HomeMy WebLinkAbout1035 CHEYENNE ST - Building Permits.1 1
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CITY OF COSTA MESA
Stp MFq
BUILDING DIVISION
- Fax 754-4856 • www.ci.costa-mesa.ca.us
F77
FAIR
DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 (714)
FOR INSPECTIONS CALL: (714) 754-5626
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PERMIT NUMBER:
BX10-00228
PERMIT TYPE
B_MISC STATUS:
ISSUED
APN: 14159514
DATE ISSUED:
10/27/2010
Zoning: R1,
ISSUED BY:
KJB
JOB ADDRESS:
1035 CHEYENNE ST CM Suite/Unit:
Vicinity:
Primary Dec: Const Type :??
SQ. FT: 0
Valuation: $15,000.00'
SCOPE OF WORK: 1. ,
FOUNDATION REPAIRS AT KITCHEN WALL,DINING WALL AND TWO REAR BEDROOMS.
OWNER: HASHIMOTO, LEONARD N
City/State: COSTA MESA, CA
Phone: 310-902-0570.
APPLICANT: FRANZ FROEHLICH
City/State:
Phone: 714-981-4157
Address:
City/State:
Zip Code:
ARCHITECT:
Phone
ENGINEER:
Phone
SOUTH COAST PIERING DBA SABER
3602 E COAST HWY
CORONA DEL MAR, CA
92625
Address:: 1035 CHEYENNE ST Unit
Zip Code: 92626
Address: - Unit:
Zip Code:
License No. 826234
Unit:
Phone 800-922-2488 Cell:
License No. "
ALPHACONSULTING AND ENGINEERING INC
714-541-9980
FEE SUMMARY
Building Plan Check:
Building Permit:
Electrical Permit: _
SMIP Residential
SMIP Commercial
Bldg Std Admin Fund
$163.31
$251.25
$0.00
$1.50
$0.00
$1.00
License No. 2838
TOTAL FEES - $417.06
HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279
Monday thru Friday - 7:00 am thru 7:00 pm. Satrudays -9:00 am thru 6:00 pm. Prohibited all hours - Sundays and the following Federal Holidays:
New Years Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day and Christmas Day
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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
CODEC. INSPECTION TYPE DATE INTITIALS CODES INSPECTION TYPE DATE INTITIALS
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 '4 It Q - 2 — /di% -
WORKERS' COMPENSATION DECLARATIOI&
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self -Insure for workers'
compensation, as provided for by section 3700 of the Labor Code. for the
perfor nce of the work for which this permit is issued.
have and will maintain workers' compensation insurance, as required by
action 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:
(This sec(gn need not oe mmplefe0 d (ne perms is valued at one hundred dWlars (s+ogf or less J
'cy - umber: % 3 `% '16
❑ I certify that in the performance of the work for which this permit is
issued, I shall not employ any person in any manner so as to become subject
to the workers' compensation laws of California, and agree that if I should
become subject to the workers' compensation pro inions of Section 3700 of
the e, I shall forthwith comply with the provis'ons.
" ¢anrs Si - tlice� ate: '
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT 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
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force and effect.
ic
ti5ctor's Si ore,/ ate
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the
performance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
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 notapply 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.).
❑ lam exempt under sec.
Business and Professions Code for this reason:
3057-46 (3/07)
t
Owner ID verified by drivb.., iIcense. ❑ 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:
❑ 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, a 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.
Apphcanl'a Signature Data
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 feel 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 application 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? ❑ Yes ❑ No
(Section 65850.2 of the Califomia 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
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
inf:mnalion given above is correct. -1 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.
Slgnalure of Legal 0.r Rrls of
/of, -37
Antl/pr Autlionzetl A phtanl ��* e.^vim
)QS (heyevoeS--r-
X1b °oZZB
alpha Consulting & Engineering, Inc.
Consulting Structural Engineers
1401 North Batavia, Suite 204, Orange, CA 92867
Tel: 714-628-9980
December 15, 2010
City of Costa Mesa
Building & Safety Department
Costa Mesa, California.
Reference: . FOUNDATION REPAIR 1035 CHEYANNE
In regards to the Saber Foundation Failure Report for the planned underpinning repair
report for the above referenced site, Alpha Engineering has inspected the site and visually
inspected the construction.
The method of underpinning recommended in the report is installed at the site..
The steel brackets supporting the slab were observed and seem to be installed per the
report. n
If you have any further questions regardin� fNiA project, please call our office.
Alpha Engineering I* f
11Exp.
FOUNDATION DISTRESS REPORT
1035 CHEYANNE
COSTA MESA, CALIFORNIA
#4194982
PREPARED FOR:
SHARON HASHIMOTO RESIDENCE
1035 CHEYANNE
COSTA MESA, CALIFORNIA 92626
CELL 310-902-0575
EMAIL sharonrumi@earthlink.net
PREPARED BY:
Concrete & Foundation Leveling Solutions.
1-800-922-2488
WWW.SABERFOUNDATIONS.COM
PREPARED FEBRUARY 22, 2010
FOUNDATION DISTRESS REPORT, PAGE 4
Service Quote
To achieve foundation stabilization and raise the foundation to maximum practical
recovery, SABER proposes to install 11 piers under the foundation as indicated in the
CAD drawing below2:
SLAB CRACK
The approximate spacing between piers is six feet.
2 The pier placement is only an estimate of the location of each pier. Once the work has begun, the on-site Job Foreman will make
the final determinations as to the actual pier placement based on the condition of the foundation and obstructions.
Customer Initials
SABER - Concrete & Foundation Leveling • 3602 E. Coast Hwy • Corona del Mar • CA • 1-800-922-2488
PROJECT ADDRESS: 1035 CHEYENNE ST UNIT:
OWNER'S NAME: LEONARD HASHIMOTO
'-'ADDRESS: 1.035 CHEYENNE ST
COSTA MESA
CA 92626
(71.4)549-3654
ARCHIENGINEER: THOMAS KRUSE REG.NO.: CO15585
ADDRESS: 518 1 0TH ST UNIT:
HUNTINGTON BEACH CA 92648
PERMITTEE: LEONARD HASHIMOTO (714) 549--3654
ADDRESS: '10350 CHEYENNE ST
COSTA MESA CA 92626
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code. and my license is in lull force and effect. _
CITY LIC.: STATE LIC.: CLASS:
Dale Signature',
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of Consent to self insure Cr a certificate of Workers'
'ompensation Insurance, or a certified copy thereof (Section 3800. Lab. C).
LICY NO,:EXP. DATE:
'OMPANY:
❑ Cenilied Copy is hereby furnished. ❑ Certified copy is filed with the city Building Division.
Date: Applicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred ($100) or less).
I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become
subject to the Workers' Compensation Laws of California.
Date: Signature'.
NOTICE: It after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor
Code. you must forthwith comply with such provisions or this permit shall be deemed revoked.
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 (Section 3097. Civ. C),
LENDER:
ADDRESS:
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason
(Section 7031.5 Business and Professional Cotle. Any city of county which requires a permit to construct, alter, improve, demolish, or
repair any structure. prior to its issuance. also requires the applicant for such permit to file a signed statement that he/she is licensed
pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or that he/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 Ifloyees with wages as their sole compensation, will do the work, and the
structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractors' State License Law
does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through
his or her own employees, provided that such improvements are not intended or offered for sale. If, however the building or
improvement is sold within one year of completion, the owner will have the burden of proving he/she did not build or improve
for the purpose of sale).
1. as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business
and Professions Code. The Contractors' State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractors) license pursuant to the Contractors' State License Law). Lam aware
that proof of their Worker's Compensation insurance should be provided to me.
❑ I am exempt under Section: B. 8 P. C.
for this reason:
Date: own
/� Own
I do hereby cendy that I am aware of and understand the requirements of California Health and Safety Code Sections 25505, 25533, and
25534 and that I or any future building occupant willlwi11 not (circle one) need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Copley Management District esldential structlon and l s are exempt from
these provisions. Q
Date: 111 1 'j -,?./ Applicant'�
I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county
state laws to building construction and hereby authorize relatives of the y,o en ter upon lh above-mentioned
property
norordinances and
inspection purposnes%.
Date. _I I� /_/ Signature'
1641.46 White-Hmleing: Green -Gree Enforcement: Ganary-nppicanp rine-hevenue: uomenroo-rssessor
CITY OF COSTA MESA - BUILDING PERMIT PERM NO; G 05063
PERMIT NO; G 050631 PLAN CHECK NO; 05321-90 S GOVT: N SUPP: N
CONSTRUCTION TYPE; 5-N PERMIT TYPE; ELE MEC PLU STR PURPOSE: ADD
JOB DESCRIPTION ADD BERM, BATH, CLOS„ ENTRY & EXT,LIVRM, .SQ FT; 562
CLAIM VALUE: 25,000,00 CALL -VALUE; 38,778,00 GROUP OCC; R-3 /M=1•
COMMENTS: SMOKE DETECTOR(S) REgUIRED IN HOME.
2 O N I N GS E R T E B Q A U C I K R S E M E NIT S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING-------=-
FRNT: 21 FT IN REAR; 10 FT IN FRNT'; FT IN REAR: FT IN
LEFT: 32 FT IIN RGHT: 6 FT IN LEFT: FT IN RGHT: FT IN
PARKING REO• PROV: PARCEL: 14159514 ZNE: R1 REF NO:
PLANNING N TES> EXPAND EX. LIVING RM 6 ADD ENTRY TO FT + MASTER BDRM.SUITE
> ADD TO REAR OF EX. SFD. - 310 SF REAR YD COVER.OK---250 PROP
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 APPROVEDBY ^^^^ DATE;
BUILDING APPROVED BY' l l DATE: _�( L -�y
APPLICATION ISSUED BY: DATE: q�
####################i #####•########
LEGALIZATION:N F E E -S U M M A R Y STRUCTURAL SEGMENT:Y
BLDG -PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 343.00 10.00 32,00 9,00 ".71
258 508 258 SMIP/NON-RES
PLAN 222.95
ISSUE FEE 3.00 15.00 15,00
BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE
TOTALS ---- > 396.71 33.00 222,95 652.66 " ..652.66 .00
REVENUE DIVISION TOTALS--> COLLECTED: 429.71 OVER/SHORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN -CHECK
343.00 13.00 47,00 24,00 2;71
I 'N D I V I D U A L F E E B R E A K D tO W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
f
SFR 562E X'�Wfi T' PE V -WOOD FRAME -GOOD 69,00 38,778,00
ELE 7 :: E LIGHTING 1 ST 20 EA. .75 5.25
ELE 111WMP1athA TLET 1 ST 20 EA, .75 8,25
ELE 10\ RECEPTESWITCH 1 ST 20 EA. 75 7,50
ELE 1 MI APPARATUS NOT LISTED REQ PERMIT 11.00 11,00
MEC tbic + - - ATING UNIT/SYS W/CNTLS 01.00 9.00
PLU 1 BATHTUB 2,00 2.00
PLU 1 SHOWER 2,00 2,00
PLU 2 WASH BASIN 2.00 4,00
PLU 1 WATER CLOSET (TOILET) DI D00') 00 0007$002 TCET 2.00
�„ (y END OF FE S oii nr+a/9' i1NF.: 16:I
VV¢� - 1j bss tie! 1�i8/92.
CONSTRUCTION AND PLANNING
,,L & SPA
%APPROVALS Permit #
Date
Inspector
APPROVALS Permit #
Date
Inspector
1. Temporary Electrical Service or Pole
52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd.
-
53. Steel Reinforcement
,3: 'Electrical Conduit Utility-Undrgrnd.
54. Forms
4. Electrical Conduit•Und(grnd.
55. Electrical Bonding r; _
S.'Steel Reinforcement
56. Rough Plumbing & Pressure Test
'
- 6. Electrical UFER Grhd.
-
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
,'?'
8. Foundation
59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P -Trap, 0 Undrgrnd,
10. Structural Floor System
61. APPROVAL TO DECK
11. Property Sewer Line & House Connection
62. Backwash & Receptor -Final
12. Sewer Cap ,
63. Heater & Vent -Final j"
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13, Roof Drains
64. Plumbing System - Final
14. Rough Plumbing
65. Electrical -Final r •
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ii
15. Rough Electrical-Cogndul
66. Solar System -Final
(f•
16. Rough Electric Wiri
67. Fencing & Access Approval �}
e
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
'
18. Rough Electrical -T
69. POOL/SPA SYSTEMS FINAL/
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS'' Permit + --L
20. Rough Factory Fireplace
21. Ducts, in Structure.
-70. Underground Hydro
22. Ducts, Ventilating
.71. Product Piping 0 Gas ❑Oil
`?
23. Gas Pipe=Rough &` Test
_
72, Underground Flush'-'
24. Roof Framing -
= _
73. Undergrnd.StorageTank"0 Gas 00il"
t�• -r
_
25. Roof Sheathing -
74:=Overhead Hydro-
'
26. T -Bar Ceiling (Structural) & Monocoat * ,
75. Dry Chemical
iI
27. Frame and Flashing
76. Dry Standpipe�-
{
4
28. Lathing & Siding
77.' FIXED SYSTEM FINAL J,
29. Insulation ••:
•�I+'--'i�-,>;ti
78. FIRE PREV. FINAL -
t
•�-
30. Drywalh Nailing
'I .5I
HEALTH DEPT. REQUIREMENT
•_-..�
_•
31. Plaster Brown Coat
��
1!
79.,FINAL INSPECTION'
32. Electrical Power -Meter -Final -
��,�
80. FOOD CERTIFICATE ISSUED
,i"
33. Final Electric
(
�- 'I•
Notes:
34- Final Heating & Air Conditioning,
35. Gas Pipe -Test'
.Final
36''Hood or Canopy
j
37. Final Factory Fireplace
-38. Final Plumbing •� •
- i
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-
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39: Water Service -Final_
-
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40. Gas Service -Final
41: Solar Domestic -Final -
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42. Backflow Preventer
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;
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EXPIRED '
._
,-
43. Backflow Irrigation
Incipm@ -
44. Landscape Irrigation System
L)..._WzV?t_ Sig _-_ _ - 411
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING
. 49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
-�
51. CERTIFICATE OF OCCUPANCY
17.
No. pate
_
����p�,,,�-/ Applicant
to fill in all s aces except those within heavy border lines and sign all P
_ - 9 appropriate declarations.
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-CITY OF COSTA MESA CONSTRUCTIONpp����/�1��PERMIT
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TRACT NO.
SLOT NO.
UNIT NO.'
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ProjecteAddress ` .. FK1!-_—
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Applicantls Mailing Addr sst '
TYPE OF CONSTRUCTION NEW ADD. 'ALTERATION REPAIR
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❑ CONVERSION El
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Owner's Name Phones J
_ __ _
' DESCRIPTION OF WORK/USE OF BLDG.
A.P.#__
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Address' O{,(Yj�1L� i
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Main Building:
-Accessory Builtling:�
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License No.
Arch/Eng.T i ;
TYPE OF PERMIT i GRADING
FOUNDATION STRUCTURAL
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Front i '
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+❑ TENANT ❑ E
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PLUMBING ❑ MECHANICAL
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PROJECT DESCRIPTION So. FT. I
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City License No.
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Pln Ref. #
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LICENSED CONTRACTOR DECLARATION
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I hereby affirm that I am liven sed u ntler_ provisions of Charter 9 (commencirig
Remarks:
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Planning Notes:RUEffEo
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with section ]000) of Division 3 of the Business and Professions Code, and
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my licenseiis in ful ip c and effect. ! .,
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license Cl icen No.
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+ ,i i - PLUMBING - I
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-/ORKE S' CO PENSATION DECLARATION-
hereby affirm that I have a ceitificate of consent to self-insure or a certificate
Bar Sink
,Showers i _
ELECTRICAL( I
_ t -
F•E E$ -
of Workers' Compensation Insurancer Or a certified copy thereof (Sec;o
3800, Lab_ ,,;,'Gi�q?,�(f-8� { 'J
Backflow Preventer
Service Smk _
- _
; Automatic Washer-
'Transformer'❑ 15-50 KIN -
t
Policy No. - company
Backflow Irrigation
Sewer Ca
1
❑ 50+JKW
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Construction Pole Sub
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[�Certifietl copy is hereby furnished. r i
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L(J C fit ��ttl�the city putt i g iyi on�-s' +e '
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Bathtubs y
Sewer Connection
Cooking Unit
Meter' ❑up to 100 amps
Date i 4�pp licant /`1 A (• a'r �t-_P
EXEMPT ON ROM WORKERS' COMPENSATION DECLARATION
Clarifiers --
Solar Collectors +
Dishwasher '
-
- Meter ❑ over '100.amp5
f
(This section need not be completed.if the permit is,for one hundred ($100 br
less). )
Dishwasher^ --
.Solar Piping
r;
Dryers ❑Gas ❑Electric' -
certify that in the performance of the work for which this permit is issuetl' I
.,SotijPanei
shall not employ any person in any manner so as to become subject to tNe
Drinking Fountains
Solar Tank
'
Fan i
I Motors ❑0-1- ❑1'/::= B; '�
Workers' Compensation Laws of California. i
- -
4 -
.. d
Date Signature - -
Floor Drains'
.Swimming Pool w/Spa' i
F,A, U:
-
Inc. Solar ❑9-15 HP ❑16;15+
NOTICE: If, after making this declaration, YOU Should become subject to the
_ _
_
Workers' Compensation provisions of the Labor Code, you must forthwith
shall be deemed revoked.
Floor Sinks i I$,"WA
l i
Fixtures +
Microwave
-
comply with such +provisions or this, permit
CONSTRUCTION LENDING i AGENCY i
forithe
Gas Service 'Outletsr
Closet I
i
Device Boxes
i
Pole Light i
1
I hereby affirm that there is a construction lending agency performance
,9
1
of the work for which this permit is issued (Section 3097 civ. CJ
i_
Interceptors
r Heater
>
Outlets '
'
Lender's Name
1
Range'
Lender's Address ' : + '�
Kitchen Sink .; -- '- L _r
Service - -
! -
-• Switches - - -
!
'Sign - - " t -
I
' "
I
OWNER BUILDER DECLARATION i
I hereby affirm that am exempt from the Contractor's License Law for the
LdydtOfl¢S I
Auto-Wash
Garbage Disposal
- !
Standing Sections +
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a Permit to construct, alter, improve, demolish Or repairp-Try
irnystructure, prior to its issuance;also retluires the applicant for such permit
p
dry Trays
Generator ❑0-5 KW ❑5-15 KW
Trash Compactor
C
t�� file a signed statement'that he/she is licensed pursuant to the provisions of
- +
Roof Drains
_ +
"re Contractor's License Law (Chapter 9 (commencing with Section.7000) of
�-
vision 3 of the Business and Professions 'Code) or that-he/she is exempt--
- • - - - - -.
- - - --i -
' - — -- -=- -
- ----
therefromland the basis for the alleged exemption. Any violation of Section
i I
.
1 7031.5. by any applicant for a permit subjects the. applicant to a civil
,Issue
i
' enalty of.not more than five hundred dollars ($500).
'Fee
$
Ill owner. of the 'Property or my employees with wages as their sole
Reinspattipn
$15
�_ Fee _
i3
compensation, will do the work, and the structure is not intended or offered
-
Reinspectidn Fee -
-
1 Issue Fee
for sale (Section 7044, 'Business and Professional Code; The Contractor's
' License Law does not apply to an-owner of a property who builds or improves
- MECHANICAL
-•
-
FEES
,$15'
__
thereon; and who•tloes such work jnimself/herselflor through his or her own
Boiler
-
Hood or Type I El
DEVELOPMENT SERVICES REQUIREMENTS:
- s
im
employees, provided that such provenl are not Intended or offered for
If, the building improvement is sold within one year of com-
Canopy 'Type ❑
Zoning Approved By
- Data
-
,sale. however, or
pletion, the owner, will have the burden of proving he/she did not build or im-
Duct - Under Ground
II
-
i
Building Approved By
-
Date
prove for thepurpose of sale).,
❑d, as owner of-the property, am exclusively contracting with licensetl con-
-• _
Duct- STructural
Refrigeration System,
Application Issued By
Dat
tractorsto-construct'the project (Section 7044, Business and Professions Code:
The-Contractor's ,License Law does not apply to an owner'of property, who
Duct - Ventilating
9
❑0-100,000 BTU ❑100,000 BTU
_
', - SUMMAR VrOF FEES 'a
-
'builds or improves [hereon, and who contracts for such projects with a con-
_
..
,
tractor(s) I tens, pursuant to the Contractor's License Law): I am aware that
Exhaust System'❑ Multiple ❑.
- -
System Repair/Alteration+
{ :
BUILDING PERMIT $, -
- --SMTP
+proof of their'Wor ker's Compensation insurance should be provided,to me.
-
_
_
PLAN CHECK $
g
PERMIT,'
❑ Lam exempt under Section e. & P. C. for this reason
Firepl/Fact: BIt.,ICBO #
Fire Dampers
-
�
Z::,' 1
PLUMBING
ISSUANCE' -` $
Date- owner - _
Heating System 8i Ducting
Registers _ C -
PLAN 'CHECK 25% $._
ENERGY P_C._�$,'-
-
'
hereby certify Chit'I have reatl this application antl state that the'ab"a
'
E:10-1 00,000 BTU 0100,000 BT
GRADING $
.information is correct..I agree.to comply with all city antl county ordinances
-
-
ELECTRICAL $
i
+
and,state laws relating to building construction, and-hereby authorize repre--
'sentatives
_
',
-
_
1 PLAN 50% • $
- _MICROFILM $
'
of this city tb -entente upon -the above-menLonetl- property for �-
_
_ -
_•
,
,CHECK
+
�.
.inspection p o + +
•Signature gate
,MECHANICAL $ -
.TOTAL FEE $
Mi
-
_..
Drivers' License of-SS #
Reinspection Fee
$15'
Issue Fee
$ 3-
PLAN CHECK -25% $ -
i
CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting;
Goldenrod - Assessor
CONSTRUCTION AND PLANNING
APPROVALS Permit #
Date
Inspector
POOL &SPA.
APPROVALS Permit #
'Date
Inspector
1. Temporary Electrical Service or Pole
52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd.•
'
53. Steel Reinforcement.
3. Electrical Conduit Utility-Undrgrnd.
54. Forms,
,
4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding 00
5. Steel Reinforcement
56: Rough'Plumbing & Pressurejest
e
J.:
6. Electrical UFER Grnd..
57. APPROVAL TO'COVER-GUNITE
7. Footings, _
i
t
58. Electrical Conduit-Undrgrnd,�;;
8. Foundation
,.
59. Gas Pipe, O Undrgmd., Testy;
!�
9. Water Pipe-Ondrgrnd..60.
Backwash Lines, P -Trap, ❑ �'Jni rgrnd.
r
�I
rt
10. Structural Floor System
61. APPROVAL TO DECK .f.:..'
11. Property Sewer Line & House Connection
-
62. Backwash & Receptor -Final LLI
12. Sewer Cap
63. Heater & Vent -Final.
13.' Roof Drains
64. Plumbing System - Final
14. Rough Plumbing
-
65. Electrical -Final
15. Rough Electrical -Conduit
66. Solar System -Final
16. Rough Electric Wiring
67. Fencing & Access -Approval
--'
-17. Rough Wiring Sign -
68. APPROVED FOR PLASTERING
18. Rough Electrical -T Bar Ceiling
69: POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit# -
- -
20. Rough Factory Fireplace -
21. Ducts, in Structure
70. Underground Hydro
-
22. Ducts, Ventilating
71. Product Piping O Gas ❑ Oil -
23. Gas Pipe -Rough & Test.
72. Underground Flush
,
24. Roof Framing -
73. Undergrnd. Storage Tank O Gas ❑ Oil
'
25. Roof Sheathing
74. Overhead Hydro
26. T -Bar Ceiling (Structural) & Monocoat
75. Dry Chemical "
27:'Frame and'Flashing
76. Dry Standpipe
28. Lathing & Siding
77. FIXED SYSTEM FINAL
29. Insulation
78. FIRE PREV. FINAL
30. Drywall.Nailing
HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat.
79. FINAL INSPECTION ,
32. Electrical,Power Meter -Final
80. FOOD CERTIFICATE ISSUED
33. Final Electric
Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe -Test
-
36. Hood or Canopyr_
37. Final Factory Fireplace
.38. Final Plumbing.
39. Water Service -Final
40. Gas Service -Final
-
41. Solar Domestic -Final -
,•
42. Backflow Preventer
43. Backflow Irrigation ..
,
44. Landscape Irrigation System
..... '-
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING -
_
48. Special'RequirementsCompleted"
49. Electric Release to Edison
-
50. Gas Release to Southern California Gas Co
-
51. CERTIFICATE OF OCCUPANCY
No. Date
' r ,
OWNER
DA
AP No14l-595-14 LOT 18 TRACT 4607 FIRE ZONE VALUES 4.000.00
INSPECTIONS
SI nature Data
TYPE if GROUP
J ZONE R-1
SOIL
SUBCONTRACTOR
Data Number Si natu.
GAS
WATER
Plumbing
ROUGH PLUMBING
PROP. SWR. LINE r] HOUSE CON.
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND POWER
ROUGH WIRING
Heatina and Vent.
TRENCHES U FORMS STEEL REINF.
FLOOR SYSTEM
BOND BEAM STEEL REINFORCE
SHEATHING
22
FRAME AND FLASHING
LATHING — IN n OUT
PLASTER. BROWN COAT
STRUCTURAL,FINAL
HEATING, VENT., REFRIG. AND A.L., FINAL
PLUMBING, FINAL AND GAS TEST
ELECTRIC, FINAL
BUILDING, FINAL
COSTA MESA BUILDINGSAFETY DEPARTMENT 3145 8%;1;6%76
P.O, BOX 1200 COSTA MESA, CALIFORNIA 92626
APPLICATION FOR STRUCTURAL PERMIT
ForApplicJant to Fill in Completely — Use Ink Only
BUILDING
/ )
ADDRESS 0� C C !9 e/ eA A G S
OWNER kCa NHral H05'/%P^ o7
MAIL
ADD R ESS 10��//3-S CA e � LA A P S -6
CITY p 4T.� M C c a NO.
BRANCH
ADDRESS
ARCHITECT TEL.
ADDRESS
CONTRACTOR
ADDRESS NO /VW1V 0 L -e y -
f TEL.
CITY ^IR ' C
F STATE CITY
LIC. NO. L. .� g LIC. NO
SIZE NO. 00 BLDG&
0. OF LOT NOW ON LOT
d USE OF
�.. - EXISTING BLDG.
FSeparate permits are required for
electric, plumbing and heating work.
(W.., USE OF BUILDING AND WORK TO BE PERFORMED
d J�
i'
J
0 1 hereby acknowledge that I have read this application and state
yr that the above information is correct and agree to comply with
0+ all laws regulating building construction, and I shall not employ
2 any person in violation of the workman's compensation laws of
W the State of California.
3 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 r.//{///���/ //�/t• )
Permittee V'/�/vM4-i^�H/i%.,dp. l/s"�
Authorized At 1 , I. 6-7i
42.5nQ I ML
RECEI E DATE RECEIVED U
V
PERMIT NO.
A.P. NO. � � � S/'r�,t
LDING �/ �^
ADDRESS 1.035 C#EyENNE Jr
TRACT 4/40
LOT II BLOCK
NEW
ADD
ALTER
PA
MOVING
OWNER
VALUE
USE $ OO
FIRE
ZONE TYPE GROUP
APPROVED
BY DATE
ZONE�,
NO. OF
PLANS O
USE OF NEW L1o�
BUILDING
YARDS APPROVED
MAIN BUILDING
YARDS APPROVED
ACCESSORY BUILDING
%FROM C/L STREET)
FROM ST.
FT.
FT,
L. SIDE FT.
FT.
REAR FT.
FT.
DISTANCE BET.
MAIN BLDGS.
BEr. MAIN &
ACCESS. BLDGS.
VAR.#
C.U.P.+
DATE
APPROVED
APPROVE2BY w.
/ 7
5114,
SQ. FT.
THE AMOUNT SHOWN UNDER VALUATION IS FOR
THE PURPOSE OF ESTABLISHING A PERMIT F ONLY:
VALUATION
$ 5?DO
PERMIT FEE $ 2 s(9
PLAN CHECK $ O
TAX $
TOTAL PAID $ S�
17045
OSTA MESA BUILDING -SAFETY DEPARTMENT
P. O. BOX 917 COSTA MESA. CALIFORNIA
For Applicant to Fill In Completely
TYPE OR PRINT
BUILDING / 3s-- C,4 ST_
ADDRESS Psr h G
COSTA MESA. CALIFORNIA
FEE IECOVED
MAY I � 1961
fIP�,1i'dCE DEPT.
CITr OF COSTA rIIi=SA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
OWNER Occidental Loan Company
RECEIPT NO. PER7CR
MAIL
ADDRESS 2 01 Benedict Can on Drive
RECEIVED BY DATE CgVED I' ""DATE IBUU9A
[V2 ,�.� -1 X962
CITY Beverly Hills No: CR —6t�o—
BUIpDD E'S5 1035 heyenne Street
ARCHITECT TEL.
COSTA MESA. CALIFORNIA
OR ENGINEER NO.
ADDRESS -
FIRE
ZONE TYPE 7 GROUP'
CONTRACTOR F
APPROVED
BY DATE
ADDRESS 2 01 Benedict Canyon Drive
ZONING
ZONE NO, OF USE OF NEW
��( PLANS z I BUILDING w J1a.
LEGAL
CITY BeverlyHills Qalifo[m
GOilIa''11^^
STATEC.
CR. -6-O `ilI
141
. NO.
DESCRIPTION Lot # 19 TR -4607
_
SIZE[
NO, OF BLDG-
I D
OF LOT 62X100
NOW ON LDT
A P NO .
USE OF
YARDS EVES
EXISTING BLDG. --
APPROVED ALLOWED
SETBACK LINE FROM
1
(CENTER LINE ST.)
CENTER OF STREET 21 REAR YARD
FRONT 5 L FT. ' IN.
SIDE YARD I LEFT 1
I RIGHT 1
R. SIDE S—�^
FT. IN.
DESCRIPTION OF WORK
L. SIDE S FT. IN.
NEW X ALTERATION I
ADDITION
REAR 3 C7 FT. z .IN.
REPAIR I IMPVING(DEMOLISH
I
APPROVED /„�,O DATEBUILDING
NO, NO. OF /
SIZE 52X48 ROOMS 6 STORIES 1
EXTERIOR Wµy
ROOF
LVOOd
COVERING �Ll1C CO
COVERING S” ROC
USE OF BUILDING AND WORK O BE PERFORMED
1 - Fam. Res. w attached Gar.
IfeXI
17
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
THE AMOUNT SHOWN U R VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM.
PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CI ORDINANCES AND STATE B REG LATIN
VALUATION
BUILDING CON 1CTION.
SIGNATURE PO
PERMIT FEE S }�-
-
PLAN CHECK S
PERMITTE
O� c
$ 19,855.00
��
AUTHORIZED AG NT
TOTAL FEE ��