HomeMy WebLinkAbout1953 FEDERAL AVE - Building Permits i��1J^'Za . • CITY OF COSTA MESA
4
�' BUILDING DIVISION
> , DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
Ft w ... i •
PERMIT J B03-01456 ,
-414tooreriso 4"
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.cam BUILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 1953 FEDERAL AV Status: ISSUED
Suite: Applied:- 08/27/2003
Vicinity: ROOF Issued: 08/27/2003 '
Parcel Number: 42251208 Zoning:
Applicant: SIMKO, BRIAN W ISSUED BY:
Address: 1953 FEDERAL AVE - .
Phone: 949-548-5665
COSTA MESA,CA ` Zip: 926274129
Owner: SIMKO, BRIAN,W
Address /1953 FEDERAL AVE
Phone: 949-548-5665
'COSTA MESA,CA Zip: 92627-4129 - .
Contractor: OWNER-BUILDER
Address: -
Phone:
Zip: , License: 000000 ' .
Arch : - Eng:
Address: , , - Address: '
Phone: - Phone: - - •
Zip: - License: License:
SCOPE OF PERMIT - .
TEAR OFF EXISTING ROOF.INSTALL 50 YEAR COMPOSITION SHINGLES;15#FELT,AND REPLACE SHEATHING AS NEEDED.1,100 S.F.
. INCLUDES ATTACHED GARAGE. - - -
- FEE SUMMARY
Plan Check: $0.00 ' Calc Valuation: ' ' •- $2,200.00.,
Permit: $83.25 Claim Valuation: 52;200.00
SMIP Res: $0.50
SMIP Corn: $0.00 ,
Other $0.00 '
Inspection: # ,$0;00 . ..- , -
Total: $83.75 .
' 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
•
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, 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 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
2448-46(6/W)
DECLARATIONS I f •' ,M
WORKERS'COMPENSATION DECLARATION: '
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a ceNficate 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:
Cartier. 4 Policy Number:
(This section need not be completed if the permit Is valued at one hundred dollars($100)or less.)
I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws m a and agree I should become subject to the workers'compensation provisions of Sectionon3700 of the Labor Code,I shall forthwith
comply withthese 0 j 2 7/cOS
Applicant Signatuwre: Date:
WARMNG:FAILURE TO SE WORKERS COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(5100,000),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm 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 effect.Lic.4 Class 4
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that 1 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 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 properly,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 pursuer - a Contra license Laws.).
iY7 I am axe: 1 •.r sec Business and Professions Code for this reason:
ature: -5Date: 81�,')jO�
Owner ID verified by driver's license. ',Yes ❑No Drivers License No. xpires: ,2,�1C�t>
Verification of Ownership by(type of doc e ,i.e.-property lax 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 thiM-six(36)feel 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 Califomla 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 Califomla 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 DoesB9or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
NO
(Section 25534 of the Califomla 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 appermlt 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 LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished 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? ❑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 a permit from the South Coast Air Duality 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 Colla Section 42303 been made? 0 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 an state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICA I • OMPUANCE AND • '•RIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
co
�
mply wi ate laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
abovrtilt
rope . . s.: ion purposes.I agree not to occupy or allow occupancy of any building authorized by it until final ns Ion.
�2 7 0
Signature Of Legal Owner(s) to
And/Or Authorized Applicant Date
BODE I IN Ptg➢gd.ffii PAIL ILLS CODE! INSPECTION TYPE Ia)E MUM
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1268 Pool Spa Final Z 208 Final Plumbing -.
p _
200 Final Re-Roof / 4 319�7 7 � 210 Final Electrical
201 Final BIook/Retaining Well 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
- ecre,
°1 ene4
%ffeaae6ifatidat,
Dcunion
•
t.-; ,f ➢ OWNER-BUILDER
VERIFICATION
A city or county, which is required to give notice pursuant to Section 19830, shall attach to such notice, and,
as a condition precedent to issuing a building permit, require the completion and require the return of, an
owner-builder verification.
Attention Property Owner:
An `owner-builder' building permit has been applied for in your name and bearing your signature.
Please complete and return this information in the envelope provided at your earliest opportunity to avoid
. unnecessary delay in processing and issuing your building permit. No building permit will be issued until this
verification is received.
1. I personally plan to.plovide the major labor and materials for construction of the proposed
property improvement:NW Yes ❑ No
2. I ave not) HR1 j signed an application for a building permit for
the proposed work.
3. I have contracted with the following person (firm) to provide the proposed construction:
Name
Address City_
Phone ( ) Contractor's Lie. No.
4. I plan to provide portions of the work, but I have hired the following person to coordinate,
supervise and provide the major work:
Name
Address City_
Phone ( ) Contractor's Lic. No.
5. I will provide some of the work but I have contracted (hired) the following persons to
provide the work indicated:
Name Address Phone Type of Work
104246 (REV.9/98) -
" ' - f n.P Larry R VMIL /—.1. ./b
JOB ADDRESS 1953 Federal Avenue BUILDING PERMIT NO. 42227
GENERAL CONTRACTOR Owner/111dr, DESCRIPTION of WORK Blockwal1
.. -Ar N.115-482-08 LOT TRACT FIRE ZONE VALUE $200.00
�°It. .CTIONS Signature Date TYPE GROUP ZONE R-1
tsoll. SUBCONTRACTOR PERMITS ISSUED
AGAS Dote I Number Signature
ATER Plumbing
I CROUGH PLUMBING
VVV PROP. SWR. LINE fl HOUSE CON. 0 iSPSINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING •
\TEMPORARY SERVICE OR POLE
UNDERGROUND ❑ POWER 0
ROUGH WIRING Heating and Vent.
TRENCHES Li FORMS LJ STEEL REINF. 0
FLOOR SYSTEM /YO Foo Tr Nr /N5pacne,V
BOND BEAM [l STEEL REINFORCE n - ALC, T-/7-2‘,. •
SHEATHING
FRAME AND FLASHING
LATHING - IN fl OUT
PLASTER, BROWN COAT
ST 'URAL, FINAL Electric
HE. ,.G. VENT., REFRIG. AND A.C., FINAL
PLUMBING. FINAL AND GAS TEST In
ELECTRIC, FINAL
BUILDING, FINAL RGA S-J?-/h
SPECIAL REOUIREMENTS
PPF—
422271-SFE"7`00 053.1- *****5.5C
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR STRUCTURAL PERMIT
For Applicant to Fill in Completely — Use Ink Only yyy
RECEIVED BY �.gATR�CEIEyEDy�/p l$5`ED/
BUILDING iys.3 Fe L°ral Au e. l/1-r/J —f/lu_) 'e/////_ // d`7
ADDRESS ,/ //y� /n• -[J q Qi P RMIT N
OWNER hArrMAIL II . vu// A.P. NO//r[r'4r1 se Q J.
ADDRESS/'I ,-CA-yr) ADDRESS I S� ( //''��1 1"1 1/'t`–
CITV 1� 4 m es A TNOL 6y616o4 TRACt7 1 Z LCtF{-°CI BLOCK ..
CONSTRUCTION NEW Dp ALTER REPAIR MOVING DEMO!ISH
LENDER
BRANCH Z.. Cb /f
ADDRESS
OWNER \ I,�^t�/�1\I ���sss �/
ARCHITECT TEL. USE�t�V v1' V VALUE d00.Y
OR ENGINEER NO
FIRE
ADDRESS hu; / `ply. ZONE TYPE GROUP
CONTRACTOR °W11Pr }(11\-1 APPROVED (t47L.. DATE,/(JTQyI ' ' ^7�ADDRESS
TEL. ZPANE NO.OF CI USE OF '/ 1
CITY NO. /` PLANS `--' BUILDIN � I
F STATE CITY YARDS APPROVED YARDS APPROVED
LIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING
14 SIZE INO.OF BLOCS. f (FROyyq�J/L STREET) �t
O. OF LOT NOW ON LOT FRONT/..—(0 F` \ FT.
Q USE OF `1 \
.�. EXISTING BLDG. R.SIDE FT.\ FT.
La
FSeparate permits are required for L.SIDEbO/ FT. \ FT.
G `electric,plumbing and heating work. REAR2—‘--) FT. FT.
G.1 USE OF BUILDING AND WORK TO BE PERFORMED
AINDISTANCELBET. BET.MAIN&
!1 //JJ �sJ) L ///� MAIN BL[Xv"'. ACCDATESS. SLOGS.
`� �ry1+?v/V�/J�/// VZClf�V VAR.+ DATE
�▪.I C.U.P.# APPROVED
Q
).. `J ��¢ �fiY R l D •A T E
! / �
..I
CO
W
at
O I hereby acknowledge that I have read this application and state
O m
Ce that the above information is correct and agree to comply with m
6, all laws regulating building construction, and I shall not employ
Z any person in violation of the workman's compensation laws of c
S the State of California. -
m
I hereby certify that I am properly licensed as a contractor under 5Q. FT. te
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the provisions of the State of California Business r -0 v
r
VALUATION PERMIT FEE $ L
and Professions Code,Division 3,Chapter 9. J m
Signature of/12(4
f/12 PLAN CHECK S C
Permittee5‘2 S�Vr7v U
TAX $ _L.J U.U.
u
Authorized Agent TOTAL PAID $ (.—CO
IPPANGE COUNTY BUILDI-
NG DEPARTMENT APPLICATION FOR PERMIT
636 North P B U 1 e ® ® N G
SANTA AN . ` q
"'`' FOR OFFICE USE ONLY
FOR APPLICANT TO FILL IN
RECEIPT NO. PERMIT NO.
AD REBSLDINFn a
ADDRESS 1953, P.de 1'F31 Ave.nCJ\/{/may .�J V
SCHOOL DIST. RECEIVED BY ATE OF APPL. ATE ISSUED
OR TOWN / -.23-
�{
CROSS T. 19th.St. 6 -23 j i . 2 fct
BUILDING I C� _3 �ri ,
/ L�
OWNER BANNOCK HOMES, INC. ADDRESS / e
MAIL 9363 WILSHIRE BLVD. SCHOOL DIST. cos nAv. Nes cr1
ADDRESS OR TOWN L-OJ/J� ,i
CITY BEVERLY HILLS NO. CR. 54361 NEAREST
CROSS ST.' /7 ,��/ i
ARCHITECT OR TEL. ZONE NO. OF TYPE I GROUP
ENGINEER GAIN R MCKERRACHER NO. SY. 64891 N / I PLANS J
ADDRESS2110 E. WALNUT ST. PASADENA SETBACK LINE FROM CENTER OF ST. 55 ft
TEL. REAR YARD 25ft. ' SIDE YARD 1 O1 __ta1 AII
VTRACTOR NEWPORR VISTA CC.NO. CR. 54361 APPROVED
BY DATE
ADDRESS9I6I WILSHIRE BLVD., BEV.HILLS
CORRECTIONS
LEGAL
DESCRIPTION I LOT NO. 1409 I BLOCK 171? '
(ATTACH METES $ BOUNDS) _ _ ,_
TRACT
I NO.OF BLDGS.
SIZE OF LOT 4-
( x 1 1(I NOW ON LOT 0
USE OF I NO. OF I NO. OF
EXISTING BLDG. FAMILIES ROOMS
DESCRIPTION OF WORK
NEW I x I ALTERATION I ADDITION I 0
O
REPAIR I I MOVING I I DEMOLISH I 4 Z
D
SIZE
BUILDING NO. OF 1034 D___
SFT ROOMS 5 STORIES 1 / E
WALL I ROOF COMPOO eI //
COVERING STUCCO COVERING CMPO FS ted"
USE OF NEW F/
BUILDING RES IPENCE r
IP0..x" 4.(xt
APPROVALS
FOUNDATION: LOCATION INSPECTOR I�jt
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS FORMS. MATERIALS, AINSP1 S
APPLICATION AND STATE THAT THE ABOVE IS CORRECT UNDERPINNING lA "�
AND AGREE Tb COMPLY WITH ALL COUNTY ORDINANCES FRAME: FIRE STOPS. n f7 /yd j/ y
BRACING. BOLTS .--)2 7) -] 4.`.1
AND STATE LAWS REGULATING BUILDING CONSTRUCTION. ��_�
LATH. INT. //��//ZA� /�
SIGNATURE OP NEWPORT TA CO. LATH. EXT. A '�_} 4 9..3 4
PERMITTEE
/�` ,PLASTER. INT.
AUTHORIZED At' /.f w ��>Q. LA ii /� /���
PLASTER, EXT. �//L.,13
$ 4830.00 P. C. $
MASONRY REINFORCED
FEE 1 v
$ / BOND BEAM
l
VALUATION �� /4 r jE
a FEE FINAL L(/f(/^a J
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