HomeMy WebLinkAbout1043 CHEYENNE ST - Building PermitsBUILDING PERMIT
Job Address: 1043 CHEYENNEST
Suite:
Vicinity: RESIDENCE AND ATTACHED GARAGE
Parcel Number: 14159513 Zoning: R1 R1
Applicant: MARTINEZ, ALBERT
Address: 1509 W FLORA ST
Phone: 714-448-8648
SANTA ANA, CA Zip: 92704
Owner: MARTIN,.RODRIGO
Address 1043 CHEYENNE ST
Phone:
COSTA MESA, CA Zip: 92626-2863
Contractor: MARTINEZ ROOFING
Address: 1509 W FLORA ST
Phone: 714-448-8648
SANTA ANA, CA
Zip: 92704 License:. 804021
ISSUED BY:
Status:
ISSUED
Applied:
03/05/2003
Issued:
03/05/2003
Yy�
Arch Eng
Address: - _ Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
REROOF RESIDENCE AND ATTACHED GARAGE: T/OEXISTING COMP ON THE PITCHED ROOF, REPAIR/REPLACE SHTG AS NEEDED, 1
LAYER 15# FELT, APPLY "30 -YEAR COMP SHINGLES.- ON THE FLAT ROOF, LAYER OVER 1 LAYER OF CAPSHEET AND APPLY SINGLE -PLY
T.P.O.
ROOF: 28 SQUARES ,
Plan Check:
$0.00
Permit:
$111.25
SMIP Res:
SMIP Com:
$0.00
Other:
$0.00
Inspection:
$0.00
Total:
$111.75
SETBACKS
MAIN STRUCTURE Front 0-0
ACCESSORY Front 0-0
PARKING Existing: 0
Rear 0-0
Rear 0-0
Required: - 0
FEE SUMMARY
PLANNING & ZONING
Left 0-0
Left 0-0
Proposed: .0
Calc Valuation:
Claim Valuation:
Right 0-0
Right 0-0
$4,800.00
$4,800.00
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)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 754.5626
!arise Isrool
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 far which this permit is issued.
My workers' compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(Th" section need not be completed if the permit Is valued atone hundred dollars ($100) or less.)
I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
wmpensation laws of California, and agree that 1 I should become subject to the workerscompensation provisions of Section 3700 of the Labor Code, I shall forthwith
=mply with these pro %�io s. 1
Applicant Signs ture: ��"/iZsf;,r" %t- ��1��)7C,— Date:
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 DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED POR 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. Lic. fl >L - Class a C-2✓ 9
Contractors Signature: iii -P -e, lk Date: Cy -n F�
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).
Lender's Name: Lender's Address:
Signature: Date:
OWNER -BUILDER DECLARATIONS:
I hereby affirm that under.penalryJof perjury that I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions
Code: Any city or courity'which requiresa 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 islioensed 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'fie ortslie 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 iio ,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 Cc(de:'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 Pis 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 driver's license.es ❑ No Driver's License No. Expires:
Verification of Ownership by (type of document, i.e. - property tax bill or dead).
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 hereby certify that no excavation five (5) or more feel 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).
present or future building Occupant need to file a registration form for �acutely ...hazardous
. z r .9..... V
........................................................................ .................... ........................ ....
2 Does or will the applicant or pr g p g a a dous materials ❑ es ❑ 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 Califomla Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
..... .........................................,..............................................................................................................................................-.........................................................................................................................................................
...e..... ...
4 If an RMPP is presently .aqui..®d, has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑ No
..................................................................................................................... ildi............................................................................................................................................................................................................................................difi...............
5 Does Or will the applicant Or present or future building occupant require for the work which is the subject of this a 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? � 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 ba constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
(it "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 Coda 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.
Of L al Owner(s) Date
And/or Authorized Applicant Date
CODE t. INSPECTION TYPE PBL. IRTTIALS CODE/ INSPECTION TYPE QiE IHTITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final —�1—A/j 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
O 1
�20� ,li a01.
TESTING
July 5, 1978
Laboratories �j ��,L,Er_�,r c°,<4-171ri.r.
v` i:p op.,IiO „Io�5c.(;t.; 520.U32
.
Examination: SC78-2786
COMPRESSION TESTS ON GUNITE CYIINDERS
Mr. Errol F. Heesch
12921 Aspenwood Lane
Garden Grove, California 92640
PRO ItCI Pool for MR. & MRS. WYLIE
ADDkESS 1043 Cheyenne, Costa Mesa
SAMPLE FROM Gunite Swift Pool
• .NiIE!;
COIR[ CIO.
South Coast Pools
Grove Gunite Co.
SPECIFIED
4'-z to 1
STRENGTH
2,000 psi
DA ii' c.-t',I
6-20-78
CYLINDER SI(E
DAit it, 'Tfo
7-4-78
7-4-78
7-4-78
CYNr,nER N;%
1
11
111
C OMI'1!i isIi.irl
14 -Day
14 -Day
14 -Day
)OlAt WAD. LCi
109,500
103,000
121,500
Put.!Nos PER i«
IN 3,875
3,645
4,300
Size:
6"xl2!FIt
611 x.12."
61'x121"
c0PAI'0Ahfcf
14 -Day test
complies with specifications.
Cyls. 4,5 & 6
"HOLD"
M�^t 6:
Gl lI+t4J 4.
GECEIVfo ON
c'I.INDERS
Tave
Heesch
6-21-78
ui Sr51su n99
E. F. Heesch - 2
Grove Gunite Co.
Costa Mesa Bldg. Dept.
i
.. �.. _ a... _ �. •- Lr'. •. ..i . _ • • .i �. .. N. • .n ♦ U .111 .5 C()SC.•. SiOnS Ou 1.
c• .> .. .r .. ... •.. .. ..l i. S... a. �. .. �. n_ .... a.... .. •. �.... ..c, i t`�> .! .rC„C •r.O ().. cf _Slf
OWNER WY7.IE, M. M. DATE 6-6-78
JOB ADDRESS
GENERAL CONTRACTOR
IAP No. 141-59r=13 L
INSPECTIONS
Pool Location
Forms
Main Drain
Steel Reinforce
Elec. Bond
Approval to Cover
Underground Electric
Gas Piping Test
Filtering System Lines
Backwash Lines and Recep.
Electrical Final
Heater and Vent Final
Filter System Final
Backwash and Recep. Final
Fencing Final
A
DING P
SUBCONTRACTOR
Electric
Plumbing
E.
COSTA MESA BUILDING -SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
2637 6%OC
-2637•:- ON/ _
lia CK t '
IA ._ ,_
APPLICATION FOKSfRU 4rk - WIMIT
For Applicant to Fill in Completely — Use Ink Only
RECEIVED By
DATE RECEIVED
DJUE ISSUED
BUILDING /JI� �} I l
�u
_ADDRESS VV C.iH 4
OWNER 1. �fC 1
f PE
A.P.NCQ f-/ - I
BUILDIN
MAIL
ADDRESS
ADDRESS
��jj TEL.
CITYety T A eJ/'7 NO.CONSTRUCTION
TRACT
LOT
W
A D
A PLENDER
BRANCH
OWNERADDRESSAflCHITECT
USEOR
TEL.
ENGINEER N
FIRE
ADDRESS
ZONE T E GRO
- ,(. �1
CONTRACTOR, 66,A4, �j�'i
APPROVED
BY DATE
L�J"/�
ADDRESS � C, 19e)e& —'S .
Le V
I/ �+ TEL. ^,,
CITY (}j J -P 177r511 NO. S��K
ZON
NO. OF
PLANS
USE OF NE
BUILDING �'�
STATE CITY
YARDS APPROVED
YARDSAPPR ED
LIC. NLIC. NO.
O. bob
MAIN BUILDING
ACCESSORY BUILDING
SIZE NO. OF BLDGS.
(FROMC/ FEET) t�
OF LOT NOW ON LOT
FRONT FT..
FT.
USE OF
EXISTING BLDG.
SOr T.'
FT.
(r
Separate permits are required for
L. SIDE FT
FT.
t /
electric, plumbing and heating work.
REAR F
FT.
US OF BUILD I NG AND WORK TO BE PERFORMED
DISTANCE BET.
BET. MAIN&
MAIN BLDGS.
ACCESS. BLOGS.
'
VAR.
DATE
C.U.P.#
APPROVED
APPROV
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
SQ. FT.
THE AMOUNT SHOWN UNDER VALUATION IS FOR
the State of California Business and Professions Code, Division 3,
Chapter 9, and that such licenses are in full force and effect, or I
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the provisions of the State of California Business
and Professions Code, D I vision 3,, Chapter 9.
VALUATION
PERMIT FEE $ /
PLAN CHECK $ ,
Signature of ,/ //
TAX $
t
Permittee /YYY///
D�
TOTAL PAID $
Authorized Agent
�V)\'A
OWNER MORSELLr Robert H. DATE 2-26-63
JOB ADDRESS 1Q3—C1BY-e1]I'1e -Ot, BUILDING PERMIT NO. 18824
GENERAL CONTRACTOR Oymer-$].dr, VALUE $ 400_00
AP No. LOT 17 TRACT 4607 FIRE ZONE DESCRIPTION OF WORKr518b--& izg�F.Yol
INSPECTIONS
Signature
DATE
GROUP i TYPE V ZONE R-1
Soil
SUBCONTRACTOR
PER vlITS ISSUED
Gas
DATE NUMBER
Water
Rough Com. Refrig. ❑ Air Cond. ❑
Rough Heating
_
Rough .Plumbing
Miscellaneous
Prop. Swr. Line ❑ House Con. ❑ St. Swr. ❑
_
Sprinkling System
Construction pole
Underground ❑ Power ❑
Rough Wiring
Trenches Crt— orms [H' Steel Reinf.
,
7777 7,, 3
Floor System
Bond Beam ❑ Steel Reinforce ❑
Sheathing
Frame and Flashing
Lathing — In ❑ Out ❑
Plaster, brown coat
Refrig. ❑ Air Cond. ❑ Final
Heating, Final
_
Plumbing Fixtures, Final
Final Gas Test
_
_
Electric Fixtures, Final
Building, FinalA-
OCCUPANCY "
FORM RN .5M - 7.61 1
I
_' I8824
WrtTA MEbA BUILDING -SAFETY DEPARTMENT
P.O. BOX 317 QO$TA MESA, CALIFORNIA
For Applicant to Fill In Completely
TYPE OR PRINT
0 COSTA -MESA, CALIFORNIA ■
}
TEL.'
STATE - TELO.. /B L7—/G'
LIC. NO.
N 7 / vn /
SIZE n. I/ DAIRY / I NO. OFHLDOS.
SETBACK LINE FROM v y / 'j y
CENTER OF STREET CI / REAR YARD 30 /1
C ` nI
SIDE YARD LEFT �/ y % Soy I RIGHT ✓ � LJ
DESCRIPTION OF WORK
i t KtI,UM
FEB 2 6 1963
FINANCE DEPT. G
CITY OF COSTA MESA v"
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
RECEIPT NO. I PE
DATE
EAV E OVERHANG SHALL BE LESS THAN
YARDSAPPROVED YARDSAPPROVED
MAIN BUILDING ACCESSORY BUILDING
(FROM C/L STREET)
REPAIR
II
ZONING
II
E
NO. OF
•�
USE OF NEW
VAR.*
C. U. P. #
DATE
APPROVED
PLANS
EXTERIOR WALL (U
COVERING COVERING
BUILDING
I
LEGAL
r ,4--
1 n T` /
. I n a
EAV E OVERHANG SHALL BE LESS THAN
YARDSAPPROVED YARDSAPPROVED
MAIN BUILDING ACCESSORY BUILDING
(FROM C/L STREET)
REPAIR
II
MOVING
II
DEMOLISH
I
DISTANCE BET.
MAIN NCEBLDGS.SE
BET. MAIN e
ACCESS. BLDGS.
VAR.*
C. U. P. #
DATE
APPROVED
BUILDING
l` SIZE ROOMS C/, STOR�I{E�S �
EXTERIOR WALL (U
COVERING COVERING
APPROVED
BY
DATE
USE OF BUILDING AND WORK TO BE PERFORMED
G
ACKNOWLEDGE THAT 1
THAT THE ABOVE 18
I -6417 -/WS
d� ; 5 '
�.
N
SD. FT.
G
ACKNOWLEDGE THAT 1
THAT THE ABOVE 18
HAVE READ THIS APPLICATION
CORRECT AND AGREE TO COM.
THE AMOUNT SHOWN
PURPOSE OF ESTABLISHING
UNDER VALUATION IS FOR THE F'
A PERMIT FEE ONLY. O
ALL CITY ORDINANCES Ary STATE LAWS REGU
CONSTRUCTION.
E OF
TING
yALUATION
y
$ /,/
v
0
PERMIT FEE
f
PL -ANC
%
,� �`
ZED AGENT
_ 17044
COSTA MESA BUILDING -SAFETY DEPARTMENT
P. O. BOX 917 COSTA MESA. CALIFORNIA
For Applicant to Fill In Completely
TYPE OR PRINT
'BUILDING �Q 113 C4
BUILD( c PYP. h h e s%_
COSTA MESA. CALIFORNIA
S=EE RECEIVED
MA`( 1.1 1961
F{NANICE DEPT.
C11Y OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
OWNER Occidental Loan CompanyT//7
RECEIPT NO. PEO
MAIL '2901 Benedict Canyon Drive
RECEIV� I DA RECEIVED DATE
"9'92
ADDRESS /
1"'
_ p1AY ? 1
Hills CR.—Q
BUILDING 1043 C eyenne Street
CITY Beverly NO.
l7
ADDRESS
ARCHITECT -- TEL.
'
COSTA MESA. CALIFORNIA
OR ENGINEER NO.
FIRE •/
ADDRESS
ZONE
ZONE TYPE l/ GROUP r
CONTRACTOR Tdelsohn
APPROVED
BY DATE
`%Q
ZONING
ADDRESS P_enPdjc,,t rAnV P
CITY Beverly hills, Californiaj�/'(�
ZON
���
NO. OF
(PLANS Z
USE OF NEW
(BUILDING �/
EO. 11+1
/
LIC. NSTA
ND' Vll.-���/ TJ
DESCRIPTION
SIZE
I NO. OF BLDGS.
OF LOT
NEW ON LOT Q
A. P. NO.
USE OF—_
YARDS' EVES
EXISTING BLDG.
APPROVED ALLOWED
SETBACK LINE FROM
1 1
(GUNTER LINE ST.)CENTER
OF STREET REAR YARD
FRONT S� FT. IN.
G
I 5 1
S—
SIDE YARD LEFT
RIGHT 51
R. SIDE FT. —� IN.
DESCRIPTION OF WORK
--
L.SIDE 5 FT. IN.
I X I
I I
3/ 3
NEW ALTERATION
ADDITION
REAR FT. IN.
REPAIR I MOVING I
DEMOLISH I
APPROVED
DATE
DIBUIL N 2X4
SUE ROOMS. STORIES 1
EXTERIOR W ROOF
COVERING ITC O ERINGWOO
USE OF BUILDING AND WORK OBE PERFORMED
1 - Fam. ReS. w attached r
W'V1
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLIGVON
THE AMOUNT SHOWN UNDER VA ION IS FOR THE
AND STATE THAT T E ABOVE IB CORRECT AND GREE TO COM.
PURPOSE OF ESTABLISHING A;P RMIT FEE ONLY.
PLY WITH ALL CI ORDINANCES ANO STAT W8 REG TI
BUILDING CONS UCTION.
VALUATION
SIGNATURE
PERMIT FEE $
PERMITTEE
/
PLAN CHECK
$ 21 021iY
AUTHORIZED AG T
, .00
TOTAL FEE