HomeMy WebLinkAbout3391 CARMEL DR - Building Permits,
{� � �� ' CITY OF COSTA MESA ~
�,�'RpMfq BUILDING DIVIS/ON
'`�� 77 FAIR DRIVE. COSTA MESA. CA 92626 •(714) 754-5273 • Fax (774) 754-4856 • vnvw.ci.costa-mesa.ca.us
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� FOR INSPECTIONS CALL: (714) 754-5626
�"'�� PERMIT NUMBER: M09-00052
PERMIT TYPE MECH
APN: 41210203
JOB ADDRESS: 3391 CARMEL DR CM
Vicinity: SIDE YARD AND GARAGE
SQ. FT: 0
STATUS: ISSUED
DATE ISSUED: 06I25/2009
ISSUED BY: RMD
Suite/Unit:
SCOPE OF WORK: MECHANICAL PERMIT TO CHANGE OUT AND RELOCATE A/C UNIT TO SIDE OF YARD AND CHANGE OUT
FAU, SAME LOCATION (LOCATED IN GARAGE). REF#: E09-00169
OWNER:
PHONE:
APPLICANT:
PHONE:
NAJARIAN, WAYNE M
MORALES, MARC
949-254-0511
CONTRACTOR: DYNAMIC AIR SYSTEMS
Address: PO BOX 11377Unit: PHONE: 949•254-0511
City/State: COSTA MESA, CA ZipCode: 92627
MECHANICAL PERMIT FEE SUMMARY
MECH ITEM FEE: $53.10
PLAN CHECK FEE: $0.00
INVESTIGATION FEE: $0.00
REINSPECTION FEE: $0.00
TOTAL FEES: $53.10
Atldress: 3391 CARMEL DR Unit:
Ciry/State/Zip: COSTA MESA, CA
Address: PO BOX 11377 Unit:
City/State/zZip: COSTA MESA, CA
License No. 826675
CELI:
NOTICE: The work authorized by this permit shall comply with all applicable hantlicap 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 aulhorized under this permit to be considered legal, such work must comply wilh 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.
0�[, INSPECTIONTYPE DpTE INTITIAL CODE� INSPEL710N7YPE � �r1TE IN FL
1878 Fixed System Final Fire Preven6on 206 Final Mechanical ,��
7266 Pool SOa Final 208 Final Plumhing
200 Final Re-Roof 210 Final EleCtdCal
207 Final BIocWRelaining Wall 212 Final Fire Prevention
202 Final Pactory Fire Plate 220 Final Planning Appmval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Ottupancy
� '
WORKERS' COMPENSATION DECLARATION:
I hereby aNirm untler penalty of perjury one of the (ollowing declarations:
❑ I have and will maintain a cehifcale o! consent to self-Insure !or vrorker5'
compensation, as provided for by sec�ion 3700 0! the Labor Code, lor the
peAormance ol the work for which this permit is issue0.
❑ I have and will maintain workers' compensation insu2nce, as required by
seclion 3700 of the Labor Code, fa Ne peAortnance of the vmrk (or which this
pertnit is issued. My vrorkers' wmpensation Insurance cartier antl policy
number are:
Carrier.
(Tles setYion neeE nol0e cnmyetetl elhe pemW is val�etl a! one nuntlretl0a'WrslSt001 a less 1
olicy Number:
� 1 certify that in the peAormance o( the vrork lor which this permit is
issued I shall nol employ any person in any manner so as to become subject
to t�e workers' compensation lavrs of Califomia, and agree that if I should
become subject ro lhe vrorkers' compensation provisions of Section 3700 0(
the Labor Co , I sha0 forthvrith comply with these pmviyo ;. �
6�
ppll�ani s SignaWre ��.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERP.GE
IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
A7TORNEV'S FEES.
UCENSED CONTRACTORS DECLARATION:
I hereby affrm that I am licensed under provisions ol Chapter 9(commencing
with Section 7000) of Division 3 of the Business and Professions Code. and
my license is in full force and effecl.
�c.�'%�� �07 � G a;aa� � � s
LGanttactor's Signacure ��2t� "�^� -
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirtn that there is a conslruction lending agency (a the
pedormance of the v.urk for wfiich this permit is issued. (Sec. 3097, Civil Cotle).
Lender's Name:
Lender's Adtlress:
Si8^alure
OWNER-BUILDER DECLARATIONS:
I hereby aKrtn that under penalty ol perjury that 1 am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the (ollowing reason (Sec. 7037.5,
Business and Pmfessions Code: Any ciry or county whiGh requires a permit to
conSWct, alter, improve, demolish, or repair any sWCNre, prior ro its
issuance. also requires the applicant tor such pertnit ro file a signed slatement
that he or she is licensed pursuant to the provisions of the Contractors
Licensa Law (Chapter 9(commencing with Seclion 7000) of Division 3 0( I�e
Business and Professions Code) or thal he or she is exempt therefrom an0
the basis lor the alleged exemption. Any violation of Section 7031.5 by any
applicaN for a permit subjects the applicant to a civil penalty of not more than
five hundretl tlollars ($500�.�:
❑ I, as ovmer of the property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and Ihe SWCNre is not intentled or
ottered for sale (Sec. 7044, Business and Professions Code: The Contractors
license Law dces not apply to an owner of propeny 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 intendetl or oflereC for
sale. If, however, the builtling or improvement is sold within one year of
completion, the owner-builder will �ave the burden of pmving that he or she
did not build or improve for purpose of sale.).
❑ I, as owner of Ihe property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRAC70RS to construct the project (Sec. 7044, Business antl
Professbns Codei The coniractors License Law tices not apply to an owner ol
property who builds or improves thereon, and who conlracls (or such project with
a contracta�s) license pursuant to the Contractors License Lavrs.).
❑ I am eaempt under sec.
Business and Professions Code for this reason:
SignaWre Dale
�osi�as �vwi
Ovmer ID verifed by driv�i s iicense. ❑ Ves ❑ No �� � �
Dnver's License No. Expires:
Verification of Ovmership by (rype of tlocument, i.e. - property laa bill or deetl):
DIVISION OF INDUS7RIAL SAFETY PERMIT CER7IFICATION:
❑ 1 hereby certify that no excavatbn frve (5) or mwe feet in tlepth into v.fiich a
person is required to descend, v.ill be made in wnnectbn with v.ork authorized
by tNs pertnit, and that no building structure, scaffdding, false�wrk, a demdition
or tlismantling thereof, will be more than [hirty-six (36) feet high. (Chap. 32, Grp
2, M 2, Sec. 341, Title 8, Califomia Atlminist2tive Code).
❑ As ovmer-builaer, I vnll not employ anyone to tlo wofk which w0ultl
require a permit fmm the Division of Industrial Salety, as nored above, unless
such person has a permit to do such vrork from the division.
Appliranfs Spnalure Date
Division of Industnal Safe[y Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the appliwnt or presenl or fuNre building occupant need to fle and
certify a Business Plan for emergency response to release or threatenetl
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the Cali(omia Health and Salety Code requires, with some
exceptions, that a Business Plan be fllea with the Costa Mesa Fire
Department by every business whic� has at any one time durinq a reporletl
year a quantiry o( hazardous matenals equal to or greater than a weight of
500 pounds, or a volume o! 55 gallons, or 200 cubic feet of compressed gas
at standard temperature and pressure).
2. Does or will the applicant or presenl or future building occupant neetl to fle
a registration fortn lor acutely hazartlous materials? ❑ Yes ❑ No
(Section 25533 0l the California Health and Safety Code, wilh some
exceptions, requires registration with the Costa Mesa fire Department by
each business which at any one time has on hantl a quantity of acutety
hazardous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet o( compressed gas at standard
temperaNre and pressure).
3. Does or will Ihe applicant or presenl or luture building occupant need Io
prepare an RMPP (Risk Management and Prevention Program (or acutely
hazardous matenals)? ❑ Yes � No
(Section 25534 of the Califomia Health and Safety Code provides that Ihe
Costa Mesa Fire Department may require the preparation, certifcation antl
fling wilh the Fire Department ol an RMPP by businesses which are required
ro register acutely hazardous matenals with the Fire Department.
4. II an RMPP is presently requireQ has Seclion 25534 0( the Califomia
Health antl Safely Cotle been fuliy complied with? ❑ Ves ❑ No
5. Dces or will the applicant or present or fuWre building occupant require for
lhe vrork which is the subject of I�is application a pertnit for such constructlon
or modi(wtion (mm the South Coas� Air Qualiry ManagemeN District or fmm
any olher air polWlion conlml dislrict or agenCy? ❑ Yes ❑ No
(Sectbn 658502 0! the Calitomia Govemment Code requires that the reQuestetl
inlorma�ion be fumished on appliwlions !a rron-residential building pertniis).
6. Will any paA o( the faciliry to Oe constructetl untler this permit be within
7000 leet from the outer boundaries of a school7 ❑ Yes ❑ No
Qf'yes", the facility must meet the requiremenl o( Sections 25534 antl 42303
of the Califomia Health and Safety Cotle�.
7. If a pertnit from the South Coast Air Ouality Management District or other
air polNtion control district or agency is required for Ihe vrork which is the
subject of this application, have all of the disclosures prescribetl by Calilomia
Health and Satety Cotle Section 42303 been made? ❑ Yes ❑ No
8. (If yes , attach certificate of compliance from the appropriata air pollution
wnUol offcer).
CERTIFICATE OF COMPLIANCE: I certify ihal under penalry of perjury the
information given above is cortect. I agree to comply with all state laws antl
city ortlinances regarding Hazardous Matenals and Emissions.
Signawre Da�e
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
cenify untler penalty of perjury that I have read this application and state that
the information given is correcL I agree to comply vnth all state laws antl ciry
ordinances relating to building conSWction, and authorize representatives of
the City of Costa Mesa ro enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
aulhonzed by lhis permit until final inspection.
S;�q WreolLegalOwner(s) ate
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�� APPRO E]
C1TY OF COST MES,
PLANNING DI ISION
SUBIECT TO BLDG. EPT. REG.
NOTF: ADDITIONS, ELETIONS,
OR CORRECTIONS HALL DE
APPROVED BY THE P NNING DIV.
MOUSE'1
BY: ���� DATE: �'ZS
Job #:
Perfortned by
�aria�, QLS
for:
>
Dynamic Air Systems s`�ie: i: �4°
The Heatin & Air Conditionin S ecialists P�e �
g g i� RightSirite Resitleltial(6n)
PO Box 11377 5.0.&5 RSR-0emo
Costa Mesa, CA 92627 zoos�wn-2s os:az:as
949-254-0511 °amenLs�W^9Ms°ft FNAG1Dem'
CITY OF COSTA MESA
��pMFsq BUILDING DIVISION
F�� 77 FAIR DRNE. COSTA MESA, CA 92626 •(714) 754-5273 • Fax (774) 754-0856 • vnvw.ci.costa-mesa.w.us
� FOR INSPECTIONS CALL: (714) 754-5626
��fi PERMIT NUMBER: E09-00169
PERMIT TYPE ELEC
APN: 41210203
JOB ADDR�SS: 3391 CARMEL DR CM
vicinity:
STATUS: ISSUED
DATE ISSUED: 0612512009
ISSUED BY: RMD
Suite/Unit:
SCOPE OF WORK: ELECTRICAL PERMIT TO RELOCATE DISCONNECT FOR A/C UNIT. REf#: M09-00052
OWNER: NAJARIAN, WAYNE M
PHONE:
APPLICANT: MORALES, MARC
PHONE: 949-254-0511
CONTRACTOR: DYNAMIC AIR SYSTEMS
Address: PO BOX 11377Unit: PHONE: 949-254-0511
City/State: COSTA MESA, CA ZipCode: 92627
ELECTRICAL PERMIT FEES
Electrical Plan Check Fee: $0.00
Electrical Permit Fee: $41.70
Reinspection Fee $0.00
TOTAL FEES $41.70
Address: 3391 CARMEL DR Unit:
City/State/Zip; COSTA MESA, CA
Address: PO BOX 11377 Unit:
City/State/zZip: COSTA MESA, CA
License No. 826675
CELI:
NOTICE: The work authorized by lhis permit shall wmply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply vrith all applicable wdes, 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.
COpEt. INSPEG110NrypE Or1TE INTITIALS �EO INSPELiIONTYPE ORyT IN➢MLS
1678 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final PI�m6ing ��
200 Final Re-Roof 210 Final Electncal �
201 Final 61oCWRetaining Wall 212 Final Fir¢ Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final $ite
204 Final Demqlition 250 Final Building/Oaupancy
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one o( the follovnng tleclaralions:
❑ I have and will maintain a certificale o( consent to self-Insure for workers'
compensation, as providetl for by section 3700 of the Labor Code, for the
pertormance of the work for Which this permi[ is issuetl.
❑ I have and will maintain workers' compensation insurance, as required by
sectbn 3700 of lhe Labor Cpde, (or the peAormance of the vrork for which this
pertnit is issued. My vrork�rs' compensation Insurance carrier and policy
number are:
Carrier
(Th�s section neetl rrol0e [wnpleted d Me permrt is valuetl at one h�ndretl0olla�s (St00) wless.)
/�Pdo,l(ic,y� Number:
vQ"^I�certify thai in the pedormance of the work for which this permit is
i`ssued, I shall not employ any person in any manner so as to become subject
to the workers' compensalion laws of Califomia, and agree Ihat if I should
become subject to the workers' compensation provisions ot Section 3700 ot
the Labor . I shall forthWith comply with these p vi ions. A
V
�AppGranCS SignaWre Da e
r�.ol-
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE
IS UNLAWFUL AND SHqLL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FIN�S UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 370fi OF THE LABOR CODE, IMEREST, AND
All'ORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aRirm that I am licensed under provisions of Chapter 9(commencing
vrith Section 7000) of Division 3 of the Business and Professions Code. and
my licerlie�lsjn full fpr�,f�a�eftect. _ D
(d! L l /
Lic�#—U . L�L� Class #
, � .�. � �._ Z � �
�CdnVadOfs5lgnbWre Da�e
'^". , C--�-4 �:T .�
CONSTRUCTION LENDINQ qGENCY:
❑ 1 here6y aKrm that Nere is a conslrucfion lending agency for the
peAormance of the �ork fa which this permit is issued. (Sec. 3097, Civil Code�.
Lender's Name:
Lender's Address:
SignaWre Date
OW NER-BUILDER DECLARqTIONS:
I hereby aNirm Ihat under penalry o( perjury that I am EXEMP7 FROM THE
CONTRACTORS LICENS� LqW for the tollowing reason (Sec. 7031.5,
Business antl Professions Cotle: Any ciry or county which requires a permit to
construct, alter, improve, demolish, or repair any sWCWre, prior to its
issuance, also requires the applirant for such pertnit to fle a signed statement
thal he or she is licensed pursuant to the provisions of ihe Contractors
License Law (Chapter 9(commencing vrith Section 7000) of Division 3 oi the
Business and Prolessions Code) or that he or she is ezempt Iherefrom and
the basis for the alleged exemption. Any violation of Section 7031.5 by any
applicaN for a permit subjeCls the applicant to a civil penally of nol more than
five hundred dollars (5500).):
❑ I, as owner of the property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and the strucWre is not intended or
oflered for sale (Sec. 7044, Business and Pmfessions Code: The Contractors
License Law does not apply to an owner of property who builds or improves
thereon, and who does such work himsel( or herself or through his or her own
employees, provided Ihat such improvements are not intended or offeretl for
sale. If, however, the builtling or improvement is sold wiihin one year ot
completion, the ovmerbuilder will have the burden of proving that he or she
ditl not build or improve for purpose o! sale.).
❑ I, as ovmer of Ihe property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORg 10 construcl the project (Sec. 7044, Business and
Professions Code: The contractors License Law dces not apply to an ovmer o!
property who builds or improves thereon, and who contracts fw such project with
a contractor(s) license pursugnt to the Cont2ctors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
Owner ID verifed by driver's license. ❑ Ves ❑ No '
Driver's License No. Expires:
Verifcation of Ownership by (rype of document, i.e. - property tax bill or tleed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby cetlAy Ihat no excavation frve (5) or more fee� in depth into wfiich a
person is required to tlescend, vrill be made in connect'ron with work authorized
by this pertnit, and lhat no builtling s[�ucNre, scaffolding, falsevrork, or demoli�ion
or dismantling thereof, �nill be more than !h'rrty-srx (36) feet hgh. (Chap. 32, Grp
2. Art 2, Sec. 341, Trtle 8, Cali(omia Atlminisl2tive Code�.
❑ As owner-builder, I will no[ employ anyone to do work which would
require a permit from the Division of Industrial Safery, as noted above, unless
such person has a permit ro do such work from the division.
Apo�icanl's Si9nature
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
certi(y a Business Plan for emergency response to release or threatenetl
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the Califomia Health and Safety Code requires, with some
exceptions, Ihat a Business Plan be fled with the Costa Mesa Fire
Department by every business which has at any one time during a reportetl
year a quantiry of hazardous ma[erials equal to or grea[er 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 vrill the applicant or present or fuNre building occupant need to file
a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Seclion 25533 of the Califomia Health and Safety Code, with some
exceplions, requires registration wilh ihe Costa Mesa Fire Department by
each business which at any one time has on hand a quantity of acutely
hazardous materials equal to or grealer than a weight o( 500 pountls, or a
volume of 55 gallons, or 200 cubic teet of compressetl gas at standard
temperature and pressure�.
3. Does or will ihe 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 Safery Code provides that the
Costa Mesa Fire Department may require the preparation, certification and
filing with the Fire Department o( an RMPP by businesses which are required
to regisier acutely hazardous materials with lhe Fire Department.
4. If an RMPP is presently required, has Section 25534 of the Cali(omia
Health and Sa(ety Cotle been (ully complied vnth? ❑ Yes ❑ No
5. Does or will the applicant or present or future 6uilding occupant require for
the work which is the subject of this application a permit (or such constmction
or modifcation from the South Coast Air �ualiry Management District orlrom
any other air pollution control district or agency? ❑ Yes ❑ No
(Section 658502 of the Califomia Govemment Code requires that the requested
infortnation be fumished on applications ta non-residential building permits).
6. Will any part of the (acilily to be constructed under this pertnit be within
1000 (eet from the outer bountlaries of a school? ❑ Yes ❑ No
Qf yes", Ihe facility must meet Ihe requirement o( Sections 25534 and 42303
of Ihe Califomia Heallh and Satety Code).
7. If a permit fmm the South Coasl Air Quality Management District or other
air pollution conhol tlistrict or agency is required tor Ihe work which is the
subject ot this application, have all of the disdosures prescnbed by Calitornia
Health and Safety Code Seclion 42303 been matle? ❑ Yes ❑ No
8. Qf'yes", attach certificate of compliance from the appropriate air pollution
control oKcer�.
CERTIFICATE OF COMPLIANCE: I certify that under penalry of perjury the
in(ormation given above is correct I agree to comply witb all state laws antl
city ordinances regartling Hazardous Matenals and Emissions.
Signawre Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certity under penalry of perjury that I have read this application antl state that
the information given is correct I agree ro comply wiih all state lavrs and city
ordinances relating to building construction, and authorize representatives of
the City of Costa Mesa to enter upon the above-described property tor
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit unlil (nal inspection.
Signawre of Legal Oaneqs) ate
SiB^aWre �aie ���—� � 'L p
305]r6(Ytl]7 MOIW�uWotitP�MMieent �.y_,��' ,r D"ab •.:. ,
�
�I
PflOJEC7 ADOBESS: 3 3 9 S CARMEL DR uxir:
� OWNEH'SNAME:NASARIAN, WAYNE M
aooeess:3391 CARMEL DR
COSTA MESA,CA 92626
� 895-1411
I APCMIENGINEEfl: BEG.NO.:
AUDRE55: UNIT:
PEHMITTEE:CRANK BROS ROOFING CO ( 714 ) 548-5569
AODflESS: 126 COMMERCIAL WAY
COSTA MESA CA 92627
LICENSE� CONiNACTOP UECIAPpTION: � tlere�y allirm t�at ai Iicense0 under 0«sions o� C�aprer 9(commencinp wi�h Semion
7000) ol Uivision 3 of I�e Busine55 antl Pmlession5 CMa an my lic¢n5e is in lull larce an0 elle
cirru'c:0'0]l59-93^� STRTELIC.A08677 cuss:
Oa1e:��� "� SignaWre: . —
WOHKEflS' LOMPENSFTION OECIABATION: I �ere0y aif t 1 I �ave a cenitkale al wnsent to sell-msure or a rtilica�e af Workers'
Compensatio��i���r��li16popyZh$ea� ( Yon ro. �an�� � O 1/ 9 4
voucr xo.:STATE FUND P DFTE:
COMPANY: }�
� Cetlilied copY is Aereby fumisAetl. LJ Certtlied capY is tile0 h �he - y Builtling Divisian.�/ fQ . A �
//
�_G� iC
Da�e: ���� / � Applicant: � �(.Z1 Y��
E%EMY�ION FAOM WOBHEBS' COMPENSATION OECIAflPTION: ' sedion neetl na� Ge cmnpkitd il �he penmt is far one �undred (5100) or less�.
I certify ihat in I�e pedormance ol the work lor w�ich IhiS Dermit is isSueG. I s�all na� emD�oy any person in any manner so as lo become
su6leci lo Ihe Workers' Compensation Laws of Caiifomia.
Date: Signature:
NOTICE: I�, aller making I�is tleclaraiion. y0u S�ould beCome suDletl �o �he WOMers' ComDensati0n pmvisions af �Ae Labor
Coae. you musl lonl�wilh compty witn such omvisfons or tnis permit shall Ue aeemed rewked.
� CONS7PUCTION 1EN01NG AGENCY: I he�e�y aliirm t�ai t�ere is a constmctiw lentlinp aAency for the pedormance ol t�e work lor
which thi5 permit is issuetl (Seciion 3097. Civ. C).
LENOEN:
ROOPESS:
/ I
OWNEF 6WLUEB UECLABPTION: I her¢by aliirm �ha� I am exempl Irom ihe Contraciors S�aie llcense Law �ar Ihe lollowing reason
(Section 703L5 Business ana Protessional Code: Any ciiy of counry w�ic� reQuires a permii to consiruct, alter, improve, Aemolish, or
�Qaair any 9Ncture. o�ior to its issuance, ats0 repuires ine aoD�iWnt for such permit to file a siAnetl statement ihat Aelshe is licensetl
pursuan� Io Ihe pmvisions of I�e Con(ractors' S�a�e License Law (Chapter 9 �commencing with Seclion 7000) o� �ivision 3 0� Ihe Business
dnU Prolessions Cotle) or ihat �e/s�e is exempi I�eretmm ana tlle basis br I�e altege0 eKemD�ion. Any violation of Seclion 7031,5 Dy
any apDlicanl for a oermit suEieCls ihe aDPlicant Io a civil Oe�ally ol no� mare inan five hunJreJ doliars (3500).
I, as owner of t�e pmDeny or my employees witA wages as t�eir sole comDensation, will do ihe work. and Ihe
❑ simcmre is not intenOeC or ollered lai ule (Sec�ion 70aa, Buvness antl Proleuional CoOe: 7he Conirac�ors' Staie License Law
Uoes noi apDly lo an owner ol a pmperly w�o Ouilds ar impmve5 i�ereon, antl w�a Goes sucM1 work himseli/hersel� or Ihrough
Ais or �er own employees, proviCeG itul suc� impmvemen�s are noi inlenAed or ollereG �or sale. Ii, however ��e Ouiltling or
impmvement is sold wilhin one y¢ar ol comple�ion, t�e owner vnll have the EurEen o� pmving he/5he tli0 nol builtl or impmve
lar Ihe purpose ol sale).
I. as owner ol �he pmperty. am exclusively conlraciinp wilh licensea Contraclors Io conslruct the pmjetl (Section 70A4, Business
❑ an0 Prole55iDn5 Code: The Conirattors' Sla�e License Law aoes nol appN �o an owner o� pmpeM who DuilOs or impmves I�ereon
and who tomratl5 tor SUC� pmle��s wilh a Coniracmq5�li[en5e DufsUant�o ��e Comratmrs' Sla�e LiC¢nie Law�.l am awafe
Ihat pmof of Iheir Worker's Compensalion insurance shoultl be pmvitletl �o me.
� I am ehempi un0er Section�. 9. 8 P. C.
br I�is reason:
Oate: Owner.
I do �ereby cerlily t�at I am aware af anU unAerstanG ihe reQuiremenis af Cahlomia Heall� antl Safety CoEe Sections 25505, 25539, antl
25534 antl Ihai I or any IuWre Ouiltling otcupan� wilVwill not (Cirtle One� need lo tomDly wi�h SaiE 51a�e wdes and Ihe re0uiremenls �or a
permit lor conslmclion or mo0ificalion �mm Ihe Air Oualiiy Managemenl Disiric�. flesi0en�ial conslmclion apDlicalions are exempl �mm
t�ese pmvisions
Daie'. NOV�icanL .
I hereby ceilily��aU havereaa I�is appli[ation antl state
oreinances antl slaie laws relaling to bwltlmg consim[�ion �
pmpetly lor inspeciion Durpos�esy.
Oale:/� � � / � Signra�u��9-
n,��o; < i,.e„�e ,,. c�.:,i m���dn, .. .
inl0rmaiion is tOrrecl. I e 1 omply wilh all City antl Counly
�rrze represen�ativesol 5 ci � o eNer upon ihe a�ove�mentionea
164t�06 Wbne—Builaing; Green—Catle E rcemenl: Canary—Applicant: Pink—Pevenoe; GolOenro4—Assessor
CITY OF COSTA MESA — BUILDING PERMIT ,
PERMZT NO: B 060747 PLAN CHECK NO; N . .
CONSTRUCTION TYPE: V—N PERMIT TYPE; STR PURPOSE: ALT
JOB DESCRIPTION : TEAR OFF, REROOF 1900SF RESID & GARAGE SQ FT: 3,683
CLAIM VALUE; 3,683.00 CALC—VALUE: 3,683.00 GROUP OCC: R-3 /M-1
COMMENTS: REROOF W/HOT SYSTEM 6 GRAVEL ROOF �������r.�.T �
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Z O N I N GS ERTEBQAUCIxRSE M E N T S
REC�UIRED
------------ MAIN BUILDING ---------- --------- ACCESSORY�i}UILDING ---------
FRNT; FT IN REAR; FT IN FRNT: FT IN REAR: FT IN
LEFT; FT IN RGHT; FT IN LEFT; FT IN RGHT: FT IN
PARKING REQ• PROV; PARCEL; 41210203 ZNE; REF NO;
PLANNING NOI'ES>
>
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D E V E•L O P M E N T S E R V I C E S R E Q U I R E M E N T S
ZONING APPROVED BY DATE:
BUILDING APPROVED BY : DATE;
APPLICATION ISSUED BY: � DATE: Z,G `��
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LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG PMT PLUMBING ELECTAIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 63.00 50
SMIP/NON—RES
PLAN �
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECH TOTAL PAID DUE
TOTALS----> 63.50 0,00 0,00 63.50 63,50 .00
REVENUE DIVISION TOTALS--> COLLECTED: 63.50 OVER/SHORT: .00
BLDG PM'P PLUMBING ELECTRZC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
63,00 .50
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I N D I V 2 D C1 A L. F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 3683 REROOF BY VALUE RESIDENTIAL NOZONE 1,00 3,683,00
END OF FEES
i
_,
CONSTRUCTION ANDPLRNNING
APPROVALS Permit m
1. Temporary Electncal Serv�ce or Pole
2. Sod Pipe-Undrgrnd.
--'
3. Elrctrical Canciuit Utinty•Undrgrn�.
'4. Electrcal Conduit•Undrgmd. � _
3. Steei Reinforcement
G. E�eetncal UFER Gmd. � �
7. Footings �
8. Foundat�on
9. 1Jater P�pe�Undrgmd.
10. Structural Floor System
17. Property Sevier ��ne & House Comect�on
12. Sewer Cap
13. Root Drams
14. Rough Plumbing
t5 Rough Eiectrical-Conduit
i6. Rough ElectriclV9ring
77. Rough !'liring Sign
78. Rough Electrica�-T Bar Ce�ling
19. Rough HeaUd9 & Air CondiUoning
20. Ru�.gh i-actorY ���eplace '
21: Ductc, �n Struct�rC � �
22. Ducts, Llentilatinu ,
23� Ge: Pipe�Raugh &•Test
2u. Roof framirg � �� .
25. Ronf �?ieathing' .
26, T�Bar Ceihng (Structurall & Nionocoat
27. Frame znd Fiashing � .
28. t;,tn ng & Sid�n9 ' �-
29. Insuls[ion •
30. Dry��•a�I.�aiiing
31. Plaster 8ro��n Coat
32. Electncal Poe��er L1eee��Final
33, Firal Elettric ' . �
34. Final HeaUng & Air Conditiorti�g
35. final Gas Pipe-Test
36. Hood or CanoPY
37. Final FactorY Fireplac3 , � �
38. Final Plumbing ' = � �
39. 4Vater Service�Fi�O�
40. Gas Service•f�nal _ �
41. Solar pom�.tocPinal'
42. Backflow Pre�enter
43. Backflow Ir�igatiop .
44. Landscape Irripatlan System
45. Sound Attcnuation�
46: Handirap Regulations
47. FINALSTRUCTURE&'BUILDING
48. fINA�PLANNING
49. Electric ftelease to Edison
50. Gas Release to Southerri�California Gas Co
No. Date
Date
E
POG . SPA
Inspectot AppROVALS Permit �
52. Poo� & Equ�pment Locatfon �
53. Steel Reinforcement
54. Forms �
55. E@ctrtcal Bonding I
56. Rouqh Plumbing & Pressure Test
57. APPROVAL TO COVER GUt�i7E
__ 58. Electrical Conduit�Undrgrr.tl. �
59. Gas Pipe, C7 Undrgrnd., Test
� 60. Badc�vash Lines, P�Trap, .7 Undrgrnd. �
j 61, APPROVAL TO DECK
62. Back�•�ash & Recepror�Finai I_
63. Heater & Vent•Final ;
64. Piumb-�ng SYstem � Final
65. E:ectrical�Final
66. Sviar System-Flnai �
67. Fencing & Access APprovai I
68. APPROVED FOR PLASTERING
69. POOUSPA SYSTEP.7S F WAL �
_ F'RE DEPT. REQUIREMENT
� � APPCiOVG,LS Permit # - �
- " - 70. U+iderground H�dro
77. PrOd�Ct Piping C�ias C; O�I
. � 72. Undergrbund FIusR'
73. Undergrnd. Stora�a Tank �^, G.,s � Oil
74. Overhead HYdm
75. �ry Chemic;�l
` 76. Dry StanApipe _
77. FIXED.SYvTEhi FINA�
� 78. FIRE PREV. FIh,�L
� FiEALTH DEP't. REQUIRE�v1ENT
�� 79. FINAL IN5PECTJON t
� I 80. FOOD CER-�IFICATc ISSUED �
I I I r�te3: _ � �-, /�
Date �Inspector
OWNER HET,TZER �tex
JOB ADDRESS 3391 Ce
GENERAL CONTRACTOR
AP No. LOT
INSPECTIONS
SOIL
GAS
W AT ER
ftOUGH PLUMBING
PROP. SWR. LINE HOUSE CON. �
SPRINKLING SVSTEM
MISCELLANEOUS
ftOUGH HEqTING 0.N0 AIR CON�ITION�
TEMPORARY SERVICE OR POLE
UNOERGROUNO � POWER �
ROUGH WIRING
TRENCHES FORMS STEEL
FLOOR SYSTEM
BONO BEAM � STEEL REINFORC
SHEATHING
FRAME ANO FLASHIN
LATHING - IN Ol1T
PLASTER,BROWN COAT
STRUCTURAL, FINAL
HEATING, VENT., REFRIG. ANO A.
PLUMBING, FINAL ANO GAS TEST
ELECTRIC, FINAL
s Costa Mesa
Drive
e J. Heltzer
TR�
��
DATE
DESCRIPTION of
FIRE ZONE
SUBCONTRACTOR
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3418.1�.
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 7200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely
BUILDING
ADDRESS 3391 harm 1 Dr oc a M ca
OWNER Heltzer FnterR,rises Gosta Mesa
ADDRESS 740 No, LaBrea Avenue
TEL.
CITV Los Angeles No.9 7-2
CONSTRUCTION
LEN�ER United California Bank
BRANCN Main Office
ADDRESS 600 So_ S„r;no Sr. i,ns Aneeles
ADDRESS 113 N.
CONTRACTOR G
ADDRESS ]/{Q
CITV Los An
uc i o. 314
S12E
OF LOT
USE OF
EXI5TING BLDG.
SI2E OF
J. Heltzer
--" -9-77ratoOO 378� **,r
�M�., 141.�„
APPLICATION FOR BUILDING PERMIT
RECEIVED DATERECEI ED DATEISSW
c-jl�, l2 -.3- i � _ .F
A.P. NO. —�'�' I
BUILDING
ADDRESS 3391 Carmel Dri�v/e
TRACT�(G✓/ LOT�/1 B
` 6§`3=�$52 S
FIRE
le H111S ZONE
APPAOVED
TEL. iLl
No.937-2
CITV
LIC. NO. 19
NO.OF BLDGS.
NOW ON LOT
NO.OF
WA�� PlasterlROOF
COVERING
11LDING AND WORK TO BE PERFORMED
Z�i
vn�us � 7 oaD
DATE
20NE NO.OF USE OF NEW ��r� '
Rl P�� Z BUILOING 9d1'dq�
YARDSAPPFOVED VAROSAPPROVED
DI5TANCE BET
MAIN BLDGS.
VAR. #
C.U.P. �
APPROVED
I horeby acknowletlge ffiat I have reatl this application antl staxe HOLD FOR
that the above intormation is corract antl agree to comply with
all lews �egulating builtlinq constt�ction, antl I shall not employ
any permn in violation ot the workmen's compensaiion laws of
the Stete ot Celifornia, / /,�
I hernby certity thet I am properly licensed as a conttactor untler a SQ. FT.
the Stata ot Californta Business entl Protessions Cotle, Oivisicn 3, THE AMOUNT SF
Chapter 9, and that s�ch licenses ere in full force antl effect, or 1 THE PURPp6E OF
am exempt trom the provi ons of the State of California B�siness VALUATION
antl Professions Code, Divi n 3, Chaoter 9.
$IB�eture of
Parmittee �� $ �y
Auffiorized Ageni (J�� ��
BET. MAIN &
ACCESS. BLD
OATE
12-2�-71
V
A
TOTAL FEE $ �
m
O
IN IS FOfl !
EE ONLv: �
¢
�� m
�/ N
J
I 0
i � E
j � LL