HomeMy WebLinkAbout1616 ELM AVE - Building Permits O q CITY OF COSTA'MESA •
�`y ►, BUILDING DIVISION •
DEVELOPMENT SERVICES DEPARTMENT
J. . . PERMIT PERMIT NUMBER
bnm
B99-00129,
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 1616 ELM AV Status: ISSUED
Suite: Applied: 01/26/1999
Vicinity: Issued: 01/26/1999
Parcel Nunmber: 13931222 Zoning: R1 R1
Applicant: MARTINEZ, GEORGE
Address: 10415 SLUSHER DR
Phone: 562-906-7773 ._
SANTA FE SP CA Zip: 90670
•
Owner SHORES; CALVIN H
Address 1616 ELM AVE
• Phone: •
COSTA MESA,CA Zip: 92626
Contractor: AMERICAN HOME IMPROVEMENT
Address: 10415 SLUSHER DR
Phone: 562-906-7773
SANTA FE SP CA
Zip: 90670 License: 721379
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
• SCOPE OF PERMIT
CHANGEOUT OF 3-WINDOWS(LIKE FOR LIKE)IN EXIST DWELLING.
•
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $1,500.00
Permit: $48.50 Claim Valuation: $1,soo.00
SMIP Res: $0.50 •
SMIP Com: ' $0.00
Other: $0.00 _
Inspection: $0.00
Total: $49.00 .,
•
•
PLANNING &ZONING •
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0:0 Left - 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 . Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTES:
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
WORKERS'COMPENSATION DECLARATION:
I I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed if t : •_rmif is V.lued of one hundred dollars($100)or less.)
❑ I certify that in the perform=• e of e wo r which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of Car•mia, : d egr:- at If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provi '•ns. -
Applicant Signature: -di-44a Date: / —7-4 ' r
WARNIi
AFAILUREE( - - �, LIT;SATION MPENS IS UNLAWFULAMAND SRLL SUEFOR I NSECTION
EMPLOYER TO CRIMINALTHEL OR CODE,I AND CIVIL FINES UPrO NO ONE EENDRED
S.
THOUSAND OOLLARE( •� COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3106 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTE ORS DECLARATION:
I hereby affirm that I am licensed und: • 'visions of hapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.# _ — Class 4
Contractor's Signature: � — Date: /'z G-99
CONSTRUCTION LEN AGENCY:
❑ I hereby affirm 7r there is a construction le 1•ing agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business end Professions
Code:My city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I.as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or Improvement Is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec.7044, Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet In depth Into which a person Is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes ❑No
(Section 65850.2 of the California Government Code requires that the requested information 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 feet from the outer boundaries of a school? 0 Yes 0 No
(If'yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If aermit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No
8 (If yes',attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions. o p
Signature: _ Date: / -Z 6 -` /
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply w' ' -II state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described prope ection •urposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Ade
?�- : •• Legal Owner(s) Date
dir:j�r :nd/Or •uthorized Applicant Date
COLS Arm'. I- 3 DATE IN AL4 CDDF! INSPECTIONTYPF peg WOWS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention _
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site /`,�
204 Final Demolition 250 Final Building/Occupancy �^Z p�_ £
2446-46
. . —...f
•
V. PROJECT ADDRESS: 1616 ELM AV UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 061640
OWNER'S NAME;SHORES, CALVIN H
ADofless:1616 ELM AVE PERMIT NO: B 061640 PLAN CHECK NO: N GOVT: N SUPP : N
COSTA MESA, CA 92626
CONSTRUCTION TYPE: 5—N PERMIT TYPE: STR PURPOSE: ALT
ARCN/ENGINEM:9 7 9—4 4 2 6 REG.NO.:
ADOESS: UNIT: JOB DESCRIPTION : T/O EXIST REROOF W 3—TAB SQ FT: 2, 500
PERMITTEE:_, 4 CLAIM VALUE: 2, 500 . 00 CALL—VALUE: 2, 500 . 00 GROUP OCC: R-3 /
ADDRESS:LEE ROOFING ( 714 ) 642-7223
2-7223
1653 SUPERIOR COMMENTS: SMOK DETEC PER 1991 ED UBC
COSTA MESA CA 92.627 *********#*******x*.%..%.X*****%****.*.%.*.%.%***>F%****XB*****xr,.#.%.%..%.a.%.,c.%. -%_*.x> *N*—X.%.%.x-X**
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. SETBACKS
ITT LIC.;x2875'. STATEUC.:349686 CLAS •C-39
Date:— i,--- C15 signature: _^l`Sh Tb�Y MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm that l have a certifica 4 onsent to self-insure or a certificate of workers' FRNT: FT . IN REAR : FT IN FRNT: FT IN REAR: FT IN
Compensation Insurance,or a certified copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLICY NO.:1300948-92 EXP. DATE: 06/30/93
COMPANY:STATE FUND_ PARKING REQ PROV: PARCEL: 13955102 ZNE: REF NO:
❑ Cembed copy is hereby furnished. X_I Certified copy is tiled with th city Building Division. PLANNING PLANNING NOTES>
, rr�� /,, ..� > - .r
LIMP ��'T`� L`> Applicant; Witt' rK-.+� #******#*****3(3 *.k*K************************** ******lF* **Y****%**#*3F,jE�!(-********4
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section nee t b completed if the permit is to one hundred($100)or less). DE V .�( O P M E N T SER VICES R E Q U 1 R E M E N -"I S
,. I certify that in the performance of the work for which this permit is issued,I shat employ any person in any manner so as to become i.^ • '
subject to the workers Compensation Laws of California- i ZONING APPROVED BY • DATE: ,
Date: Signature:
NOTICE:If.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : , DATE:
Code,you must fodhwith comply with such provisions or this permit shall be deemed revoked. i
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION I SS`UED B Y: _ ' —'' DATE; 'L{-c,7 6 S
which this permit is issued(Section 3097,Civ.C). ---
******************-X-K-#*X.* ******x+t' aw ' *,vier fE * •it*K'wx. **.rt, it ********x.********A-it-a-#*
•LENDER: ,!' *14-*1E******7F*#**K*fE*****#*#K*****#*******klF***X•*******%.X.***%K**********3i#********
ADDRESS: LEGALIZATION:N F E E SJMMARY STRUCTURAL SEC,NIENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that lam exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SNIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or ,
repair any structure.prior to its issuance,also requires the applicant for such permit to Zile a signed statement that he/she is licensed PERMIT 54 . 00 5 0
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the BusinessSNIP/NON-RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN I1
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE •
I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV-> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS————> 54 . 50 0 . 00 0 . 00 54 . 50 54 . 50 . 00
• does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through
his or her own employees.provided that such improvements are not intended or offered for sale. It,however the building or
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED: 54 . 50 OVER/SHORT: 00
I for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I,as owner of the properly,am exclusively contracting with licensed contractors to construct the project(Section 7944.Business 54 . 00 . 50
❑ and Professions Code. The Contractors'slate License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'Slate LicenseLaw). l am B.&P.C. aware **.%*#*******#*X.ip*.i(.x.*.*.*.***.*i¢**k*KIF**!l.*****f(.*.*y:*.**.**K*.x.:c.%*X#*if*?(*iF##**X-3f****1P Kt(#±k
that proof of their Worker's Compensation insurance should be provided to me.
o am exempt under Section: I N D I V I D U A L F E E B R E A K D O W N
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: Owner:
do hereby certify mad am aware of and understand the requirements of Calimrnia Health and safety Code Sections 25505,25533,and SFR 2500 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 2, 500 . 00
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a END OF FEES
permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from
these provisions.
Date; Applicant:
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county
or mantes and state laws relating to building construction and hereby a horize rept sentalives of this city to enter upon the abo e-mentioned
raperty for inspection purposes. zU1�L � �/'(J/�/�,/{�
Dater K/ �3 Signature;_ - ' �% til `�-z -
Driver's License or Social Security h:
164L46 Wmte—Building:Green—Code Enforcement;Canary—Applicant;Pink—Revenue:Goldenrod—Assessor � � - • � �
CONSTRUCTION AND PLANNING POOL lA
�I Date Inspector Date Inspector
APPROVALS Permit# APPROVALS Permit #
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location • .
2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement
I
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd.
I
10. Structural Floor System • 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection -. ' 62. Backwash & Receptor-Final
I 12. Sewer Cap 63. Heater& Vent-Final -
i
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing • 65. Electrical-Final
15. Rough Electrical-Conduit , 66. Solar System-Final
, 16. Rough Electric Wiring . ' 67. Fencing & Access Approval
I •
17. Rough Wiring Sign68. APPROVED FOR PLASTERING
18. Rough Electrical-7 Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas J Oil
25. Roof Sheathing VO j n, 74. Overhead Hydro
26. T-Bar Ceiling (Structural) Si Monocoat '�" 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing& Siding ' I 77. FIXED SYSTEM FINAL
.
29. Insulation I 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat • 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric i • I Notes: ,G'
34. Final Heating& Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy I •
37. Final Factory Fireplace ( -
38. Final Plumbing
39. Water Service-Final '
, 40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer I
• 43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations r
• 47. FINAL STRUCTURE & BUILDING '`/"I(t 4 �e_
48. FINAL PLANNING If J ot•'
49. Electric Release to Edison •
•
50. Gas Release to Southern California Gas Co I
51, CERTIFICATE OF OCCUPANCY
/- Vo. Date
•
I
•
10759
FEE RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT �
. R O.BOX 317 COSTA MESA. CALIFORNIA �C:Gd//--V.-S
TOR APPLICANT TO FILL IN COMPLETELY APPLICA}�ty K€MPc iRMIT
TYPE OR PRINT GB��1 I Dc9la MESA
ADDRESS 1616 Elm Street •
COSTA MESA, CALIFORNIA FOR OTT/CE USE ONLY
OWNER Knightwell Land Company RECEIPT NO. PERMIT NO.
T+ 1. nay, y g_0'7
MAIL 419 E. 17th Street RECEIVED Y DAT/E RE
EL/IVED DATE !ISSUED
ADDRESS Calif. I lb 7. I M0\-1 c MC
CITY Costa Mesa, CTELL' 81159 ADDRESS ! ti 1 �i •
ARCHITECT Carlson & LIC.
OR _._-1NEER _l _„_k NO. COSTA MESA, CALIFORNIA
AL .5 Garden Grove FIRE
�" -a,
ZONE TYPE GROUP
u e o egrove, nc• STATE 167293
CONTRACTOR LIC.NO. APPROVED
St.,
BY DATE
ADDRESS 419 E. 17th St., Costa Mesa ZONING
LEGAL LOT p 3487 Z NO.OF UBE OF NEW 1 /�7
DESCRIPTION I NO. O2 I BLOCK I TRACT /� I PLANS .1._..,
I BUILDING I /
A.P.NO. APPROV D ( I ' ✓ ^� �,]
BY (A/C-f DTE /I � 1 /
SIZE 75' x loot I NO.OF BLDGSNone YARDS BS-E�/ 5
OF LOT NOW ON LOT REQUIRED ALLOWED
USE OF (CENTER LINE ST.)
EXISTING BLDG. None FRONT �/ V
. IN.
CENTER OFI STREETM 23' REAR YARD 22' R.SIDE / IN.
SIDE YARD ILEFT 51
RIGHT 101 L.SIDE FT. IN.
DESCRIPTION OF WORK ^'
REAR /�' FT. IN.
NEW I XII ALTERATION II ADDITION
REP.. I II MOVING I DEMOLISH I /
BUILDING
ROOM 7 STORIES 1 aa r/
SZI 1647 ROOMS
EXTERIOR WAL ROOF ) fl
COVERING �t11C00 COVERING Rock / W
•
USE OF BUILDING AND WORK TO BE PERFORMED
Single family residence with
attached garage
Plan 760 AR ,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
BUILDING CONSTRUCTION
VALUATION
SIGNATURE OFr. PERMIT FEE $ 36.00
PERM ITTEE /" --
$ 1_--- PLAN CHECK $ 18.00
AUTHORIZED AGENT Dike & Col grove, Inc. TOTAL FEE $ 54.00 rn