HomeMy WebLinkAbout443 ELMHURST LN - Building PermitsCITY OF COSTA MESA
��'tpMFs BI/ILDING DIVISION
F.., � 77 FAIR DRIVE, COSTA MESA, CA 92626 • p14) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
° � FOR MSPECTIONS CALL: (714) 754-5626
�"'°'""°`� PERMIT NUMBER: E10-00106
PERMIT TYPE ELEC
APN: 14137229
JOB ADDRESS: 443 ELMHURST LN CM '
Vicinity: - ,
STATUS:
DATE ISSUED:
ISSUED BY:
Suite/Unit: ,,
ISSUED
0610912010
RMD
SCOPE OF WORK: ELEC7RICAL PERMIT TO UPGRADE SERVICE PANEL TO 200A AND RELOCATE PANEL 10".
OWNER: BIALECKI MICHAEL D/PLASTER NIKKI M Add2ss: 443 ELMHURST LN Unit: '-
PHONE: 949-633-1490-` , - CitylState/Zip: COSTA MESA, CA -
APPLICANT: MCCUTCHEON, GEORGE � , , � Address: 3929 W STH ST Unit:STE 107
PHONE: 949-939-8372 - �' City/State/zZip: SANTA ANA, CA .
CONTRACTOR: THE�ELECTRICIAN
Address: 3929 W STH STUnit: STE 107
City/State: SANTA ANA, CA ZipCode: 92703
ELECTRICAL PERMIT FEES
Electrical Plan Check Fee: $0.00
Electrical Permit Fee: $54.00
Reinspection Fee $0.00
TOTAL FEES $54.00
License No. 680424 �.
PHONE: 949-939•8372
CELL:
NOTICE: The work authorizeq by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: 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
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
CODE1. INSPECiIONTYPE OATE INTf11AL5 COUE� INSPEC110NTYPE DAIE IN7ITIRLS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing SLLSLL
200 Final Re-Roof 210 Final Electnwl ��
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Appmval
203 Final Sign 222 Final Site
204 Final Demoiition ' 250 Final Building/Occupancy
WORKERS' COMPENSATION DECLARATION:
I hereby aKrm under penalty ot perjury one of the following declarations:
❑ I have and will maintain a certifcate o( consent to self-Insure for vrorkers'
compensation, as provitled tor by section 3700 of the Labor Code, for the
peAortnance of the work for which lhis permit is issue0.
❑ I have and will maintain wnrkers' canpensalion insurance, as required by
sectbn 3700 of the Labor Code, for Ihe performance o( the work for which this
pertnit is issued. My vrorkers' compensation Insurence wrner and policy
number are:
Cartiec
(This se[fm nee0 nof Oe romp'eteCR I�e pe�mA a valueCaf ine huntlred daMars (5100) nless )
Policy Number:
U�.—�cef rtify ihat in Ihe performance o( the work for which this pertnit is
issue0, I shall not employ any person in any manner so as to become subject
ro the workers' compensation lav+s of Califomia, and agree thal if I should
become subject ro the vrorkers' compensation provisions of Section 3700 of
the Labor Code, I s II forthwith comply wilh these provisio .
\ D
Appli�nCs S1gnaWre
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
(3100,000), IN ADDITION TO THE COST OF COMPENSATION, DAFMGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrtn that I am licensed untler provisions o! Chapter 9(commencing
with Section 7000) of Division 3 0! the Business and Professions Cotle, and
my license is/i_n full (orrtce an`d effect.
(yic '�—��C:�`I��I ciass-�ff"�
0
Can2clors �gnaWre +
CONSTRUCTION LENDING AGENCY:
❑ I hereby a(�um that Ihere is a construc�bn lending agency for Ihe
pertortnance of the wvrk fa wfiich lhis permit is issued (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
OWNER-BUILDER DECLARATIONS:
I hereby affrm Ihat untler penalry of perjury that I am EXEMPT FROM THE
CON7RACTORS LICENSE LAW for Ihe follovring reason (Sec. 7031.5.
Business and Pmfessions Code: Any ciry or counry which requires a permit to
consWct, alter. improve, demolish, or repair any sWCNre, prior to its
issuance. also requires Ihe applicant for such permit to file a signetl statement
that he or she is licensed pursuant to the provisions of Ihe Contractors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business and Pmfessions Code) or that he or she is exempl theretrom and
the basis !or the alleged exempGon. Any violation of Section 7031.5 by any
applicant for a pertnit subjects the applicant to a civil penalty o( not more than
five hundred dollars ($500).):
❑ I, as ovmer of the property, or my employees vnth wages as their sole
compensation, WILL DO 7HE WORK, and the sWCNre is not intended or
oflered for sale (Sec. 7044, Business and Pmfessions Code: The Coniractors
License Law does not apply to an owner of property who builds or improves
ihereon, and who does such vrork himself or herself or ihrough his or her own
employees, providetl ihat such improvements are not intendetl or oRered for
sale. If, however, the building or improvement is sold vrithin one year of
completion, the ovmer-builder will have the burden of proving t�at he or she
did not build or improve for purpose of sale.).
❑ I, as owner of lhe property, am EXCWSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to conslruct the project (Sec. 7044, Business and
Professions Code: The contractors License Law dces not apply to an ovmer of
property who builds or improves thereon, and who contracis for such project with
a contractor(s) license pureuant to lhe Contrac[ors License Laws.).
❑ I am exempt under sec.
Business and Professions Cotle for this reason:
Signatore
�OS1�46 �3/0]�
Ovmer ID venfed by driver's license. ❑ Yes ❑ No
Driver's License No. Expires:
Verifcation of Ownership by (type o! document, i.e. - property tax bill or deetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certHy that no excavation frve (5) or more feet in depth into which a
person is required to descend, vrill be made in connection with work authorizetl
by this pertnit, antl that no builtling stmcWre, scaffdding, falsework, a tlemolition
or tlismantling thereof, vrill be more than thirty-su (36) feet high. (Chap. 32, Gry
2, Art 2, Sec. 341, Title 8, Cali(omia Administrative Code).
❑ As owner-builtler, I will not employ anyone lo do work wliich would
require a permit from the Division of Industrial Sa(ety, as noted above, unless
such person has a permit to do such work from [he Oivision.
Appliranl's Signalure pate
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 (or emergency response to release or threatened
release of a hazardous matenal? ❑ Yes ❑ No
(Section 25505 of [he Calitornia Health and Safety Cotle requires, with some
exceptions, that a Business Plan be fled wilh the Costa Mesa Fire
Department by every business which has at any one time tluring a reportetl
year a quantiry ot hazardous materials equal to or greater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet ot compressed gas
at stantlard temperature and pressure).
2. Does or will the applicant or present or fuNre building occupant neetl to file
a registration form for acutely hazardous materials7 ❑ Yes ❑ No
(Section 25533 of the California Health and Safery Code, with some
exceptions, requires registration with lhe Costa Mesa Fire Depahment by
each business which at any one time has on hand a quantity of acutely
hazartlous materials equal lo or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet o( compressed gas at slandard
temperature and pressure).
3. Does or will the applicant or present or fuNre building occupaN need to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous malerials)? ❑ Yes ❑ No
(Section 25534 of [he Califomia Health and Sa(ety Cotle pmvides that the
Costa Mesa Fire Depariment may require the preparation, certification and
filing with the Fire Department of an RMPP by businesses which are requiretl
to register acutely hazardous matenals with the Fire Department.
4. If an RMPP is presently required, has Section 25534 of the California
Health and Safery Code been tully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or tuture building occupant require for
the work which is the subject o( this appliwtion a permit for such construction
or modifcation from the South Coast Air Quality Management District or from
any other air polWtion control tlistrict or agency? ❑ Yes ❑ No
(Section 658502 0( �he Calitomia Govemment Cotle requires Ihat the requested
infortnation be fumished on applica[ions !a non-residential building pertnits�.
6. Will any part of the facility to be constructed under this permit be within
7000 feel from the outer bountlaries of a school? ❑ Yes ❑ No
Qf'yes", the facility must meet the requiremen[ of Sections 25534 and 42303
of the California Health and Safety Code).
7. I( a permit from the South Coast Air Qualiry Management District or other
air pollution con[rol district or agency is required for Ihe work which is the
subject of Ihis application, have all of the disclosures prescribed by Califomia
Health antl Safety Code Section 42303 been made? ❑ Yes ❑ No
8. (If "yes", attach certificate of compliance from the appropnate air polWtion
control offcer).
CER7IFICATE OF COMPLIANCE: I certify Ihat under penalty ot perjury the
information given above is correcL I agree to comply with all state laws and
city ordinances regarding Hazardous Matenals and Emissions.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certi(y under penalty ot perjury that I have read this application antl state that
the information given is correcL I agree to comply with all state laws and city
ordinances relating to building construction, and authorize represematives of
the Ciry of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this pertnit until fnal inspection.
Si9^alure f Legal Ovmer�s) Da�e
ArMIOr'AUN e0 AOOlirant b-� �'Oale
(714) 754-5273 • Fax (714) 754-4056 • www.ci.costa-mesa.c�UILDING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626
Job qddress: 443 ELMHURST LN
Suite:
Vicinity: ROOF
Parcel Number: 14137229
Applicant BARRY HALL
Address: PO BOX 1740
Zoning:
� Phone: 714-9663048
COSTA MESA;�CA' � � - � Zip: 92626
Owner. GRAY, GARY C TR � �
Address 807 VIA LIDO SOUD
, - � � ' Phone:
MEWPORT BEACH, CA � Zip: 92663
Contractor: COIVSTRUCTIVE IMPROVEMENTS
Address: PO BOX 1740 �
COSTA MESA, CA
Zip: 92626
Arch ;
Address:
Zip:
Phone:
. � License:
Phone: 714-9663048
License: 751535
Eng:
Address:
Status: ISSUED
Applied: 07l09/2003
Issued: 07/09/2003
� J
ISSUED BY: �
Phone:
License:
, .
SCOPE OF PERMIT
TEAR OFF EXISTING ROOF. INSTALL 30 YEAR, COMPOSITION SHINGLES, 30#�FELT, AND REPLACE SHEATHING AS NEEDED. 1,500 S.F.
INCLUDES ATTACHED GARAGE. "
Plan Check:
Permit
SMIp Res:
SMIP Com:
Other:
Inspection:
Total:
$0.00
$97.25
$0.50
$0.00
$0.00
$0.00
597.75 .,
SETBACKS
MAIN S7RUCTURE Front 0- 0
ACCESSORY Front 0- 0
PARKWG Existing: � o
Rear 0- 0
Rear 0- 0
Required: 0
FEE SUMMARY
PLANNING & ZONING
Left 0- 0
Left 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation
RigM 0- 0
Right 0- 0
$3,800.00
$3,800.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, antl all
required inapections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (774) 754-5626
2446-46 (6/00)
WORKERS'COMPENSAnON DECLARAnON: � �
I hereby effirm under penalry oi perjury one ot the tollowing tledarations: ' �
�
❑ I heve end will maintain a cenificate oi consent ro sel4lnsure lor workers' compensation, as provided for by section 3700 of the Lebor Cotle, tor Ihe pertortnance oi tha
work tor which this Dermit is issued.
�, I have antl vrill maintain workers' compenuUon insurance, as required by section 3700 of the Lebor Cotle, for the pertortnance of the work for which ihis pertnit is issued.
My,workqrs' compensation urence c�rl�r antl policy number are:
Cerrier: �CtRf� /N � PoliryNumber.
(This section need nof be complefe0 i/ the pertnif is va/ued et one hundred dollars ($ f 00) or /ess.)
❑ I certify that in Ihe pertortnan f the work tor w'ch this permit is issue4 I shell not employ any person in any manner so es to becoma subjeq to the workers'
compensatlon laws of Cal' la, and egree th t I s�ould become subject to the workers' wmpensation provisions of Saction 3700 0l ihe Lebor Co�e, I shall forihwith
compty wiih these p �7 '7
Applicenl SignaNre: Data: '!�� �'— n l
WARNINO: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CFIMINAL PENPLTIES AND CIVIL FINES UP TOONE HUNDRED
THOUSAND OOLLAFE (5100,00p), IN ADORIpJ TO THE COST OF COMPENSAiION, DAMAGES AS PflOVI�ED FOR IN SECiION 3106 OF THE LABOR COOE, IMEREST, AND ATTORNEY'S FEES.
LICENSED CON7RACTORS DECLARATION:
I hereby attirm that I am
torce antl ettecl. Lic. q_
Comredofs Signature,
9(commencing with Section 7000) of Division 3 af the Business end Pr euions Cade, end my license is in tull
Class x'
Date: % " �� n
CONSTRUCTION IENDING AGENCV:
❑ I �ereby aHirm that there is a construciion lending agency for the performance ot the work for which Ihis permit is issued. (Sec. 3097, Civil Code).
Lendels Name: Lendefs Address:
Signature: Date:
OWNER-BUILDER OECLARATONS:
I hereby aflirtn Ihat under penelry of perjury thet I am E%EMPT FROM THE CONTRACTORS LICENSE LAW tor the followinq reason (Sec. 7031.5, Business antl Professlons
Code: Any ciry or counry which requires a permit to construct, alter, improve, tlemdish, or repair any stmcture, pnor to its issuance, also requires the epplican� for such permit
to file e signea statement Ihat he or sha is Ilcensetl pursuant to the proNsions of Ihe Coniractors License Law (Chaptar 9(commencing with Seciion 7000) oi Division 3 oi Ihe
Business antl Pmtassions Code) or that he or she is ezempt therefram and the basis tor the allegetl evempiion. Any violation ot Section 7031.5 by any applicent tor e permit
subjects Ihe applicent to a civil penalry of not more than five hundred dollers ($500)J:
❑ 1, es owner oi the properry, or my employees with wages es iheir sole compensation, WILL DO TT1E WORK, antl the structure is not intended or oHeretl for sele (Sec.
7044, Business end Pmfessions Code: The Contractors License Ww dces not appty to an owner of properry who builds or impmves ihereon, and who does such work
himself or herself or Ihrough his or her own employees, pmvided thet such improvements ere not intended or ottered tor sale. If, howaver, the building or improvement is
sold within one year ot completion, ihe owner-builder will have t�e burden oi proving ihat he or she did not build or improve tor purposa ot sale.). '
❑ I, as owner of the proDerty, am EXCLUSIYELY CONTRACTING WITH LICENSED CON7RAC70RS to conswa the prolect (SecJ044, Business and Pmteuions
Cotle: The comrecbrs License Lew does not apply to an owner of property who builds or improves Ihereon, antl w�o coniracts for such project with a coniractor(s)
license pursuant �o the Coniractors License Laws.).
❑ I am enempt under sec. Business and Professions Code for Ihis reason:
Signature: Date:
Owner ID verilietl by tlrivefs license. ❑ Ves ❑ No Dnvefs License No. Expires:
Venfication of Ownership by (type oi tlocument, i.e. - property ta�c bill ar �eetl):
DIVISION OF INDUS7RIAL SAFEN PERMIT CERTiFICATION:
❑ I hereby cetlify Ihet no excavation five (5) or more feet in depth into which a parson is required to descenq will be ma0e in connection with work authonzed by this
pertni6 and Ihat no building sWcture, scaffoltling, falsework, or tlemolition or dismantling Ihereof, will be more than thiny-six (36) feet higR (Chap. 32, Grp 2, Art 2, Sec.
341, 71pe 8, Califomia Administrative Cotle).
❑ As owner�Duilder, I will not employ anyone to tlo work whic� would require a permit irom the Division of Industnal Sefety, es noted ebove, unless such person has a
permit to tlo such wark irom ihe division.
Signature: Date:
Division oi Industrial Satery Permit Number:
CERTIFlCATE OF COMPLIANCE AND AIJfHORIZA710N OF ENTfiY: I cenity under penalty ol perjury ihat I have read this apDlication and state that ihe intormation given is
wrrect. I egree to comply with all state laws and dry ortlinances relating to builtling construction, end euthonze representatives of ihe Ciry ot Costa Mesa to enter upon Ihe
ebove-describetl property for inspection puryases. I egree not to occupy or allow occupancy of any building authorized by this pertnit until final inspeciion.
Of Legal Owner(s)
CQDE I. INSVECf10NTVPE
1616 Fixed System Final Fire Prevention
1266 Pool Spa Final
200 Flnal Re-ROof
201 Finel Block/Retaining Well
202
203
Final Factory Fire Place
Final Sign
204 Final Demolition
�� �
��` �.61iL
CQOE 1 INSYECTION TYPE
206 Final Mechanical
20B Final Plumbing
210 Final Electricel
212 Final Fire Pravention
220 Final Planning Approval
222 Final Site
250 Final BuilaingiOccupancy
�g �
, Costa Mesa Bailding Department
�'"� 111 EA8T 20th STREET
' COSTA MESA,.CALIFORNIA
I FO�APPLICANT TO FILL IN
F3a
Costa Mesa, California
�
Metea and
04
New
No.
LiC.
No.
Block I Tract L
INo. of Bidgs
Now on Lot
No.of No.of
Families Rooma
Rear Yard ¢
SideYard �
r oF woRg
1 I I Addition I
II Demolish I
of
ms Stories
APPLICATION FOR PER �
���� BUILDiNG
FOR O�'I+'ICE USE ONLY
Recelpt No. Permit N�
� 9��
Received'by D te Redd. Date Isaui
- i� ��7� �"� I ��x fa,
Address
Costa Mesa, California
Nearest
Cross St. �
of � Type
CORRECTIONS
riny � covering APPROVALS
_ of New
Building Residence & betached Foundation Lacation inspector
Forms, Materials,
(Tay�? � Under-Pinning
� Frame: Fire Stops,
Bracing, Bolts
I hereby acknowledge that I have read this ApplicaUon
and state that the above is correct and agree to comply Lath. Int.
with all City Ordinances and State Laws regulating
building construction. Lath. Ext.
Signatureof
Permittee Harbor Construc 10 CO. Plaster,lnt.
Authorized Agt. Plaster, Ext
Valuation Permit Fee $�si -�� Masonry Reinforced
, Plan Check $ % '��
Bond Beam
$ 11 � 200. Total `
Fee $ � FINAL
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