The URL can be used to link to this page

Home My WebLink About1071 CHEYENNE ST - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 1071 CHEYENNE ST Suite: Vicinity: RESIDENCE AND ATTACHED GARAGE Parcel Number: 14159521 Applicant: BOULGER, SHAWN Address: 845 W GROVE AVE Issued: ORANGE, CA Owner: CODY, MARK, Address 107fCHEYENNE ST SMIP Res: $0.50 " ,COSTA MESA, CA - Contractor: LINNERT ROOFING INC. Address: 845 W GROVE AV Other:.. - UNIT B," " ORANGE:CA Zip: " 92865', - Arch Address: Phone: 'Zip: .License: Zoning: R1 R1 ISSUED BY: Phone: 714-974-5059 Status: ISSUED Applied: 11/07/2001 Issued: 11/07/2001 Zip: 92865 Phone: Zip: 92626 - Phone: (714)974-5059 License: 664319 Eng: l Address: Phone: i -License: SCOPE OF PERMIT TEAR OFF EXISTING COMP'ROOF, REMOVE AND REPLACE ALL BAD SHEATHING AS NECESSARY APPLY 30 YEAR ASPHALT SHINGLES. INCLUDES ATTACHED GARAGE. - - - - - - FEE SUMMARY - Plan Check: $0.00 _ _ Calc Valuation: $4;700.00 Permit: $111.25 Claim Valuation: $4,700.00 SMIP Res: $0.50 SMIP Com: $0.00 Other:.. $0.00 Inspection: '-$0.00 Total: - $111.75 PLANNING & ZONING SETBACKS. MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 - ACCESSORY Front 0-0 Rear 0-10 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES 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 2446.46 (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. ❑ 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' compenlation Insurance carrier and policy number are: Carrier: �YfPolicy Number: (This section need not be completed if the permit is valued at one hundred dollars (�o0)1,11'155.) ❑ 1 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 provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUWECT 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 FOR IN SECTION 37060E THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby all imn that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cade, and my license Is in full force and effect. Lic. q Class it Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby aft!" 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 fallowing reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to constmct, 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 penia' subjects the applicant to a civil penalty of not more than live 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, Le. - properly 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 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 Celifomia 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 appplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? El Yes ❑ No (Section 25534 of the Califomia 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 appermil for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 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 (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 Code Section 42303 been made? ❑ Yes ❑ No ................................................................................................................................................' ai r....... l l ut......................................................................................................................................................................................................................... 8 (If 'yes", attach certificate of compliance from the aPPropnate 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 slate 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 Of Legal Owner(s) Date And/Or Authorized Applicant Date CODE�0 INSPECTION TYPE 2AN INTITIALSS CODE I INSPECTION TYPE 2&6 INTITIAL 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 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 CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT . Job Address: 1071 CHEYENNE ST Suite No Vicinity: Parcel Nunmber: 14159521 Applicant: JOHN PENSO Address: 4522 EISENHOWER DR ANAHEIM. CA Owner: CODY, MARK Address 1071 CHEYENNE ST COSTA MESA, CA Contractor: ECONO AIR Address: 4522 EISENHOWER DR REF:M00-00210 ANAHEIM, CA ELECTRICAL PERMIT Phone: (800) 503-2666 Zip: 92809 Phone: Zip: 92626 Phone: (800)503-2666 Zip: 92809 License: 445220 NUMBER 77 FAIR DRIVE, COSTA MESA, CA 92626 ISSUED BY: SCOPE OF PERMIT INSTALL 200 AMP SERVICE, NEW RESIDENETIAL A/C UNIT AND REPLACE EXISTING FAU. Status: ISSUED Quantity ISSUE FEE $23.50 05/22/2000 Temp service test $0.00 0 Res. a/c package $54.50 0 New Res (1-2 units) $0.00 0 New Res (3+units) $0.00 0 Pool / Spa $0.00 0 Lighting Fixts '$0.00 0 Recept Outlets $0.00 0 Switches $0.00 0 Non Res Appl $0.00 0 Res Appl - $0.00 0 Service to 200a - $30.50 1 Service to 1000a $0.00 0 Service over 1000a $0.00 0 Motors to ihp $0.00 0 Motors to 10hp $0.00 0 Motors to 50hp $0.00 0 Motors to 100hp $0.00 0 Motors over 100hp $0.00 0 Communication drops $0.00 0 Sub panel to 200a $0.00 0 Pole Light Pkg $0.00 0 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 Intermed Pole $0.00 0 Status: ISSUED Applied: 05/22/2000 Issued: 05/22/2000 FEE SUMMARY ' ' Quantity Temp Dist System / Lighting $0.00 0 Busway /100 ft $0.00 0 Standing Section $0.00 0 Misc Electrical Equipment $0.00 0 Transformers up to 1 kva/kw $0.00 0 ................ up to 10 kva/kw $0.00 0 .................up to 50 kva/kw $0.00 0 .................up to 100 kva/kw $0.00 0 ..................over 100 kva/kw $0.00 0 Low Voltage Equipment, $0.00 0 Low Volt Wiring System / Ckt $0.00 0 Misc. Conduit. $0.00 0 Misc. Conductor $0.00 0 Circus ( gen or ride) $0.00 0 Circus (mech ride or lights) $0.00 0 Christmas Tree Stand $0.00 0 Fireworks Stand $0.00 0 Other Electrical Fee $0.00 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $108.50 COMMENTS / SPECIAL CONDITIONS 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 DECLARATIOMS 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��°°mpensatt IInsurr n�5a carer and policy number are: j� / o Carder: / lus `^' � Policy Number: SW b `b 78 714 (This section need not be completed if the permit is valued at one hundred dollars ($100) or less.) ❑ I certify that in the perforrman of )for 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 Califf is, Q re that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with Ihase.previ o �;;o'd O Applicant Signature: Date: WARNING: FAILURE T SEC WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($1 000), 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 p is of Chapter 9 (c mencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Lic. k Class N ConlractoYs Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: 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).): ❑ 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. 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 drivel's 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: ❑ 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 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? [I Yes ❑ No __.._..-....---_.._._..__._ is the 5 Does or will the applicant or present or future building occupant require for the work which is the subject this a plication apermit for such construction or motllfication from the South Coast Air Quality Management District or from any other air pollution control district or agency? UYes 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? El 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 6 (It "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. Bj at 19 f Legal Owners) _ Date Arii:MMuthi5rized Applicant Date CODE #, INSPECTION TYPE PAN INITIALS CODE I' INSPECTION TYPE pj¢, IAL 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical-/i-emsl� 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy 2"6-46 (714)754-5273 • Fax(714)754-4856 CITY OF COSTA MESA BUILDING DIVISION FIEIT NUMBER DEVELOPMENT SERVICES DEPARTMENT. PERMIT 77 FAIR DRIVE, MECHANICAL PERMIT Job Address: 1071 CHEYENNE ST Suite No Vicinity: Parcel Number: 14159521 Status: ISSUED Applied: 05/22/2000 Issued: 05/22/2000 ISSUED BY: $0.00 Applicant: JOHN PENSO Inst FAU <100 k BTU $14.80 Address: 4522 EISENHOWER DR Repair/ Alt Cooling/Heat $0.00 Inst / Rep. Recess Wall Htr - Phone: (800) 503-2666 Refrig Sys >100 k BTU ANAHEIM, CA Zip: 92809 owner: ' CODY, MARK Hood w/Mech Exhaust $0.00 Address: -1071 CHEYENNE ST Vent Fan / Single Duct - $0.00 Appliance $0.00 Phone: $0.00 Smoke Dampers COSTA MESA, CA Zip: 92626 Contractor: ECONO AIR Address: 4522 EISENHOWER DR Arch / Eng : Address: REF:E00-00457 Phone: (800)503-2666 ANAHEIM, CA Zip: 92809 License: 445220 Phone: Zip: License: SCOPE OF PERMIT - INSTALL NEW RESIDENETIAL A/C UNIT AND REPLACE EXISTING FAU. ISSUE FEE - $23.50 Inst FAU <100 k BTU $14.80 Inst FAU >100 k BTU $0.00 Repair/ Alt Cooling/Heat $0.00 Inst / Rep. Recess Wall Htr $0.00 Refrig Sys <100 k BTU $14.80 Refrig Sys >100 k BTU $0.00 Gas Piping $0.00 Factory Fireplace $0.00 Hood w/Mech Exhaust $0.00 VAV Box $0.00 Vent Fan / Single Duct - $0.00 Appliance $0.00 Fire Dampers $0.00 Smoke Dampers $0.00 Inst or Relocate Appl Vent $0.00 Air Handlers < 10000cfm $0.00 Air Handlers > 10000cfm $0.00 Floor Furnace $0.00 Floor or Suspend Heater $0.00 Quantity FEE SUMMARY Repair / Alt Absorbtion Unit Repair / Alt Refrigeration Unit Ventillation System Evaporative Cooler Commercial Incinerator Domestic Incinerator Compressors / Absorption Svstems Up to 3hp/100k BTU 3To 15hp/500k BTU 15 To 30 hp / 1,000 k BTU 30 To 50 hp / 1,750 k BTU Over 50 hp / Over 1,750 BTU Boilers. Up to 3 hp 3 T 15 hp 15 to 30 hp 30 to 50 hp Over 50 hp Other Mechanical Fee Investigation Fee Plan Check Fee Reinspection Fee TOTAL CALCULATED FEES COMMENTS / SPECIAL CONDITIONS Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 $0.00 $53.10 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 DECLARATIONS WORKERS' COMPENSATION DECLARATION: 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 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' lmTsati suran carrier end policy number are: Carrier: �/(N 'WSJ Policy Number: (This section need not be completed lithe permit is valued at one hundred dollars ($100) or less.) ❑ I certify that in the performance offor 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 Californ' re that it I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisio ^ .'n,(�' Applicant Signature: �' — Date: "S-- Z -a'- �t1 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 FOR IN SECTION 3706OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am license under provisions g hapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Lic. # `j-91c�i�kzS`/% Class # : Contractors SignatureO ggw, Date: 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: 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. 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 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 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 neetl 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 an RMPP is presently required, has Section 25534 of the California Health and SafetyCode been fully complied with? ❑Yes ❑ No .__..-__which..is.............................f this 5 Does or will the applicant or present or future building occupant require for the work which is the subject c this a plication a _J No for such constmction 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). __..___"---"".....................nst-...---..............-....---_s permi-bew�n11000._. 6 Will any part of the facility to be constmctetl under this permit be within 1000 feet from the outer boundaries of a school? ❑Ves ❑ 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 Code Section 42303 been made? ❑ Yes ❑ No 8 (it "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 or insption purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. OOf oLegal Owner(s) s Zoo v Date nruhrized Applicant Date CODE I. INSPECTION TYPE QAM INTITIELL CODE d INSPECTION TYPE DATE� 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 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 244616 NSHADE STRUCTURE - (Construction to existing slab) STREET ADDRESS:. 1071 Cheyenne Street Costa Mesa, CA 92626 TRACT NO: 4536 LOT NO: 4 OWNER: Nancy Walke '607/0 evveg 601, it /0t 91dTA0V& #60S6 o ppaD �v�9Qa6E (040 --- 14, STRUCTURAL 'APPROVAL ONLYSTEPARAE PERMITS AR HEATING, E REQUIRED FOR ELECTRICAL, PLUMg,�I VENTIL4TIi- ANO REFRIGERATION WORT( TH�C��A R D � I APPIROVED CITY OF COSTA MESA PLANNING DEPT. SUBJECT TO BLDG. DEPT. REO. L DAT DIRECTOR OF PANNINO City ofCost esn Building Dept. BY __.__..._..._..._..._DAT l'4.'• THESE PLANS MUST BE ON JOB AT ALL TIMES MAKE NO CHANGES WITHOUT PRIOR APPROVAL OF DEPT. OR APPROVAL i it€--nrkYis rZ,smc4' dii r�` 1 �39x lVtlSEA hhOtSVPP1Y PACIFIC NATURAL PATIO KIT BY "SHORTY" NO COVERING ON ROOF AND NO SLOPE IN BEAMS v," DIAMETER CARRIAGE BOLT 4" x 4" ROUGH SAWN DOUGLAS FIR PSTS SPACED S' -0 - CENTER TO CENTER 2" WIDE x 18" LONG STEEL "H" STRAP W/(2) -4z" DIAMETER _ MACHINE BOLTS TYPICAL @ ALL POSTS 12" DIAMETER CONCRETE FOOTING FINISHED GRADE 2" x 6" ROUGH SAWN DOUGLAS FIR GRAB 8EAMS-1 EACH SIDE OF POST (TYPICAL) III- /YY-'•. IIII.�YIIt�IN� �IIWII%I d - SEE CODE FOR MINIMUM DEPTH "All Wood Should Receive (2) Coats of'BEHR' Stain" 2" x 6" ROUGH SAWN LEDGER LAG TO HOUSE WITH W" DIAMETER LAG SCREWS SPACED 32" ON CENTER TOP OF EXIST ING DOOR OR WINDOW 2" x 6" U JOIST HANGER TO LEDGER TYPICAL 2" x 3" ROUGHSAWN DOUGLAS FIR SPACED 6" ON CENTER MINIMUM HEIGHT' MUST CLEAR l'OP OF DOOR OR WINDOW EXISTING HOUSE WALL FINISHED FLOOR ELEVATION INSIDE (EXISTING) EXISTING STEP FINISHED GRADE GENERAL NOTES (Unless otherwise specified) 1. Grab beams shall have no slope 2. Patio roof shall have no Covering. 3. Builder shall verify all minimum code requirements before beginning construction. QTY: MATERIAL LIST LENGTH: DESCRIPTION: 4" x 4" Ro. D/F, Posts _ 2" x 6" Ro. D/F. Plate 2" x 6" Ro. D/F. Rafters 2" x 3" Ro. D/F. Lattice _ 2" x 6" U -Joist Hangers, Ro. Post anchors/Post grips 16d E.G. Box nails Teco nails Y," x 9" Carriage bolts CUSTOMER: ORDER #: DATE:_/ / PATIO SIZE PROJ.: WIDTH: WILL CALL OR DELIVERY DATE: / _ '1" x 5" Machine bolts %" x 5'h" Laq screws _ _ 3/8" x 1h" Lag screws 3/8" Lead shields _ X" Flat washers 3/8" Flat washers 8-76-2M PH Form 03 PATIO COVER DETAIL 6/1/67 SPA SIZE C OVERHANG /c RAFTERS: .rEcuc:TH _,- SLOPED FOR DRAIN 4! % MAX � BEAM STATE SIZE 3/16 X z U_s z POST -BEAM CONNECTION POST 9/�j x 5'Logs 32% —� Predrill Ledger 4 Predrill Existing ''/4-3 Deep JOIST HANGER or other approved methods of support . tie. ALL LUMBER DOUGLAS FIR L0NSiRUCrt0N0 GRADE SHOW SIZE SHOW SPACING SHOW LOCATION ON REVERSE SIDE. DROP PATIO f— SLOPE TO DRAIN :g V THICK SLAB o. PUDDLED•_ SAND. FILL Remove Gross And Weeds Down To Natural Grade 12 CONCRETE MIX 1:3:4 MAXIMUM WATER CONTENT POST ANCHOR _L1.�...... ; 71 GALLONS PER SACK CEMENT. For Pipe Post. Embed r12!.-4 Provide 26 Go G.I. Flashing At Wood Floor Co Pipe In Footing. Provide Flange Or Weld Plate Screwed Or Bolted To Frome. FORM BU -40 CONTINUOUS LEDGER NOTE: USE REVERSE SIDE R 2iETER-C TYPICAL JOIST � ;ANCH;ORg-3 NO I FOR OPEN EGG CRATE FOR SOLID SHEATHING. ALUMINUM OR PLASTIC SHINGLES OR BUILT UP NOTE: USE REVERSE SIDE NOTE: FOR PROPOSED OR FUTURE ROOM,O WALLS ARE TO BE BUILT. USE2NO.2 WIDER RAFTER SIZE MAY BEONTERI SPACING ONLY. z FOR PROPOSED OR FUTURE ROOM<OE WALLS ARE TO BE BUILT SUBMI AND ADDITION PLANS _' (n 4 W 0 (PATI O )N LY. FOR PATIO L HOUSE COSTA MESA BUILDING DEPT. 77 FAIR DRIVE 834-5273 R 2iETER-C JA 0' NO I FOR OPEN EGG CRATE FOR SOLID SHEATHING. ALUMINUM OR PLASTIC SHINGLES OR BUILT UP ROOF COVERING ROOFING. MAXIMUM SPAN SIZE SPACING MAXIMUM SPAN 17' O" 2x6' 12°/.- —MI5_ 1" W1c 15, 0" 2"x 6" 24 W SIO o f 12' 0' 2x 4" I27% CL �-_I- 'o 11, 1 1 ' ON 2'x 4' 16% ` x iE % - 10' 0" 2x 4' 24% _% I" NOTE: FOR PROPOSED OR FUTURE ROOM,O WALLS ARE TO BE BUILT. USE2NO.2 WIDER RAFTER SIZE MAY BEONTERI SPACING ONLY. z FOR PROPOSED OR FUTURE ROOM<OE WALLS ARE TO BE BUILT SUBMI AND ADDITION PLANS _' (n 4 W 0 (PATI O )N LY. FOR PATIO L HOUSE COSTA MESA BUILDING DEPT. 77 FAIR DRIVE 834-5273 OWNER WALKN, NANCY DATE 5-20-77 JOB ADDRESS 1071 Cheyenne Street BUILDING PERMIT NO. 44027' GENERAL CONTRACTOR Owner Builder DESCRIPTION of WORK patio (over AP No. 141-595-21 LOT 4 TRACT 4 FIRE ZONE VALUE S INSPECTIONS Si nature Date TYPE - GROUP ZONE –1 SOIL SUBCONTRACTOR - M cns Date — Number $i nature ! AGER - PI nbin ROUGH PLUMBING . PROP. SWR. LINE HOUSE CON. SPRINKLING SYSTEM MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND POWER `ROUGH WIRING Heatino and Vent. TRENCHES FOAMS STEEL REINF, FLOOR SYSTEM BONG BEAM STEEL REINFORCE SHEATHING FRAME AND FLASHING LATHING — IN OUT PLASTER, BROWN COAT /y3\ STRUCTURAL, FINAL I ri hA II HEATING, VENT.. REFRIG. AND A.C., FINAL I it O t.I P n flI V IJ f PLUMBING, FINAL AND GAS TEST I tom.%% # ---A If nil irk 1 ELECTRIC, FINAL " U V4..l{ fl Id 1 BUILDING, FINAL YS' J21 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 4AY 20 77PAIu001'011* ***** cnsa 9.50 APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Use Ink Only RECEM I DATE RECEIVED E II BUILDING /J ! ADDRESS _2 PERMIT ,,"� OWNER /v ii/f/G yr yFfL�F A.P. NO. L�' MAIL BUILDING L ADDRESS u tiJ ��,/ ADDRESS ` 1l66/J NOL✓V�_%rL3 ��,,,��''zzCITYCISTjI TRACT"'(✓,J(Q LOT L BCONSTRUCTION W A D PLENDER BRANCHOWNERADDRESS l VALUE S �T`� S ARCHITECT TEL. -- OR ENGINEER FIRE ADDRESS ZONE TVP GROUP APPROVED ��CONTRACTOR OW,.d/��Q BY DATE - ADDRESS %ONO. TE OF / USE OF NEW CITY Cows} NOL, $V& -74(g3 PLANS BUILDING je L% STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING SIZENO. �1/ OF BLDGS. (FROM /L STRE ) OF LOT ,Z X NOW ON LOT FRONT.JOW,FT. USE OF/ ��f✓IOE///C� I EXISTING SLOG. R.SIDE'lpp /%�/( FT Separate permits are required for L SIDE f FT V FT. REAR FT. FT. electric, plumbing and heating work. USE OF BUILDING AND ORK TO BE PERFORMED f.N ' DISTANCE BET. BET. MAIN & /O O W -rl o COVE MAIN SLOGS. ACCESS. BLDGS. VAR.* DATE C.U.P.0 APPROVED APPROVED r x" ,11 DATF 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 Ilcensetl es a contractor untlar �fl SO. 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 VALUATION PERMIT FEE E end Professions Code, Division 3, Chapter 9. PLAN CHECK E Signature of /f d0 TAX 5 3-0 i Permittee $ 7Q0 �� 617 TOTAL PAID is t7 Authorized Agent • `, ` 18707 COSTA MESA BUILDING -SAFETY DEPARTMENT P. O. BOX 917 COSTA MESA. CALIFORNIA EEE RECEIVED YFEB 1 9 1963 FINANCE DEPT. For Applicant to Fill In Completely PP P y f Elly k1 -p&& MESA APPLICATION FO TYPE OR PRINT BUILDING ILDING [ADDRESS Office Use Only C05TA MESA. CALIFORNIAFor RECEIPT NNER MAIL - RECEIVE 0Y DATE RECEIVED L'DAT1ISSUEy6� ADDRESS' �_ FEB 1 8 796 TEL. CITY NO.5JO5ADDRESS BUILDING�J y� /O ARCHITECT TEL. COSTA MESA. GKALIFORNIA OR ENGINEER NO. FIRE ADDRESS ZONE TYPE GROUP - CONTRACTOR APPROVED BY DATE ZONING ADDRESS ZONE OF USE OF NEW�7 ?Vp CITY — PLANS Z FLA BUILDING �v/� I STAE TELf LEGAL NO. — OEBCRIPTION INO. OF BWGS. NOW ON LOT A. P. NO. YARDS EVES kLOT LDG. APPROVED ALLOWED E FROM /7Q 1 (CENTER LINE ST.) 6TRELT REAR YARD FRONT '5FT. IN. ILEFT ( RIGHT 5 R. SIDE 'S FT. IN. DESCRIPTION OF WORK — s — L. SIDE 3 FT. IN. II I (ADDITION 1 36 NEW r ALTERATION REAR FT. 3 IN. REPAIR II MOVING I DEMOLISH AAPIS,PROVE�II�� a,u DATE C`, li 1 BUILDING //,, NO. OF // ' SIZE Y ROOMS O STORIES_ EXTERIOR WAL IRCOOOFVERING COVERING USE F BUILDING AND WORK TO BE PERFORMED 1- p CKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION THE AMOUNT SHOWN NDER VALUATION IS FOR THE THAT THE ABOVE IS CORRECT ANO AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. ALL CITY ORDINANCES AND STATE LAWS REGULATING LRED VALUATION CONSTRUCTION. OF _PERMIT FEE FEE S ITT /J �I� y S r>L _PLAN CHECK 5 K $ D AG TOTAL FEE % J__