $7,000.00
.'�'- . �. . . _ .. _ . .. . � -
�,���. , , . �
SCOPE OF WORK: NON-STRUCTURAL INTERIOR REMODEL. SCOPE OF WORK TO INCLUDE: INSTALL CAN LIGHTING
THROUGH OUTTHE RESIDENCE. INSTALL NEW WINDOW IN BATH. SAME SIZE/SAME LOCATION. CHANGE OUT SINGLE
SINK IN MASTER BATH AND,INSTALL A DUAL SINK VANITY. MANDATORY MEASURES ATTACHED TO JOB CARD.
OWNER: HOYE, DEREK AND KATRINA
Phone:
APPLICANT: SHETTLESWORTH, JOE
Phone: 562-743-1587
Address: 2894 ELLESMERE AVE
City/State/Zip: COSTA MESA, CA
Address: 70 ARGONNE
City/State/zZip: LONG BEACH, CA
CONTRACTOR: SHETTLESWORTH CONSTRUCTION License No. 912872
alione: 562-743-1587 . Address: 70 ARGONNEUnit:
Cell: City/State: LONG BEACH, CA� - � .
ARCHITECT:
E GN INEER: �
n�:, .
COMBINATION P�RMIT FEE SUMMARY
gliilding Plan Check: � � � �� , �
Building Fees: . �
Electrical Fees: , - � ,
Fitechanical Fees:
Plumbing Fees: . .�
SMIP Residential: � � �
SMIP Commercial: ' .
Bldg Std Admin Fund -
TOTAL FEES:
("i4
License�No. �
License No. -
$0.00 -
$139.25 ��� . ..
$102.25''. � .
$0.00 .
$43:10
$070 _
$0.00
$1.00
$286.30
Unit:
UniC :
ZipCode ,90803
PHONE:
PHONE:
HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279
thru Friday-7:oo am thru 7:0o pm. Saturdays-s:oo am thru s:ao pm. Prohibited all hours - Sundays and the following Federal holidays:
New Years Dav. Memorial Dav. Indeoendence Dav. La6or Dav. Thanksaivina Dav and Chrisfmas �av
AF ',
��
.NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
qggulations. (Ord. No. g2-28, § 1, 12-21-g2)
iEXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
{fNSPECTIONS: 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 fnal approval will result in the expiration of this permit.
f��i
DEt. INSPEGTIONTYPE DATE INTITIRLS C�DE� INSPECTIONTYPE �Al N R
$676 Fixetl Syslem Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing �-�' 6e�-M�
200 Final Re-Roof 210 Final Electrical -% �- I'i In�
+: 0
2Q1 Final 81ocWRelaining Wall 212 Final Fire Prevention
�2b2 Final Factory Fire Place 220 Final Planning Appmval
22s3 Final Sign , 222 Final Site /��'/,���
d4 � Final Demolitioq 250 Final Building/Occupancy ' ' �' �+ '��
�Cr
s..
�
WORKERS' COMPENSATION DECLARATION:
I hereby affrm under penalry of perjury one of lhe foilowing declarations:
❑ I have and will maintain a certifcate.at consent lo self-Insure for workers'
compensation, as providetl for by section 3700 oF the Labor Code, for the
pertormance of the work tor which this permit is issued.
❑ I have and will maintain workers' compensation insurance, as required by
seclion 3700 of the Labor Code, for lhe peRormance of ihe vrork (or which this
pertnit is issued. My workers' compensation Insurance carner and policy
num�er are:
Carrier
(ThissMionnetdnotbemmple(etlAf pe rif val tor�ehuntl Bj6lkss)
licy N ber
certify that in the peAormance of the work for wl �ch this permit is
d, I shall not employ any person in any manner so as to become subject
to the work� ' ompen tion laws of California, and agree ihat it I should �
become LDject e rkers' compensation provisions ot Section 3700 ot
the La or Code ia b orthwith aiply with these provisions.
_ 5 -f-f 2
_fjpyi sSignaWre Date
ARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affrtn that I am licensed under provisions of Chapter 9(commencing
with Section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force and eftect.
Lic. i Class #
� r �
Contra Siqnawre Date
CONSTRUCTION LENDING AGENCY:
❑ I hereby a(firtn lha[ there is a construction lending agency tor the
peAormance of the work for which this pertnit is issuetl. (Sea 3097, Civil Code).
Lendefs Name:
Lender's Address:
Signature
OWNER-BUILDER DECLARATIONS:
I hereby affrm thal under penalty o! perjury that I am EXEMPT FROM THE
CONTRAC70RS LICENSE LAW for the following reason (Sec. 7031.5,
Business and Professions Code: Any city or counry which requires a permit [o
constmct, alter, impmve, tlemolish, or repair any slrucNre, pdor to its
issuance, also requires the applicant for such permit to fle a signed statement
tha� he oi she is licensetl pursuant to Ihe provisions of the Coniractors
License Law (Chapler 9(commencing with Section 7000) of Division 3 of ihe
Business and Professions Code) or that he or she is exemp[ therefrom and
Ihe basis for the allegetl exemption. Any violation of Section 7031.5 by any
applicant for a permit subjects Ihe applicant to a civil penalry of not more than
fve 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
oHered for sale (Sec. 7044, Business and Professions Cotle: 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 oHered for
sale. If, however, ihe building or improvement is sold within one year o(
completion, the owner-huilder will have the burden of proving that he or she
did not build or improve for purpose of sale.).
❑ I, as owner ot the property, am EXCLUSIVELY CON7RACTING WITH
LICENSED CONTRACTORS [o construct the projec[ (Sec. 7044, Business and
Professions Code� The conlractors License Law does not appy to an owner o(
property who builds or improves thereon, and who contracts (or such project wilh
a cont2clor(s) license pursuant to the Cont2ctors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
305]�46(3I0])
Owner ID verifetl by driver's�e. ❑ Yes ❑ No
Driver's License No. Expires:
Verifcation o( Ownership by (rype of document, i.e. - propeAy tax bill or deed):
DIVISION OF INDUSTRIAL SAFETV PERMIT CER7IFICATION:
❑ I hereby certify [hat no excavation fve (5) or more feet in depth into which a
person is required to descend, will be made in connection with work authonzed
by ihis pertnit, antl that no builtling strucmre, scaffoltling, falsevrork, or demolition
or tlismantling thereof, will be more ihan thirty-six (36) feet high. (Chap. 3.2, Grp
2, Art 2. Sec. 341, Title 8, Califomia Administrative Code).
❑ As owner-builder, I will not employ anyone to tlo work which would
require a permit from the Division of Intlustrial Safery, as noted above, unless
such person has a permit to do such work from the division.
ApplicanYs Signalure
Division o(lndustnal Satety Permit Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future building occupan� need to file antl
certiry a Business Plan (or emergency response lo release or threatened
release of a hazartlous material? ❑ Yes ❑ No
(Section 25505 of ihe California Heaflh and Safery Code requires, with some
exceptions, that a Business Plan be fled with the Costa Mesa Fire
Department by every business which has at any one lime dunng a repoAetl
year a quantiry of hazartlous ma[erials 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 temperaNre and pressure).
2. Does or will the applicant or present or future building occupant need b fle
a regisiration form for acutey hazardous materials? � Yes ❑ No
(Section 25533 of l�e California Health and Safery CoCe, with some
exceptions, requires registration with ihe Costa Mesa Fire Department by
each business which al any one time has on hand a quanti[y 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
temperaWre 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 acutery
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the Califomia Health antl Safety Code provides that the
Costa Mesa Fire Departmenl may require the preparation, certi(cation and
fling wilh the Fire Depariment o( an RMPP by businesses which are required
to register acutely hazardous malerials with the Fire Departmen[.
4. If an RMPP is presently required, has Seclion 25534 of the California
Health and Safery Code been fully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or fuNre building occupant require for
the work which is the subject of ihis application a permit for such construction
or modifcation (rom the South Coast Air Quali�y Management Distric[ or from
any other air polWtion coMrol tlistrict or agency? ❑ Yes ❑ No
(Section 658502 0( the Cali(omia Govemment Code requires that the reques�ed
infortnation be fumished on appliwtions for non-residential building permits).
6. Will any part o( the faciliry to be construcled under this permi[ be within
1000 (eet from the outer 6ountlaries o( a school? ❑ Yes ❑ No
(If "yes", �he facility must meet the requirement o( Sections 25534 and 42303
of the Califomia Health and Safery Cotle).
7. If a permit from the South Coast Air Qualiry Management District or other
air polWtion control disMct or agency is required for ihe work which is the
subject of ihis application, have all of the disclosures prescribed by Califomia
Health and Safery Code Section 42303 been made? ❑ Yes ❑ No
8. Qf `yes", attach certifcate of compliance trom lhe appropnate air pollution
contml officer).
CERTIFICATE OF COMPLIANCE: I certity that under penalty of perjury the
intormation given above is correct. I agree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty o( perjury that I have read �his application and state that
the information given is correct. I agree to comply with all state laws and ciry
ordinances relating to building consUuction, and authorize representalives of
the Ciry of Costa Mesa lo en[er upon ihe above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorizetl by this permit until fio227jnspection.
� /
Sgnat .BaLOvnKr(s}---- �i-- �ate
�/^� i
MNorANM1orizetlAppli[anl Dale
f t �
4 7'rescriptive Certificate of�Cumnliance:
P aeirletttia[ f1 [zer[ninns
Ih�ujecl N:unc:. ���� . '-
General Inlorm.�timi
Site Address: riir
Iiuilding Type�Single Family ❑ MWti Familr
Conditioned Fluoi Are;� (CPA):
T6is fnrn� is nn� �n Lc used lar Ncrvl p Consvuc�ed
-- , .� � �� -
Lnlorcemenl Ag����'.)':
"Lonc q
llate:
CT-IR-ALT
(f'a�c ] of'�)
� I q of Sturies
� `
i��!
Circle the Froni Orientation: Ih, L, S, V��, or degrees
Projeci Type: herauons ❑ Envelope O Fenesvatiou ❑
Replacemeni or Chan[!c Ou1 ❑ Duci RepincemeN ❑ N'mer
iiltfii:es ar Additinns
1 n.sulnfinn V�dues Fm' Opnryuc Sur/nces ((a• Furring u.se 1he Mas.s and Furring SYrips Cons�i�ucNon mGle below)
Assemhlv Alteration
O Opening of O�umed carih• alone- A6ermions dm� invoh�e �he opening oJ(heJramed caviry� qf n wafl, ceiling, or' finm� musl irtsmll the
rnundurnm mininnun insidmion vnluc per §l50 /br d�e a6ered assemblv. Fill in Colunnu A-C und en�er mmidaiom insulaiion value in Cohmm H.
❑ Replucement of entire nssem6ly-ltep(acemeni oJ�mi emire wall, ceiling. orPom� Qsa�emb(p r'eyuires Ihe ins�alla�ion o(Componen�
Par.Aave- D ine�id�lion vahrs in Ta61e 157-C. Fill in Cbhimns A- J.
Surf'ace
B
Tag/ I Assembly Name
ID' or7voe'
Na�e
lun�ed purtinned ofMass VJalls see
. D L �
Material
U-
R-value, see Pagc
Cunstruction 7'nble beloe�.
Values From JA4 Table
Framed Continuous JA4
]A4 Table Caviry Insulation Assembly
Numbers R-value� R-Value' Cell Value
14-3 nnd Egimfion 4-J. For' colpda�ing fon'red wa(la vse !he
Fi�rring Cwxrv+rcGmr mble belmr.
1. For Tng//D indicate the iden�ificmion name tha( matchu Ihe building plans.
2. Indicn�c ihe Assemb(r Name or rype: Rooj/Cetfing, W'a(!s, Floors', Slabs, Craw! Space, Doors ond etc...lndim�e !he Frame rype and Size: Fm�
Wood, Me�a(, Me�a! Buildings, Mass, enier 2x4, 2zG, or e�c... see JA4 for o(her possible.finmc rype assem6l ies.
3. Enier the ihiclniess {ar muss in incher or Spacino Genveen /i'aming members emer; 1 G"or 24 "OC; or Other far all oiher assembtn descripiion
ruclr as Cbncrete Sandwidr Panel, Syandre! Panel, Logs, Sn�ow Bale Panel and ete.... ,
4. Based on Ihe Clima�e Zone; emer the S�andm�d U-(acmr fi�om Table 15/-B, C a' D(or eoch dJJererv assembly Name or type
5. L�ver �he Tab7c numGer tha� closel7� resembles dir proposed ose�embh�. � � �
fi. E�e�er !bc R-volue Ihab is Leing ina7oll ed in lhc wall cm�irn a' Leiwew� Ihc fi'nnring,- ollreiavise, enler "0 ".
7. L•nier �he Cominunus Lisula�imi R-nalue (or the proposed assembf��; mher-wisc. emer "0 ". ' .'
b'. Lmer �6e roN� and column ojthe U-(ac�a� valuc Gased mi Colurnn FTnhle Numher and eruer (he dssembly U-fuc�a� in Calumn J
). The 1'ropn.scr/ d.xsembli� U-(nciar, Calaumr ./, nnisi 6e e9ual to or /ess lhan Ihe S(audnrd U-(actor in Column E �o canpl��.
Purring Strips Cunstn�ctiun Table for Mass Walis Oulv
A B C D C P G H I J IC L M
Prupused 1'ruperties uf Masuury und Concrelc Added ]ntcrior or liX[crior Insulalinn
H'alis Rrum licferaice in I�un'ing Space 1'rum Relerencc
Juinl A i�cuclia 9�ablc 4.3.5. A3.G. A3.7 Jninl A>�cndix 9'ablc 4.3.13
— �c %� `c u
i.1 ,j V y �' (.%
u: y; L.. � L L � ✓ U
Aszembly �'e =+ �.�'� ~ o v c�� z.'v '_ Final
Mass Nomcar 1A41abic .� _ 'u y� R ry p '= F r. � � � Assemb4��
Thickness' T c' Nwnher ��` — = ui ° i:. u. G c r 5^ � , Udactor' Commem
I i
� � �
Ilegia�n�uiinn Ntmiher: 12eAislrotion Uu�e/Time: IiLRS Ib�nvider:
300d' lie.siclential Compliunce Forms fiugus� 200J
7'rescri itivr Ceriillcatr nf�Cumyli��nc�,: )'tesidential CP-Lt-ALT �
Res'itleittird Alter�uiu�as . (p,tai. j �f� �)
Yruj�cllvnme: . . ( Climate'Luuci! ., ' I f'ufS�uries
� • r
� , .
fI�7:5 1'�I�IF1CA7701�' SUMMARY 7%�e en(orxeme�v ugencl� shou/rlyrn� specmi nne�vion m �hc PIG'RS' /ile�isure.�� e'pecified m i6is
chccldis� Gelmr il rompleied und signed CF-47( Form (or �dl ihc nrena�w�es spcciJied,rhall Le submiued ro iiir bui]ding inrnecio:� belw�v I�nn%
Duct 5c.tline d; I�eSYiue HLIfS reri/icn�ion i.erequiredJm�ihi,� mcus:n�c.
❑ YL$ ❑ NO YCS:In Clinmie "Lones ^_ and �-IG, ii� inore tha�� 401inear ieet o1'new ui ieplucement ducts are iusudled ii� unconditioned
space, the ducls urc �o be se�decl per j�152(b)lliii mid lhe ncwll' inStalled ductr, ure tu Uc insululed per { I51(ill U.
❑ EaClil'7'lUf�: Lxistin� ducl s�•stems tlial ure estended; wliich :ire cunsvucted, inzul;ued or seuled �vith :�sbestus.
❑ YES � NU 1'PS: ln Climate "Lones' and 9-1G, iI the er.isting spacr-conduioniug sysien-� (}l\iAC r.yuipmenl and duciingJ is repl'aced. Ih:
ducu are w be sealed pei §1 �2(bp Li.
❑ PES ❑ NO YES: lu Climate 2ones ? �nd J-16, if the esisiinp HVAC equipmen� is repluced jincluding the replac�mem o1 the nir handler,
ou�duor conelensing unii of n splii system, cooling or heating coil, or the fumace heai exchan�er) the ducis �re ta be
sealed per � 152(b)1 E.
O EXCEPT70�': Luct systems H�nt are dacumenied iu iinrc been previously senled confirmed tLruugh HERS
' ��� vei`Sii��tlou in�accordunce �vitli prucedures in the Reference Residential Appendix 1LA3. _, ___ _ _
❑�XC�PTION: liuct sys�ems with �lesa tli�n 4U Iinear feet in uncouditioned space.
❑ EXC�PTIO�: Cxistinr duct spstems constructed, insulated or seuled wit6 as6es[us.
kefricerant Charge - Split System HERS verifica�ion is regidreci /or ihi.+ meosurc.
❑ Y�5 ❑ NO YES: ln Climaie Zones 2 and E-I5, wlien the e>;isting HVAC equipmeni is replaced (mcluding the replacement of ihe air
handler, outdoor condensing unit of a split system A/C or lieat p�mp, cooling or heaeine coil; or tn� Fumace heat
exchaneeri a refrieerant charee measuremem shall be veriiied per §152lb)7F.
Centra] Fan Interrated (CFI) Venfilation S}�stem and Fan V�'att DraH�
The ven[ilation remiirements of F150fo1 do not anoh� m existine residentfal homes.
Ducted Split S,ystems - Air Conditioners and Aeat Pumps: Airflow AERS reri/icaiion is reguirecl jor tnia measuure.
❑ 1'�S ❑ NO PES: In Climate Zones 1 U through 15, when the existing snace-conditioning system (HVAC equipment and ductingj is
replaced. the airflow and t"an watt drav.- shall be verified uer §] S2(611 Ci to mee� the requirements of & I Sl (f17E.
accurat^ nn
1Jame:
Hddress: �j� �/,� � � Dn � �
� � i/��
v,��,/�/
�U
m
Responsiblc Ituildi�t�, 3'iesi�ner's lleclaratiuu Statemen� '�
�] um eliEiblc under Livision 3 of tlr Cal itornia Seisiness and Professions Codc tu accep� responsibi6�y lor Wc building design identified on
thla CeniScnte of Compliance.
• 1 eeriify that the energp feuture;, and performance speciGenlion:. 1or the buildiug design identiLed on thi:: Certificxte ol' Cumpliunce cuniorm
to thc: iequircmems ofTitic 24, Pans 1 ancl 6 of thc Culiibrnia Codr of' ]tegulatiuns.
• The building design fentures identiGed on lhie. Certificnte of' Cumpliunce tve cunsis�eni wilh thc Inlurmatiou provided to ducumem thi:�.
building design oi� the other applicable compiitmee ionn�: wurl:shuets, calculations, plxns and specifica�ionh siibnntted w lhc eni'orcmnem
ueence foi apPra��.d with this building nennii annlicalion. - _---. .
)vamr:
Cuntp.in)':
Hdn,ess:
Cn�dStotelZip�
Si�naturc�.
liatc:
Licens=.
I'houe:
Frn aa�si.euuicc nrquca�timr:. re�urding thc E�reroi-Stmitlartl,r. cmi�rzc! the Lrvergr Ilotline atr 1-R(l0-;72 _�31111.
1(ciia�b�anou IJwnbcr' /(egi.evoi�wi Laic/Timc' J-1L1:5 /'romcim':
n.,,,,.. �
d
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
�ob Address: 2894 ELLESMERE AV
Suite No C
Vicinity:
Parcel Nunmber: 42412144
Applicant KEVIN SZABO
Address: 17390 MT CLIFFWOOD
-"FOUNTAIN VALLEY �'
Owner: TKB INTERNATIONAL INC
Address 760 W'I6TH ST STE M
COSTA MESA, CA
PLUMBING PERMIT
Phone: (714)241-1414
Zip: 92708
Phone: '
Zip: 92627
Contractor. COAST ROOTER PLUMBING HTG & AIC
Address: 17390 MT CLIFFWOOD
FOUNTAIN VALLEY
CHANGE OF WATER HEATER.
ISSUE FEE
Backflow irrigation
BackBow Prevenler
Bathtub
Clarifier Syslem
Connect pce,Soda,etc)
Dental Units
Dishwasher
Drain, Floor
Drain, Rainwater '
Drain, Roof -
Drinking Founiain , �
Expansion Tank
Gas Earthquake Valve
Gas (1-4 ouUets)
Gas (Over 4 outlets)
Gas Repipe
Gas Service
Interceptors (Grease, Oil)
Inlerceptors (Sand Auto )
AMT
$23.50
50.00
50.00
50.00
50.00
50.00
$0.00 �
50.00
50.00
50.00'
$0.00
$0.00"
$0.00
$0.00
$0.00
$0.00
30.00
50.00
50.00
50.00
Qn
0
0
0
0
0
0
0
0
0
0
0, ,
0-
0
0
0
0
0
0
0
Phone: (714) 241-1414
Zip: 92708
License: 529127
SCOPE OF PERMlT
FEE SUMMARY
AMT
Laundry Tub I Washer $0.00
Landscape Irrigation $0.00
P-Trap $0.00
Pressure Regulator $0.00
Process Piping (per 10 k) $0.00
Receptors $0.00
Septic Tank $0.00
Sewer Cap for Demo $0.00
Sewer Connect $0.00
Sewer Private Line $0.00
Shower . $0.00
Sink, bar . $0.00
Sink, commercial $0.00
Sink, Floor $0.00
Sink, kitchen " $0.00
Sink, servlce/mop � $0.00
Spa (private) . $0.00
Spa (public) $0.00
�TY
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Status: ISSUED
Applied: O6/30I2005
Issued: O6/30/2005
ISSUED BY:
SumpPump
Swimming Paol
Trap Primer
Urinal
Vacuum Brkr BkOow(1-4)
Vacuum Brkr Bkflow(5+)
Wash Basin
Wasb Basin Set
Waste and Venl Syslem
Water Closet (Toilet)"
Water Heater / vent ,
� Water Piping (Inst or Rep.)
Water Re-pipe
Water Service
WaterSoftener
OTHER
� V IOLATI ON
�PLAN CHECK
REINSPECTION
AMT
$0.00
50.00
$0.00
ao.00
$0.00
50.00
$0.00
$0.00
S0.o0
$0.00
$12.30
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
TOTAL CALCULATED FEES: E35.80
aTY
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
NOTICE: The work authorized by this permit shall compty with all applicable handicap access requirements under Califomia statutes and related
regulatlons. (Ord. No. 9248, § t, 12-21-92)
EXPIRATION: This permit shall automatically expire and become vold if work is not commenced within 180 days, or il work is suspended or abandoned
for a period of 180 days.
INSPEC710NS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable cotles, and all
required Inapeetlona and tinel epproval must be obtained. Failure to obtflin Inspecllons and final approval will result In}he axpiratlon of this permit.
FOR INSPECTIONS CALL; (71q) 7545626
zaasaelarool
WORKERS' COMPENSATON DECLARATION: '
I hereGy ettirtn under penalry of perjury one tl� �a tollowing tledaratians:
❑ I heve end wlll maintaln e certiticate ot crnsent to sell-Insure lor workers' compensetion, es proNdetl lor hy section 3700 0l the Labor Code, tor Ne peAortnence of Ne
work tor whlch ihis pertnit is issued.
� I �ave end wlil maintain workers' compe�setlon insurance, es required by section 3700 0l the Lebor Code, for Ihe pertortnance of Ihe work lor which NIs pertnit is issued.
My workers' compenutlon Insurance carder end poliq number are: �1 / �[
Carrler: S��l E � a I �.1 %� Policy Number: � I!7 8� SU � Z(i C� "I
(Thfs secNon neetl not be comp/efed it Ure pB�lt is velued et one hunCred dollars ($100) or less.)
❑ I certily that in t�e Dertortnance ot t�e work tor whlch this permit is issued, I shall not employ eny Dereon In any manner so es to bocome subject to t�e workers'
compensetlon laws oi Calitomia, end egre at I� I s�ould became suE�ect to the workers' compensetion provisions o1 Section 3700 ot the Lebor Cotle, I shall foMwlth
compty with �hese provi io 6�. � � I�� O�
ApPllcen� SlpnaNre: Date:
WAHNINCi: FAILURE TO SEW HE WO (E ' OOMPEMSATIOH COVEfiAGE IS WJLAWRIL AND SHFl1 SUBJEGf AN EMPLOYER TO CHIAUNAL PEfULTIE$ AND CML FlNES UP TO ONE HUNDRED
TFIOUSAND DOUARE (5100,000�, IN ADDfiKKJ T07ME CQST OF COMPENSATION, DMIAC�ES AS PROVIDEO FOR IN SECiION 31080F THE LA60R CODE, INTEpEST, AND ATTOfiNEVS FEES.
LICENSED CONTFiACTORS DECLANATON:
I here6y eHlrm (het I Brt
force end eflect. LJc. a,
ConlrectoYs SlgneNre:
with Section 7000) of Dlvision 3 0l the Buslness antl Prolessions Cade, end my license is In tull
Class a
oaia: G• �yz os
CONSTRUCTION LENDING AGENCV:
❑ I hereby aHirm ihat Ihera is e consiruction lentlinp egoncy lor the pertormance of the work lor w�ich this permii is issued. (Sec. 3097, Civii Code).
Lenders Name: Lenders Atltlress:
Signature: Date:
OWNER-BUILDER DECLARA710NS:
1 hereby etfirtn that under penalry of petjury tl�et I em E%EMPT FROM THE CONTRACTORS LICENSE LAW far t�e tollowing reasan (Sec. 7031.5, Business anA Professions
Code: Any dry or oounry,which�requires e pe��� to construct, elter, imprwe, demdish, or repflir eny slrucWre, prior �o its Issuenca, elso reqWres �ha applican� for wch pertnit
to flle a signetl atetemerlt thet he'ar, she Is Ikensetl purwant m Ihe provisions of the Contrectors Llcense Lew (Chepter 9(canmendng wlth Section 7000) oi DMslon 3 of ihe
eusineu entl Pmfessforis�Code) oqthat he o� she Is esempt t�erefrom and Ihe 6asis br Ihe elleged exemption. Any vidation of Section 7031.5 by eny applicant for e permit
sub�ects the eppliwnt to e cMl penalty of'not more then,frve huntlretl ddlars (5500).):
❑ V, ss owner o1 the p�operiy, or my employees wllh wapes as iheir sde compemation, WILL DO THE WORK, and tha sirunure is not fMended or orieretl tor sala (Sec.
7044, Business end'Pmfessions Code: The Contractars lJcense Lew does not apply to en awner of pmperry who builtls or improves theraon, anU who does such work
himsetl or hereelf or through his or her own employees, pmvided that such Improvements ere not Intended or ofleretl tor sale. II, however, Ne hullding or improvement ig
sold within one year af completion, tha owner�Duilder wiil heve ihe burtlen ot provinp ihet he or she tlid not build or imprave for purpose of sele.). �
❑ I, as owner ot the property, am EXCLUSIVELY CONTFiACT1NG WfTF1 LILENSED CONTRACTORS m construct the pro�ect (Sec. 7044, Business end Pmfessions
Code: The contractors License Lew dWs not epply to en owner ot pmperty who bulltls or Improves ihereon, antl who contrects far suc� D�oject with a contrector(s)
license pursuant to ihe Contractors Licanse Laws.).
❑ I em exempt under sec. Business and Profeuions Cotle lor this reeson:
Signatura: Date:
Owner ID veritied by tlrivers license. ❑ Ves ❑ No Drivers License No.
Vediicetion of Ownership by (rype ot tlocumen�. i.e. - properry tex bill or deed):
F�pires:
DIVISION OF INDUSTRIAL SAFETV PERMR CERTIFICATON:
❑ I hereby certity Ihat no exwvation five (5) or more leet in depth inm which e pereon Is requlred to descend, wlll be metle in wnnectlon with work aut�odzed by this
pertnit, entl that no building structure, s�eflolding, lalsework, or tlemolition or dlsmentling thereol, wlll Ge more then ihirty-six (36) leet high. (Chep. 32, Grp 2. Ar12, Sec.
341, 71t1e B, Califomla Administretive Cade).
❑ As owner-bullder, I wlll not employ enyone to do work which would require e permit Irom Ihe Divislon of InOustnel Safoty, es notetl ebove, unless such person hes e
pertnit to do such work trom the divisiM.
SigneWre: Dete:
Division of Industrial Safery Permil Number.
CEHTIFlCATE OF COMPLUWCE AND AUTHORPATION OF EMAY: I certily under penelty ot perjury �hel I heve read this epDlicetion end state thet �he infortnation given Is
conect. I apree to compy vrith ell siete laws erM dry oNinences relating to buildi�g constmction, and authodze representeUves of Ihe Ciry of Coste Mesa ro enter upon Ue
ebove-deuribed properry for inspection WTOsas. I egree not to oaupy or ellow xwpenry at eny building euthonzed by this permit unW finel inspection.
`_ igne re OI LeBal Owner(5) /_ Date
� M
Cz �O`n�
MNOr AuihorlYeA MD�i�en� Date
COOE I. INSVEC710NTYPE
1876 Flxotl System Flnal Fire Preventlon
1288 Pool Spe Final
200 Flnel RB-Roof
201 Flnel Block/Retaining Well
202 Final Factory Fira Place
203 Finel Sipn
204 Finel Demolitlon
Q�¢, � �1 a INSPECTIONTYYE
208 Final Mechenlcal
208 Finel Plumbing
210 Final Electricel
212 Final Flre Prevenilon
220 Final Plenning ApprOval
222 Final Slte
250 Final
�g ��
• Y- C
(714) 754-5273 • Fax (714) 754•4856 • wv+w.ci.costa•mesa.��LDING PERMIT » FAIR DRIVE, COSTA MESA, CA 92626
JobAddress: 2894 ELLESMEREAV
Suite:
Viciqity:
Primary Occ: R3 Type of ConsVuction: V-N
Parcel Number: 13927212 Zoning: R1
Applicant: REYNALDIO ESTRADA
Address: 1044 W ORANGE RD
SANTA ANA, CA
Owner: LEVIN, JACK A
Address 2894 ELLESMERE AVE
COSTA MESA, CA �
Convactor: KING ROOFING
Address: 7044 W ORANGE RD
SANTA ANA, CA
2ip: 92706
Arch :
Address:
Phone: 714-542-0101
Zip: 92706
Phone:
Zip: 9262&3604
Phone: 714-542-0101
License: 759061
" Eng:
� � � . Address:
Phone:
Status: ISSUED
Applied: O6/13/2005
Issued: O6I13/2005
ISSUED BY: �'
Phone:
Zip: , License: License:
SCOPE OF PERMIT
T/OFF COMp. SHINGLES INSTALL 2 LAYERS 15 LB FELT AND 30 YR COMP. SHINGLES.
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other:
Inspection:
Total
$0.00
$125.25
$0.60
$0.00
$0.00
$0.00
$125:85
SETBACKS
MAINSTRUCTURE Front 0-0 �
ACCESSORY �Front - -0. 0 � �
PARKING Existinq: o
NOTES:
f2ear 0- 0
Rear 0- 0
Required: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Left 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation;
Right 0-0
Righ'f 0- 0
Ss,000.00
ss,000.00
�. NOTICE: The Work euthodzed by lhis permit shall comply with all applicable handicap access requirements under Californla� statutes and related
regulations. (Ord. No. 9248, § 1, 12-21•92)
EXPIRATION: Thls permlt shall automatically explre and become void if work Is not commencetl withln 180 days, ar If work is suspended or abandoned
I for a pedod of 180 days.
INSPECTIONS: In order for the work euthorized under ihis permit to be considered legal, such work must comply wlih all appliceble cotles, end ell
requlred Inepectlons and tlnel epprovel must be obtflined. Fallure to obtaln Inspections and tlnal epproval will result In the expiratlon of this pertnit.
FOR INSPECTIONS CALL: (714) 754-5626
�
WORKERS'COMPENSAnON DECLARAnON: ' • �
I hereby aMhiT undar pBnalry of perjury o�a of tha following declarations:
❑ I heve antl will meimein e certificate af wnseN to sell-Insure for workers' compensatlon, es provitled for by sectlon 3700 of Ihe Labor Code, for the pertortnance of Ihe
work for whkli ihLq pertnit is issued.
I heve end wlll meintain woAcers' cortWensatbn insurence. es requiretl by seUlpn 3700 ot the Lebor Catle. for �he peAo�mence oi the work fw wNU� this peimit is Lssuetl.
rkers' compensaUon Insurence carrier antl policy number ere:
Pollty� / � � � % CS �
0/1955.)
❑ � certly t�et In the peAortnance of the work for which this pertnit Is IssueO, I shell not employ any person in any menner so as to become subject m ihe wwkers'
wmpensetlon laws af Celifomia, end e r' I should Cemme sub�ect to Ihe workers' compen5ation provislons of Secilon 3700 of the LeWr Cotle, I shall forthwiN
Ih Ihese Provisions. �)
pli SI �e: • oe�a� c� C—/ 3— n r
FNLURE TO SEWRE WOW(ER$' WMPEW^nT10N NVEMpE IS UNUWFUL AND S/ULL SUBIECT AN EMPLOYER TO CWMINAL PENALTIES AND CML FlNES UP TO ONE HUNDRED
TM�USPND OOILPiiE (Et00,WU), IN ADOrt10N TO THE CQST OF CqMPENSqTpN, pptlqGES AS PPAVIOED FOR IN SECTIIXJ 3]OBOf TNE LABOii CDDE, INiEREST, AND ATTORIiEY'S FEES.
LICENSED CONTRACTORS DECLAflAnON:
I hereby eM t I e Ilcensed untle provisions of Chapter 8(commencing wilh Sectlon 7000) of Divisian Business and Professlons Code, end my license is in full
lorce e G� I c�Z N
cont cto . re: —- � _ p 6— 7 3— U�
—�--•—'
CONSTRUCTION LENDING AGENCV:
❑ I �eroby aRirtn that there Is e conslNction lendinp apency lor Ihe peAortnance ot t�e work for which this permlt Is Issued. (Sec. 3097, Civil Cotle).
Lenders Nema: Lentler's AOtlress:
Signeture: Date:
OWNER-BUILDER DECLARATONS:
I hereby eXirm thal unCer penelry of periury thal I em EXEMPT FROM THE CON7RACTORS LICENSE LAW for Ihe lollawing reawn (Sec. 7031.5, Business end Prolessions
Catle: My Gry or counry which reQWres e pertnit to mnstrua, elter, imprwe, demdis�, or repair any sW cture, prior to Its issuance, elw requires the eppliwnt for such pertnii
lo rile a signetl stetement 1he1 he or she �s �ica�sed Dursuant to Ne provfsions of Ihe Canlrectors License Lew (Chepler 9(commencing wlth Secllon 7000) ai Drvlslon 3 ot ths
Business entl Professions Code) or that he ar she is ezempt Iherefrwn entl the besls for the elleged anemptlon. Any Ndetion of Section 7031.5 by any epplicant for e pertnf
sub�ects the appllcant ro e clWl penalry of not more lhan five hundretl ddlers (5500).):
❑ I, as owner of Ihe D�aPerry, or my emplayees with weges es �helr sole compensation, WILL DO THE WORK, and Ihe structure Is not Intended ar aHeretl for sele (Sec.
7044, Business and Professlons Coda: The Contraciors llcense Lew does not apply to en owner of property w�o builds or improves iheraon, and w�o tloes such work
himselt or herself or through his or her own employees, provided that such improvements ere not Intentled or oflered tor sele. tl, however, ihe building or Improvement is
sola within one year oi completion, Iha owner�huilder will have �he burden oi proving that he or she did not build or imDrove Por purpase of sale.). �
❑ I, es owner ol the properry, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the prolect (Sec. 7044, Business and Professions
Coda: The contractors License LeW does not eppty to en owner al propeny w�o builds or improves thereon, end who contrects for such prqect with e contrector(s)
license Oursuant to the Contrectors ��anse Lews.).
❑ I em exempt under sec. Busineu end Professions Code for ihis reason:
Signature: Date:
Owner ID veAfletl by drivers Iicensa. ❑ Yes ❑ No Drivefs License No.
VedticaUon af Ownership by (ypa ot tlowment, i.e. - properry tvc bill or tleadj:
F�ir85:
DIVISION OF INDUSTRIAL SAFETY PEAMR CERTIFICATION:
❑ I hereby Certlty Ihet no excavetion fNe (5) or more tee� In dep�h into which a person Is required to descend, will be metle In rnnnection with work authorized by Ihis
permil, end thet no building structore, scaHoltlinp, talsework, or tlemolition or dismaMfing t�areot, witl be more ihan ihiny-siz (38) feet high �Chap. 32, Gry 2, Art 2, Sec.
341, TitIB B, Celifomie Adminl5�retiVe Code).
❑ As owner-builder, I will nai employ enyone ta tlo work whic� would reQuire e pertnit Irom the DNislon ol Intluslrlel Sefery, es nated above, unless such person �as e
permil to do such work trom the tliNsion.
Signature: Date:
Division oi Intlustdal Safery Permit Numbec
CEHTIFlCATE OF COMPLIANCE /WD AIRNOROATION OF EHTFiY: I cenify under penalry ot perjury that I heve read this epplication an0 state that �he InfortnaLon gNen U
wrrec�. I egree la compN with ell stete laws end dry ordinances relaUng to Dulltling constructlon, entl euthodze representellves ot Ihe Clry of Coste Mesa to enter upon Ihe
ebove-descnbe0 property for inspectian purposes. I agree not to occupy or ellaw accupanty of eny building euthorized by this permit until final inspection.
Signature
nooe�. iHsvecnoNme
1818 Flxetl Syatam Finel Flre PrevenOon
1268 Pool Spe Finel
200 Flnal Re-Rool
201 FIna181ocWRelelning Well
202 Finel fedory Fire Place
203 Finel Sign
204 FlnelOemolitlon
���
um. '.
CO�E I INSPECf10N TYVE
206 Flnel Mechanical
20B Flnal Plumbing
210 Flnal Electrical
212 Finel Flre Prevemlan
220 Finel Plenning Approval
222 Finel Site
250 FInelBulltlinplOccupancy
PAg It�Lfl
CIT.Y OF;COSTA MESA
BUILDING DIVISION • ,
ROOF COVERING CERTIFICATION
Permit No. � J—�� ` W �P
T
Properry Address � 8 9 y-� � � t L� �YIS �2c- �`��) _
Owner Ck �- t-- � V � 1�C '
Contractor L� ► ntr („�C) b F I ti C
� C�
State Contractor License Number %��� �, Classification �_ � 1
I hereby certify that I have instalied, or caused to be installed, a minimum Class C roof covering at ihe
above address in conformance with Chapter 15, and Appendix 15 of the latest adopted edition of the Uniform
Building Code, and the installation instructions of the manufacturer.
❑ I turther certify that I am the owner of the property. (Owner-Builder permittee only).
[] I further certity that I am:
� Owner of sole proprietorship company
❑ Full partner of the company
❑ Limited partner of the company
❑ Officer of the corporation
I certiiy that as an authorized oHicer or agent of the company or corporation, I am empowered to make this
certification, which shall be binding on all successors or assigns of the company or corporation.
� shall deliver a copy of this Certi(ication to the above listed owner, after submittal of form to the Building
Division for acceptance.
Received by Building Division
By:
�
�n;ei d7 f
099ba6 MW 60p W ���a � BuAtlmq Div.: Ca�xy � Cmvac�or: PinF - Ovma
�/ il%�� - :KO O F � ►.( �.. ,
C mpany or Corporete eme
10L1/-1-(��.C�rLAti,r- �zn.
Add�ess
`� �- EY�L�'�ST�f4 r0/�
Printed m 7yped Name
� �1.�''l�
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 31� COSTA MESA. CALIFORNIA
fOR APP[/CANT TO f/[[ /N COMPLETECY
TYPE OR PRINT
ADD E'S5 2894 Ellesmere Avenue
COSTA MESA. CALIFORNIA
GI ARGH ITECT
1555 Placentia
B,W, Koll
NLEWL ILOT C(� I
S DESCRIPTION NO. J" BLOCK
�5'ZE 94x1oo
OF LOT
rvo.p-
LIC.
611
NO.OF BLDG3. O
NOW ON LOT
�EE RE�CEIVED
�LC� ..1-3-Gc
FINANCE DEPT.
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
FOR OFf/Cf USE ON[Y
I REGEIPTNO. I P A rlir/
flECEIVE�BY I UAT�RECEIVE� I ���E�B
L"! ..:i f io
COSTA MESA, CALIFORNIA
FIRE
ZONE TVPE GROUP b.
ZONING
ZONE/� NO. OF U8E OF
I� / I PLANS � BUILDII
• �
APPROVED
RV III a /�/ / OAT
USE OF NOIIB (CEHTER LINE ST.1
EXISTING BLDG. FRONT
SETBRCN LINE FflOM ( o �
cErvi[R op SinEei O REAR YARD 2V R.SIDE
SI�E YARD ILEFT � IRIGHT � L.SIOE
DESCRIPTION OF WORK „ ____
NG
�
I N-I C-
and Attached Garage
a i -�
1 HENEBY ALKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT 1 ABOVE 1 CONF[� T M1Fp AGPEE TO COM� THE AMOUNT SHOWN UNDER VALUATION IB FOR THE
PLY WITH ALL Y OtDINAN O /rl%5 HEGOLATING
PURPOSE OF E9TA9LISMING A PERMIT FEE ONLY.
BUILDING CON RyC.T DN. �1 � VqLUAT10N
SIGNATURE ,'1I Q ��^ PERMITFEE $ 3��
PERMIiTEE 5 /Q f �`h� � P�N CHECK $ � / '�
AUTHORIZED AGENT TOTAL FEE S `�` ��