HomeMy WebLinkAbout1649 BIMINI PL - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
MECHANICAL PERMIT
Job Address: 1649 BIMINI PL
Suite No
Vicinity:
Parcel Number: 13922314
Status: ISSUED
Applied: 10/01/2004
Issued: 10/01/2004
ISSUED BY:
Applicant:
SCOTT FARTHING
"
Address:
904 DOGWOOD,
,
-.
NON -LOAD BEARING WALLS, RAISE LIVING CEILING TO HEIGHT
..
_ •" Phone: (949) 500-2870
- -
COSTA MESA, CA - Zip: 92627
YEAR DIMENSIONAL ROOF, REPAIR/REPLACE SHEATH] NG�AS.NEEDED: REF.: B04-01702
Owner:
',�DEUTSCH, WILLIAM DOUGLAS
Address:.'
1649 BIMINI PL
-
-
Phone:
,
FEE SUMMARY 4,
COSTA MESA, CA Zip: 92626
_ Quantity
�' /�" �
Contractor:
FARTHING DEVELOPMENT INC
ISSUEFEE$23.50
Repair? Alt Absorbtion Unit i
$0.00
0 ' {
Address:
904 DOGWOOD
- - - -, •,
" _-•
Phone:. (949) 500-2870
-
$0.00,
. COSTA MESA, CA .- ,-Zip: 92627
-
-
` License: 560875
- •. •' -
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes hd'related
regulations. (Ord. No. 92-28, § 1, 12-21-92) /j
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspend d'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 appl ale 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
2448-6(6100)
SCOPE OF PERMIT
INTERIOR ALTERATION TO EXISTING S.F.D. WORK TO INCLUDE: KITCHEN AND BATH
,
• " REMODEL, REMOVE INTERIOR
NON -LOAD BEARING WALLS, RAISE LIVING CEILING TO HEIGHT
..
OF COLLAR TIES, AND WATER
REP,IPE, CHANGE OUT HVAC UNIT -INSTALL 30# FELT, 50
'
YEAR DIMENSIONAL ROOF, REPAIR/REPLACE SHEATH] NG�AS.NEEDED: REF.: B04-01702
MECHANICAL TO INCLUDE: 1
INST FAU < 100K BTU, 1 REPAIR/ALT COOLING/HEAT, 1 HOOD'
-FAN.
W/MECH EXHAUST, AND 1 VENT -
-
FEE SUMMARY 4,
_ Quantity
�' /�" �
Quanti1 1
ISSUEFEE$23.50
Repair? Alt Absorbtion Unit i
$0.00
0 ' {
Inst FAO <100 k BTU ' ` $14.80 1
RepairTAll Refrigeration Unit YP !
'10,00—
0 r'
Inst FAU >100 k BTU .���� „ $0.00 0
,; ,�.-. Ventillation System ;j -r/
$0.00,
0,,;
Repair/Alt Cooling/Heat ��- $13.70 1""•Evaporative
Cooler ,i!"-'
`x$0:00
/
Inst / Rep:'Recess Wall Htr� $0.00 0
,= 7 �t-� '_ Commercial Incinerator %%,�
$0.00 ,
;O/
Refrig Sys <100 k BTU' :,; $0.00 0
- .- Dorirestic Incinerator
$0.00","0'
, ,
Refrig Sys >100 k BTU '� ",'$0.00 --,-0.,, : •
-�6 Compressors / Absorption Systems.
'
Gas Piping :A $0.00 0,
, �, Up to 3 hp 1100 kBTU /". "
$0.00
0
_
Factory Fireplace $6.00 $0 00 0
-,
- " . "":3 To 15 hp /.500 k BTU
,$0.00
0
Hood w/Meeh Exhaust` $10.65 '; 1 .
_ 15 To 30 hp 11;000 k BTU] ��
$0.00
0
VAV Box $0.00 0'<,'
-t. :30 To 50 hp /-1;750k BTU "�. A !
% $0.00
0
Vent Fan /Single Duct - ; $7 25: . 1 -
- - ,Over 50,hp % Over 1,750 BTU "'
,'$0.00
0
Appliance ..$0.00 0-�
_ -Boilers
Fire Dampers$0.00 , 01
-� Up to 3,hp- .
$0.00
0
Smoke Dampers 11,$0.00 0
3 To 15 hp -
$0.00
0
Inst or Relocate Appl Vent _$0:00` 0 "
�t 15 to 30 hp. - , _ _ -
$0.00
0
Air Handlers < 10000cfm-s0.ov. 0,-
_ _- r ,��� -30 to 50 hp
$0.00
0
Air Handlers> 10000cfm $0.00 �,0��=--
-•
-_ Over 50hp-�;;-..>=j-'
$0.00
0
Floor Furnace $0.00 0 --_
_.",--�.,: Other Mechanical Fee
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes hd'related
regulations. (Ord. No. 92-28, § 1, 12-21-92) /j
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspend d'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 appl ale 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
2448-6(6100)
DECLARATIONS
WORKERS' COMPENSATION DECLARATION: -
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 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 the permit is valued at one hundred dollars ($100) or less.)
EWertify 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 of Callfomia, and gree th t i uld become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with these provision
gnal
q ure:� /� at6'e:-.1.�1�1���y
WABNNIGBULNG ETO SECURE ORKEFIS'OOMPENS04C40VERAGE IS UNLAWFUL AND SHALL SUEuECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED
THOUSAND DDLLARE ($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 affirm that I am licensed under ter 9 (commencing with Section 7000) of Division 3 of the Businegpnd Professions Code, and my license Is in full
e arid'effecF. Lia. II ' - - (l /
ctpr .signature'.*-` T'-* L Dat-,;, / O u
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).
Lenders Name: Lenders 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 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 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.).
❑ 1 am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑ Yes ❑ No Drivers 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 ❑ 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? ❑ Yes ❑ 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 It an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑ No
............................................................................................................................................................................................................................................................................................................................................................................................
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication aEEermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 5 Yes LJ Na
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
....................................................................................................................................................................................................................
6 Will an facility p ...... ..... .... ............ ... ... .
y part of the facili to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ 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 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 ❑ No
............................................................................................ ................................................................................................................................................................................................................................................................................................
B (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.
Signature: Date:
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 with all state laws and city ordinances relating to building construction, and authorize representatives of the City 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 permit until final inspection.
Si at Of La n ) D
r:r$And/Or7Au prized ant
CODE t. INSPECTION TYPE DATE INTRIALS CODE? INSPECTION TYPE PAIS ItiTITIAL@
1616 Fixed System Final Fire Prevention 206 Final Mechanical -oS a^,
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'
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
PLUMBING PERMIT
Job Address: 1649 BIMINI PL
Suite No
Vicinity:
Parcel Nunmber: 13922314
Status: ISSUED
Applied: 10/01/2004
Issued: 10/01/2004
ISSUED BY:
Applicant:
SCOTT FARTHING .
Address:
904 DOGWOOD,
- Phone: (949) 500-2870.'-
-
COSTA MESA, CA Zip: 92627
-
Owner
DEUTSCH, WILLIAM DOUGLAS
Address
1649 BIMINI PL -
Phone:
. • -
COSTA MESA, CA Zip:, 92626
,�
Contractor:
FARTHING DEVELOPMENT INC
Address:
904 DOGWOOD
Phone: (949) 500-2870
COSTA MESA, CA Zip: 92627
'
License: 560875
. - Arch/'EnB:.
Address:
"
Phone:
�ll!
l TIP:_
_License
SCOPE OF PERMIT
t INTERIOR ALTERATION TO EXISTING S.F.D. WORK TO,INCLUDE: KITCHEN AND BATH REMODEL,,_
�
REMOVE INTERIOR NON -LOAD BEARING WALLS, RAISE LIVINGCEILINGTO
HEIGHT OF COLLAR' "�'
+'
TIES, AND WATER REPIPE, CHANGE OUT HVAC UNIT. INSTALL 30# FELT,
50Y' AR DIMENSIONAL
ROOF, REPAIR/REPLACE SHEATHING AS NEEDED: REF.: B04-01702
PLUMBING TO INCLUDE: 1 GAS OUTLET (1-4), 1 GAS OVER 4'OUTLETS, 1. GAS REPIPE; 1
i;•"
i
'
SHOWE, I;KITCHEN-SINK, 2 WASH BASINS AND'1 WATER CLOSET._',' -7;.
R
,/
r FEE SUMMARY
'AMT - QTY- -� AMT.
r �, !
AMT
QTY
ISSUE FEE
_ _QTY _
$_23.50• LaundryTub] Washer - $0.00 - "0
Sump Pump,`' _
$0.00
0
Backflow irrigation
$0.00 0 ' - Landscape Irrigation -- $0.00 - 0 -
Swimming Pool -
$0.00
0
Backflow Preventer`-$0.00-
0�. `. P -Trap. $0.00, 0
Trap Primer,
$0.00
0
Bathtub
$0.00 0 .'Pressure Regulator ', $0.00 - 0
Urinal.`"
$0.00
0
Clarifier System
$0.00-' 0 Process Piping (per 10 ft) $0:00 - 0..
.-, Vacuum Brkr Bkflow(1-4)
$0.00
0
Connect (Ice,Soda,etc)
$0.00 �0_." '- Receptors—j - $0.00 0
Vacuum Brkr Bkflow(5+)
$0.00
0
Dental Units
$0.00 0 •Septic Tank. $0.00-,, ,0,!' -,�,
Wash Basin
$19.60
2
Dishwasher
$0.00 0 Sewer Cap.for Demo -C, $0.00. 0
Wash Basin Set
$0.00
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 became 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. IS
FOR INSPECTIONS CALL: (714) 754.5626 40
2"6.46 (6/00)
DECLARATIONS
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 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 the permit is valued of one hundred dollars ($100) or less.) ,
��-
I- ertify 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'
�mpensation laws of California, and agree that it I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
Com ly with these pr
hcanl —�..
ARNING: FAILURE TO SECURE WOWERS'COMPELSdON COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMIIFOTEWTB CRIMINAL PENALTIES D CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOL -ARE ($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 hereb a firm thaLl.am license n rpt ions of Chapter 9 (commencing with Section 7000) of DivisionBusinesSAnd Professions Code, and my license Is in full
Una d e4,e t,,Wc. #'? (! Glass # /S
fwJ' Y aF°.ASstpa'. x.r .t`o.�//, P 7
CONSTRUCTION LENDING AGENCY:
❑ 1 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).
Lenders Name: Lender's Address:
Signature: Date:
OWNER -BUILDER DECLARATIONS:
1 hereby affirm that under penalty of perjury that I 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).):
❑ 1, 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. It, 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.).
❑ 1 am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑ Yes ❑ No Drivers 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
peril, and that no building structure, scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-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 ❑ 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 aDPlicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ 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 en RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? []Yes ❑ No
...............................................................................................................................................................................................................................................................................................................................-..........-........-.....................................
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication a permit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ 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 facilityto be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ 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 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 ❑ No
................................................;r-t.ificate................................................................................................................trol....................................................
................................
................
...................
...........
............
...................
.............
..........
.......
.....
8 (It'yes", attach canificete 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.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and stale that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City 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 permit until final inspection.
Signature O1.Legal O` � s) D
Ain'-j(7AUMort2e'tl�f6CeM._.."�r'A_ -
CODE 1. INSPECTION TYPE Qe¢, IIfjTMIAL CODE# INSPECTION TYPE pig NAL$
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing 3 -all - 0.5
200 Final Re -Root 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
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
,lob Address: 1649 BIMINI PL
Suite:
Vicinity: BATH AND KITCHEN
Parcel Number: 13922314
Applicant: SCOTT FARTHING
Address: 904 DOGWOOD
Status: ISSUED
Applied: 10/01/2004
Issued: 10/01/2004
Zoning: R1 R1
ISSUED BY:
Ph � - 949 5002870
Phone: (949) 500-287(
COSTA MESA, CA
Zip: 92627 License: 560875
'Arch Eng_
Address: - Address:
Phone: -' _ - - — - Phone:
.� Zip: , • - License: License:
SCOPE OF PERMIT \
INTERIOR ALTERATION TO EXISTING S.F.D.,WORK TO.INCLUDE: KITCHEN,ANDBAT,H.REMODEL, REMOVE INTERIOR *NON -LOAD BE
WALLS, RAISELIVING CEILING TO HEIGHT OF COLLAR TIES, AND WATER REP-IPE,�CHANGE OUT HVAC UNIT. INSTALL 30# FELT, 50,YEAR
DIMENSIONAL ROOF,-
REPAIR/REPLACE SHEATHING AS NEEDED. - r
i
one.
-( )
COSTA MESA, CA' Zip:
92627,
Owner:
DEUTSCH,-WILLIAM DOUGLAS
Permit:
Address
1649 BIMINIPL
`Ss0,060.00
SMIP Res:
Phone:.
-
�-
COSTA MESA, CA - Zip:
92626 - '-
Contractor.
FARTHING -DEVELOPMENT INC
\ • Other
Address:
X904 DOGWOOD '
P;,/
Phone: (949) 500-287(
COSTA MESA, CA
Zip: 92627 License: 560875
'Arch Eng_
Address: - Address:
Phone: -' _ - - — - Phone:
.� Zip: , • - License: License:
SCOPE OF PERMIT \
INTERIOR ALTERATION TO EXISTING S.F.D.,WORK TO.INCLUDE: KITCHEN,ANDBAT,H.REMODEL, REMOVE INTERIOR *NON -LOAD BE
WALLS, RAISELIVING CEILING TO HEIGHT OF COLLAR TIES, AND WATER REP-IPE,�CHANGE OUT HVAC UNIT. INSTALL 30# FELT, 50,YEAR
DIMENSIONAL ROOF,-
REPAIR/REPLACE SHEATHING AS NEEDED. - r
i
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 applicab odes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiratlo this permit.
FOR INSPECTIONS CALL: (714) 7545626
244646 (6/00)
FEE SUMMARY.
Plan Check:,'
$418.76
---- - Calc Valuation: %;
$50,000;00
Permit:
$644.25
Claim Valuation:,����
`Ss0,060.00
SMIP Res:
$5.00
;!
;
SMIPCom:,
,
.$0.00
0-0 - -Left -- 0-0
Right 0-0
\ • Other
$0-00
%i
P;,/
Inspection
$0:00
0-0 ` Left 0=0 ' ' `
Right ,0-0 ,'
PARKING Existing: O
:Recuired:
0 -' Proposed:
,Total:
$1 068 01"I
i
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 applicab odes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiratlo this permit.
FOR INSPECTIONS CALL: (714) 7545626
244646 (6/00)
PLANNING'& ZONING
SETBACKS`
MAIN STRUCTURE' -Front 0-0
Rear
0-0 - -Left -- 0-0
Right 0-0
ACCESSORY Front -A-0 _
Rear
0-0 ` Left 0=0 ' ' `
Right ,0-0 ,'
PARKING Existing: O
:Recuired:
0 -' Proposed:
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 applicab odes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiratlo this permit.
FOR INSPECTIONS CALL: (714) 7545626
244646 (6/00)
DECLARATIONS
WORKERS' COMPENSATION DECLARATION: -
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 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.
❑ 1 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 the permit is valued of one hundred dollars ($100) or less.) ,
Ify 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'
pensation laws of California, and agree that lf-J should become subject to the workers' compensation provisions of Section 3700 of the Labor Coda, 1 shall forthwith
comply with these prowsIons.
AppllCanSSklnelur.Date: /C) y
AILURE TO SECURE WORKERS' COMPEN TION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN LOYER T6CRI CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION WDS OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licens u tler r i ns C spier 9 (commencing with Section 7000) of Divisio Business and Professions Code, and my license is in full
orcaend:effecrLic-N----- - (/
rectors Sig 9tu[a:- „�.Da[e:. l r
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).
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 and Professions
Cade: 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 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.). '
❑ 1, 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.).
❑ 1 am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑ Yes ❑ No Drivers 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 6, California Administrative Cade).
❑ 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 ❑ 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? ❑ Yes ❑ 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 en RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? [3Yes [INo
......................................... ........... .......................... ...................... ............... ......... ..................... ........... ........................................................... ......................................-.... -..................... ....... ........................ ....................... ........... -...............................
5 Does or will the applicant or present or future building occupant require for the work which is the subject of thisa plication aPPermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 8 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 pan of the facility, to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ 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 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 ❑ 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.
Signature: Date:
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 with all state laws and city ordinances relating to building construction, and authorize representatives of the City 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 permit until final inspection.
Signature wner(s) Da
And/ -" horized-Apphc 11�••- � -"'� ' ale—
CODE t. INSPECTION TYPE 2ATF INTMALS CODE I INSPECTION TYPE 2AM INITIALS
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 '
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
ELECTRICAL PERMIT
Job Address: 1649 BIMINI PL
Suite No
Vicinity:
Parcel Nunmber: 13922314
Applicant: SCOTT FARTHING
ISSUED BY:
Status:
ISSUED
Applied:
10/01/2004
Issued:
10/01/2004
Address:
904 DOGWOOD
Phone: (949)500-2870.-,
949)500-2870--
COSTA
COSTA MESA, CA' ' .. - i ,.
Zip: 92627 "
j
Owner:
/DEUTSCH; WILLIAM DOUGLAS__ -
Address
'1649.BIMINI PL -
- -
'
Phone:
i
i
COSTA MESA,, CA '
Zip: 92626
Contractor:
FARTHING DEVELOPMENT
INC
Address:
904 DOGWOOD
- 6,Phone:.
(949)500-2870 +
`COSTA MESA, CA
`i Zip: 92627
'
'License: 560875
SCOPE OF PERMIT
-
INTERIOR ALTERATION TO EXISTING S.E.D. WORK TO.INCLUDE: KITCHEN AND BATH REMODEL, Z
REMOVE INTERIOR NON-LOAD`BEARING WALLS, -RAISE LIVING CEILING'TO HEIGHT OF COLLAR r
J
TIES, AND WATER'REPIPE, CHANGE'OUT HVAC UNIT: INSTALL'30# FELT, 50 YEAR DIMENSIONAL
.
ROOF, REPAIR/REPLACE SHEATHING AS NEEDED, REF.: B04-01702
.
TO INCLUDE: 15
6"SWITCHES.ELECTRICAL
LIGHLFIXTURES; 20 OUTLETS,
.
_ �AND
i'
FEESUMMARY� ,
-
- -Quantity
- _.-. , Quantity;, .
r
ISSUE FEE
ti -r $23.50
Temp Dist System / Lighting i$0.00 �o
Temp service test,
$0.00
' e Bbsway /100 ft $0.00
Res, 'a/c package
$0.00
Standing Section
New Res,(1=2 units)
x,$0.00 0
Misc Eleotrical:Equipment $0.00 /, 0
New Res (3+units)
x$0.00 0
Transformers up.to-1. kva/kw-._ -,,so :00'/ 0, "
Pool / Spa - -
.� $0.00 '0�
.. ..up to 16 kva/kw" -� - $0.00 0
�
Lighting Fixts
g g � �
„$16:50\ - �15
.., up to 50 kva/kw - -$0.00, 0 .
Recept Outlets -�
+�. ' $22.00 20 -
+
...up to100kva/kw j'$0.00`'/ 0-
Switches
-
$6.80 `6.' �-
.....:....over 100 kva/kw -' ; ;o
Non Res Appl \�
,� $0.00` ", 0--
_$0.00
Low Voltage Equipment-"� $0.00, 0
Res Appl
` - �� $OAO. ` ,0
.Low Volt Wiring System / Ckt '� $0.06-' ,'0;
Service to 200a
$0.00 0 -
Misc. Conduit • $0.00 - '- 0/-
Service to 1000a
$0.00 " - 0 i -
,Misc. Conductor,; $0.00 ; �0
Service over 1000a
$0.00. 0
- Circus ( gen or -ride) $0.00- , 0
Motors to 1 h
$0.00.' -,o
+ - -Circus (meth ride or lights) --;, %i $0.00 0
Motors to 10hp
$0.00 —< 0-1- -Christmas
Tree Stand ". ��� % $0.00 0
Motors to 50hp
$0.00 0 ,_�
- -Fireworks Stand"/ ' '� $0.00 0
Motors to 100hp
$0.00 0
Other Electrical Fee $0.00
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)4'
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 de and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration this7permiI.
FOR INSPECTIONS CALL: (714) 754,5626
:aaua6larool
DECLARATIONS
WORKERS' COMPENSATION DECLARATION: - • '
I hereby affirm under penalty of perjury one of the following declarations: '
❑ 1 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.
❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the pertormance 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 the permit is valued at one hundred dollars ($100) or less.)
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 of California, and agree that i should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with these provision / t/� /�/
���yyyyyy p (������cant �--5''gnaW_�'C?T� �� [..Date: /L/ 7
R IAILURE TO SECURE WORKERS' COMPE IIXJ COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN E� OYER COT WMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE ($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:
hereby affirm that I em licensed pr s? he ter 9 (commencing with Section 7000) of Division 3 of the Businal and Professions Code, and my license is in full
1end'ofeCl'CIc'p^-t_ ii..�� sp=/j
6oIn aclofs Sim ig'atu %'` pate:- 1
11�
Ili
CONSTRUCTION LENDING AGENCY:
❑ 1 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).
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 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 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 drivers license. ❑ Yes ❑ 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:
❑ 1 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 6, 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 ❑ 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).
................................................................................................................................................................................................................................................................................................................................................. ......................... I.................
2 Dces or
.Wil
applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the Califomia Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any
one time hes 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? ❑ Yes ❑ No
...........................................................................................................................................................................................................................................................................................................................................................................................
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication a ffmit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes u 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 ❑ 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 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 ❑ No
.......................................................ific..............c-o--..............................-th-..........................................luti................................er)............
.......
.....
..........................
.......
.....................
...............
...............
.............
..................
............
..........
............
.....
e (If 'yes", attach certificate of compliance tram 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.
Signature: Date:
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 with all state laws and city ordinances relating to building construction, and authorize representatives of the City 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 permit until final inspection.
Signet bgal Owners
Ar4Authodzed.A pl .
CODE 0. INSPECTION TYPE 2AM INTMALj CODE INSPECTION TYPE I 2AM 1NTITELS
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 BlocWRetaining 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"
OWNER DEUTSCH. WTLLIANI D. DATE 10-6-78
JOB ADDRESS IrLQ BiTnini PI sop
BUILDING PERMIT NO. 46845
GENERAL CONTRACTOR Owner -Builder
DESCRIPTION of WORK
Blockwall
AP No. LOT 197
TRACT 487 FIRE ZONE VALUES 600.00
NSPECTIONS
Signature Date
TYPE TTT GROUP
J ZONE -
solL
SUBCONTRACTOR
M
,SOI
-Date Number Signature
WATER
Plumbin
ROUGH PLUMBING
PROP. SWR. LINE HOUSE CON.
SPRINKLING SYSTEM
`MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND POWER 0
ROUGH WIRING
'Heatina and Vent.
TRENCHES (J FORMS Lj STEEL REINF.
FLOOR SYSTEM
BOND BEAM STEEL REINFORCE
SHEATHING
FRAME AND FLASHING
LATHING — IN 1 OUT
PLASTER, BROWN COAT
STRUCTURAL,FINAL
Electric
HEATING, VENT., REFRIG. AND A.C., FINAL
PLUMBING, FINAL AND GAS TEST
ELECTRIC, FINAL
BUILDING, FINAL
BUILDING PERMIT NO. 42305
GtNtRAL CUNTRACTOR er/Bldr_
DESCRIPTION of WORK Bl
AP No.i qq—qq-i—iA LOT
TRACT FIRE ZONE VALUE
INSPECTIONS
Si nature Date TYPE V GROUP
SOIL
GAS
SUBCONTRACTOR
WATER
Plumbing
1 ROUGH PLUMBING
PROP. SWR. LINE n HOUSE CON.
'I
`-
SPRINKLING SYSTEM
MISCELLANEOUS
UGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND POWER
ROUGH WIRING
Hea ina and Vent.
TRENCHES FORMS STEEL REINF.[�
FLOOR SYSTEM
BOND BEAM STEEL REINFORCE
SHEATHING
FRAME AND FLASHING
LATHING — IN ❑ OUT
PLASTER. BROWN COAT
STRUCTURAL. FINAL
Eleatr'e
NFATING VFNT_. REFRIG. AND A.C.. FINAL
FINAI
m
0468
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
6352 10/05/78
6352 TO/05/76
35 000 0 41168 29
10.50.. TU
10,50CAT6
.1A
For Applicant to Fill in Completely — Use Ink Only
APPLIC ION FOR 3TRUCTURAI PERMIT
ev
`
YE�E
(/�
�TF 'SS'l,�
! l
ADIDRESS 164 Palau
vOWNER
A
MAIL
ADDRESS 1646 $ a a
BUILDING
BUILDING /l O_ n H�¢
ADDRESS f0 GLX,OIAA..
TEL.tS
CITYMesa N
y
TRACT 3 p 7
LOT 135 BLOCK
CONSTRUCTION
LENDER none
NEWjkl)q.
R
P
BRANCH NIA
ADDRESS
VALUE B0
$
ARCHITECT TEL.
OR ENGINEER none No.
FIRE
'ZONE TYPE GROUP '
ADDRESS N/A
�y�
CONTRACTOR Owner/Builder
APPROVED
BY DATE
ADDRESS 1646 PalauZONE
,Q
RIf
NO. OF
PLANS Z
USE OF NEW LO It 1<
BUILDING WALL-
CITY Costa Mesa Uv 40 7551
LIC. NO. N/A LICYNO. STACITO
APPROVED
ANS BUILDING
(4RDS APPROVED
CCE SORY BUILDING
SIZE
OF LOT
NO. OF SLOGS.
NOW ON LOT
(FROM C/L STREET)
FRONT 416 FT.
7` V FT.
USE OF
EXISTING BLDG, residence
R. SIDE FT. r
FT.
.Separate permits are required for
electric, plumbing and heating work.
L. SIDE FT.
9/ FT.
_
REAR O FT.
O FT. -�
USE OF BUILDING AND WORK TO BE PERFORMED
DISTANCE BET.
MAIN SLOGS.
BET. MAIN &
ACCESS. BLOCS.
Construct 4" concrete block fenc
VAR.#
C.U.P.#
DATE
APPROVED
On Rr0perne
APPROVED Cu% e 1
-DATE /�
I hereby acknowledge that I have read this application and state
that the above information is correct and agree to comply with
all laws regulating building construction, and I'shall not employ
any person in Violation of the workman's compensation laws of
the State of California.
I hereby certify that I am properly licensed as a contractor under
the State of California Business and Professions Code, Division 3,
Chapter 9, and that such licenses are in full force and effect, or I
am exempt from the provisions of the State of California Business
and Professions Code, Division 3, Chapter 9.
Signature of
Permittee -'^— .�
SO. FT.
THE AMOUNT SHOWN UNDER VALUATION IS FOR
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
VALUATION
8'�
,,,
$ v/
PERMIT FEE $.,
PLAN CHECK $
TAX $
Authorized Agent
TOTAL PAID, $ �.
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 317 COSTA MESA. CALIFORNIA
FOR APPLICANT TO f/[L /N COMPLETELY
TYPE OR PRINT
r
ILDING 16 6 Palau Place
DRESS
COSTA MESA, CALIFORNIA
MAIL n
ADDRESS Dox 6
CITY Balboa Isla
LIC.
NO.
a�1zt IiLU..d'9.
447
1 f � �nSI,LL
DEPT,
LaI ( U': COSTA '"I- 1
APPLICATION FOR PERMIT
BUILDING
fOR OFF/CE USE ONLY
BUILDING
RECEIPT NO. I _ PERMIT
COSTA MESA, CALIFORNIA
)
TYPF !/ GROUP r 17
MaOCO CO
STATE
880]487
APPROVED
CONTRACTOR
, LIC. NO.
BY
DATE
Box 6$ Balboa
7slaid Calif.
ZONING
ADDRESS
LEGAL
- LOT 5 I
13"
- I QSO
NO. OFI
UBE OF NEWODESCRIPTION
NO. BLOCK
TRAC
_
PLANS
BUILDING
APPROVED
A.P. NO.
BY
�
DATESI
7000
No, of BLG.YARDS
LOT
OW ONLOT
REQUIRED
ALLOWED
USE OF
(CENTER LINE ST.)
EXISTING BLDG
SETBACK LINE FROM
CENTER OF STREET 0 REAR YARD J rn L
SIDE YARD (LEFT 5 (RIGHT 5
DESCRIPTION OF WORK
NEW x ALTERATION I ADDITION
REPAIR I MOVING I DEMOLISH
SUILDIN NO. OP
SIZE ROOMS STORIES
EXTERIOR WALT- ROOF
COVERING $Lj]CCO COVERING
USE OF BIAIL DING AND WORK TO BE PERFORMED
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM-
PLY WITH ALL CITY ORDINANCES ANb STATE LAWS REGULATING
BUILDING CONSTRUCTION.
SIG�URE OF7 GLENVEEDE HOMES,INC.
R.I1
ai
THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
VALUATION �i
n PERMIT FEE
PLAN CHECK $ /�
TOTAL FEE
D