HomeMy WebLinkAbout900 CEDAR PL - Building Permitsr
' � CITY OF COSTA MESA �
BI/ILD/NG DIVISION
77 FAIR ORIVE, COSTA MESA, CA 92626 •(774) 754-5273 • Fax (714) 754-4856 • w�vw.ci.costa•mesa.ca.us
FOR INSPECTIONS CALL: (714) 754•5626
PERMIT TYPE: B COMBO
Sub Type: RES_RRIP
�oe qoDRess: 900 CEDAR PL CM
nPN: a2252223 Zoning: , ,
Vicinity:
Congt Type: V-N
SQ. FT: 1897
PERMIT NUMBER: BC07-00397
STATUS: ISSUED
DATE ISSUED: 06/20/2008
ISSUED BY: RMD
SuitelUnit:
Primary Occ: R-3U1
Valuation: $140,581.80
SCpPE OF WORK: ADD 1,128 SF TO AN (E) 1-STORY SFD TO CREATE A 2ND STORY (FIRST FLOOR 142 SF, SECOND FLOOR
986SF}, NEW 74 SF PATIO COVER, REMOVE (E) ATTACHED CARPORT, REBUILD A NEW 536 SF ATTACHED GARAGE AND
INT�RIOR REMODEL OF HOUSE, AND 60 SF2ND STORY BALCONY. 1 FIRE PLACE, 1 VENT FAN, 3 NEW HEATERS, 1 MOTOR
TO
1 HP, 25 LIGHT FIXTS, 38 OUTLETS, 25 SWITCHES, MISC EL FOR HEATERS, 1 BATHTUB, 1 GAS OUTLETS (1-4), 1 GAS PIPE, 1
LAUNDRY TUB, 1 SEWER CONNECT, 1 SHOWER, 1 WASH BASIN, 1 WATER CLOSET, 1 WATERHEATER, 1 WATER PIPE INST,
1 WA7ER REPIPE. REF: MM-07-16 FOR 9 FT. 2N0 STORY STREET SIDE SETBACK.
OWNER: RUSSELL, ROBERT LUTHER
Phone: 949-637-7999
APPLICANT: KIftK, KRIS7EN
Phone: 714-891-g443
Atldress: 900 CEDAR PL
Ciry/State/Zip: COSTA MESA, CA
Address: 15587 PROOUCT LANE
City/State/zZip: HUNTINGTON BEACH, CA
Unit:
Unit :C16
ChoryeRAn �R�"l ,��' � WI.� �!n'Atldress: U�� �'JS�IenPro�Cu.�}- 1 n . ./�1
� `'� 1 � � C%Y � City/State: .i l�� •�� �`L� �` Z pCode Cl � ({ (-�v �
I" �Q 1
ARCHITECT: ANNA MARIE BARD, AIA �icense No.C30859 PHONE:949-500-3861
ENGINEER: NELSON, WILLIAM M License No.3417 pHONE:949-752-2070
COMBINTATION PERMIT FEE SUMMARY
Builtling Plan Check: 5795.18
Builtling Fees: $1,223.35
Electrical Fees: $132.89
Mechanical Fees; $85.80
Plumbing Fees: ��42.50
SMIP Residential: 514.06
SMip Commercial: $0.00
TOTAL FEES: $2,393.78
"Ref¢r ro tee receipts for all fees paitl for pmject
E��iRED
DATE �_ �� I S� i0 �,19M B�%
��
N0710E: The work authonzed by this permit shall comply with all applicable handicap access requirements under Califomia sWtutes and relaled
regulations. (Ord. No. 92•28, § 7. 12-21-92)
EXPIRATION: PERMIT EXPIRES 780 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 musl comply with all applicable codes, and all
reqUired inspections and final approval must be obtained. Failure to oblain inspections and fnal apDroval will result in the expi2tion ot this permit.
co�,r �xsvEcnarirre � ixnnn� CQDEI �xsaEcnoNrne , n.� .
1818 Fiaed System Final Fire Prevenlion 206 Final Machanical L
1266 Popl Spa Final 208 Final Plumbing �l
200 Final Re-Roo( 210 Final Electrical ��
207
202
203
Final elock/Retaining Wall
Final Factory Fire Place
Final Sign
204 Final Demolition
212 Final Fiie Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
e ,
WORKERS' COMpENSATION DECLARATI .
I hereby aKrm untler penalty of perjury one of the following declarations:
❑ I have and will maintain a cetlifcale o( consent to self-Insure for workers'
compensation, as provided for by section 3700 ot the Labor Code, (or the
performance of Ihe work for which this permit is issued.
❑ I have and will maintain v.orkers' compensation insu2nce, as required hy
section 3700 oi the Labor Code, for the pedortnance of the work for which this
pertnit is issued. My workers' compensation Insurance wrner antl policy
numberareI.\�, �.f � '' •
Carrier: �1/�1�% 1A/V1�0.1'�/J�Q.��
(IDissecf' iptbecam/p�e/te�tl4tneperm'aIis'vIaluetlatarenundfre1tlCdlars(St00)aless)
PolicyNumber: ��� (J'I� '—Y�I � �%� l/7i
❑ I certi(y that in the peAormance of the work for which this pertnit is
issued, I shall not employ any person in any manner so as to become subject
lo th workers' compensation laws of Califomia, and agree that i( I should
beco e subj t to the rker com ensation pmvision of Section 3700 of
th abor Co e. I shall o h' i com ly vnth these provi ions. �
� O
. Apvb nfs5 Wre � �e
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE
IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
AITORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirm that I am licensed under provisions ot Chapter 9(commencing
with Section 7000) of Division 3 of the Business and Pmfessions Code, antl
my license is in full force and effect.
Lic. # Class #
\
�� ��
Con c rs gn Wre Dale
CONSTRUCTION LENOING AGENCV:
� I hereby affum that there is a construction lending agency for the
peAormance of the work for wfiich Ittis pertnit is issued. (Sec. 3097, Civil Code).
Lentler's Name:
Lender's Adtlress:
Signalure
OWNER-BUILDER DECLARATIONS:
I hereby affrm tha[ under penalty o( perjury lhat I am EXEMPT FROM THE
GONTRACTORS LICENSE LAW for the follovnng reason (Sec. 703L5,
Business and Professions Code: Any city or wunty which requires a pertnit to
wnsirucl, aller, improve, demolish, or repair any siructure, prior to its
issuance, also requires t�e applicant tor such permit lo Ne a signetl statemeN
that he or she is licensed pursuant b tne provisions of ihe Contractors
License Law (Chapter 9(commencing with Section�7000) of Division 3 of the
Business and Professions Code) or lhat he or she is exempt there(rom antl
the basis for the alleged exemption. Any violation of Section 7037.5 by any
applicant for a permit subjects the applican[ to a civil penalty ot not more than
five hundred dollars ($500).):
❑ I. as owner of the property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and the slructure is not intended or
oHered (or sale (Sec. 7044, Business and Professions Code: The Contraclors
License Law dces not apply lo an owner of property who builds or improves
thereon, and who dces such work himself or herself or through his or her ovm
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvemenl is sold within one year of
completion, Ihe ovmer-builder will have the burden of proving that he or she
did nol build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WI7H
110ENSED CONTRACTORS lo croslruct the project (Sec. 7044, Business and
Protessions Code: The contractors License Law dces not appy to an o.mer of
pmperty who builds or improves thereon, and wfio contracts fw such project vrith
a contractor�s) license pursuant to Ihe Cont2clors License Laws.).
❑ I am exempt under sec.
Business and Professions Code (or �his reason:
SlgnaWrc Dale
309<6 (YW �
. ��..
Ovmer ID verified by Arive en$e. ❑ Yes ❑ No
Dnver s License No. Expires:
� Verification o( Ownership by (rype of documen[, i.e. - property tax bill or dee0):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: -
❑ I hereby certify that no excavation frve (5) or more (ee[ in tlepth into wfiich a
person is required [o descend, will be made in conneclan with wnrk authorized
by Ihis permit, and tha[ no builtling slructure, sc�fdding, falsework, or tlemolilion
or dismantling thereof, will be more Ihan thirty-su (36) fee[ high. (Chap. 32, Grp
2, Art 2, Sec. 341, Title 8, Califomia Administrative Code).
❑ As ovmer-builder, I will not employ anyone to do vrork which vrould
require a permit (rom the Division of Industrial Safety, as notetl above, unless
such person has a permit to do suc� work fmm Ihe division.
Appl¢anfs 9gnalure Dale
Division of IndusMal Safety Pertnit Number.
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applican[ or presen[ or fu�ure building occupant need [o file antl
certify a Business Plan (or emergency response to release or threatenetl
release ot a hazar0ou5 matenal? ❑ Yes ❑ No
(Section 25505 ot the Califomia Health and Safety Code requires, with some
exceptions, thal a Business Plan be filed with the Costa Mesa Fire
Department by every business which has at any one time during a reportetl
year a quantily of hazardous materials equal [o or greater than a weight of
500 pounds, or a volume ot 55 gallons, or 200 cubic feet of wmpressed gas
at stantlard IemperaWre and pressure).
2. Does or will Ihe applicant or present or fuWre building occupant need lo (le
a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Nealth and Safety Code, wi[h some
exceptions, requires registration with the Cos[a Mesa Fire Department by
each business which at any one time has on hand a quantity of acutely
hazardous matenals equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic fee[ of compressed gas at s�andard
temperature and pressure�.
3. Does or will the appliwnt or present or fuNre builtling occupant need to
prepare an RMPP (Risk Management antl Prevention Program for acutely
hazardous materials�? ❑ Ves ❑ No
(Section 25534 of Ihe Califomia Health antl Safery Code provides tha[ Ihe
Costa Mesa Fire Department may require Ihe preparation, cetlifica[ion and
filing with Ihe Fire Depa�men[ of an RMPP by businesses which are required
to register aculely hazardous materials vrith the Fire Department.
4. If an RMPP is presently required, has Section 25534 of the Califomia
Health antl Safety Code been fully complied vnth? ❑ Yes ❑ No
5. Dces or will the appliwnt or present or future building occupant require for
Ne work which is the subject of this application a permit for such wnstniction
or modification from the South Coast Air Quality Management District or from
any other air pollution control district or agency? ❑ Yes ❑ No
(Section 658502 of the Califomia Govemment Cotle requires that the requested
information be fumishetl on applications far ran-residential building permits).
6. Will any part of the faciliry to be wnstmctetl under this permit be within
7000 feet (rom lhe outer boundaries of a school? ❑ Yes ❑ No
Q('yes", the taciliry must meel the requirement of Sections 25534 and 42303
of lhe Calitomia Health antl Safery Cotle�.
7. If a pertnit from the South Coast Air �ualiry Managemen[ Dislrict or other
air polWtion contml disinct or agency is required for the v,nrk which is the
subject of this application, have all of the disclosures prescribed by Califomia
Health and Sa(ety Code Section 42303 been made? ❑ Yes ❑ No �
8. (If 'yes', anach certifiwte ot compliance from the appropriale air pollution
coMml oKcer). '
CERTIFICATE OF�COMPLIANCE: I certify that under penalty of perjury the
infortnation given above is correct. I agree to comply with all state laws and
city ordinances regarding Hazardous Malenals and Emissions. �
SignaNre Dale
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury that I have read this application and state that
the infortnation given is correcL I agree ro comply with all state laws and ciry
ordinances relating to building consWction, and authorize representatives of
lhe Ciry o( Costa Mesa ro enter upon the above-described pmperty for
inspeclion p� rposes. I agree not to occupy or allow occupancy of any building
aulhorized b Ihis pe it until final inspeclion. �
$ig ! e LegalOr er j D
M orAulM1on OOIi nl ale
CITY OF COSTA MESA
P.O. BOX 1200 • 77 FAIR �RIVE • CALIFORNIA 92fi28-1200
DEVELOPMENTSERVICES DEPARTMENT
New State Law:
Swimming Pool Safety Act of 2006 (Assembly Bill 2977)
Effective January 1, 2007
California Heal[h and Safety Code Section 175928 "(d) Whenever a buildingpermit is issued
for the remodel or modification of a single family home wi[h an existing swimmin�pool,
toddler pool, or spa, the permit shall require that the suction outlet of the existing swimming
pool, toddler pool, or spa be upgraded so as.to be equipped with an anti-entrapment cover
meeting the current standards of the American Society for Testing and Materials (ASTM) or
the American Society of Mechanical E�gineers (ASME)."
�'Cl� C��' Dl, . (�r7s�'�- 9-��, C'�l-�Z�7��—
Address/Permit Number
Permit Ap�licant or Contractor's Affidavit (Please check appropriate box):
❑ There is an e�tisting swimming pool, spa, or toddler pool on this property. I will
install an anti-entrapment device that conforms to this law, and I understand that the
installation of this device is required prior to final building inspection approval.
[�] There is no swimming pool, spa, or toddler pool on this property.
'70� Pr� 1`' � l USS��I
Name (please print)
�� �i � ���2%�
Signa[ure/Date
Building Division (714) 754-5273 • Code Entorcement (716) 754-5623 • Planning Division p14) 754-5245
FAX (71a) 75a-a856 • TDD (71a) 754-52a4 • www.ci.costa-mesa.ca.us
October 5, 2010
�
` CITY OF COSTA MESA
P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628-7200
DEVELOPMENTSERVICES DEPARTMENT
BUILDING DIVISION
COURTESY NOTICE OF PERMIT EXPIRATION
Robert L. Russell
900 Cedar Place
Costa Mesa, California 92627-4162
PERMIT NUMBERS: BC07-00397
900 Cedar Place, Costa Mesa, California
FOR: Interior and Exterior Remodel
Our records indicate the above iisted permit(s) were obtained for property improvements or alterations
at the above address. Per the 1997 Uniform Building Code, Section 106.4.4 Expiration, permits are
valid for 180 days from the date of such permit, or the date of the last inspection for the project.
Our records do not show an inspection for these permits within the last 180 days nor have they had an
approved final inSpection. If you have a signed inspection card showing that an inspection was made
within 180 days, or that the final inspection was approved, please contact this office so we may correct
our records. If you do not have an approved final inspectio�, your permits will expire on
October 15, 2010. Additional fees will be required to finalize expired permits.
Requestinq an inspection - If you need to request an inspection, please call our Inspection Request
Line at 714-754-5626.
Requestina an extension -If you wish to requesf an exfension, requests must be made in writing
addressed to Bill Nunes, Chief of Inspection at the above address, detailing circumstances and listing
an estimated date of completion.
If you have any questions, please contact the Building Division at 714-754-4871, between 8:00 a.m.
and 4:30 p.m., and a staff member will assist you. The accuracy of records affecting your property is
our goal and we appreciate your working with us to resolve this matter.
Sincerely,
April Ma ooper
Office Specialist II
Bp{Iding Division (714) 754-5273 • Code EntarcemeN Q74) 754-5623 • Planning Division (714) )54-5245
FAX p14) 754�856 • TDD p14) 754-5244 • www.ci.wsta-mesa.ca.us
e � ;
CITY OF COSTA MESA �
BIIILDING DIVISION
77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 •�w+w.ci.wsta•mesa.ca.us
FOR INSpECTIONS CALL: (714) 754-5626
PERMIT TYPE ELEC
APN: 42252223
JOB ADDRESS: 900 CEDAR PL CM
Vicinity; LEFT REAR CORNER SFD
�
PERMIT NUMBER: E08-00417
STATUS: ISSUED
DATE ISSUED: 11125I2008
ISSUED BY: BJK
Suite/Unit:
SCOP� OF WORK: RELOCATION OF AN ELECTRICAL METER TO LEFT REAR CORNER OF AN EXISTING SFD. 1 SVS TO 200A
OWNER: RUSSELL, ROBERT LUTHER
PHONE;
APPLICqNT: RUSSELL, BOB
PHONE; 949-231-0644
CONTRACTOR: OW NER-BUILDER
Address: UniC � PHONE:
City/State: ZipCode:
ELECTRICAL PERMIT FEES
Electrical Plan Check Fee: $0.00
Electrical Permit Fee: $54.00
Reinspection Fee $0.00
TOTAL FEES $54.00
Address: 900 CEDAR PL Unit:
Ciry/SWte/Zip: COSTA MESA, CA
Address: 900 CEDAR PL Unit:
City/State/zZip: COSTA MESA, CA
License No. 000000
CELL:
0
..rl
O
I�
NOTICE: 7he 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. � _
INSPEC710NS: In order for tbe work authonzed under this permit to be considered legal, such work musl comply wilh all applicable codes, and all
requirad inspections and final approval musl be obtained. Failure to obtain inspections and fnal approval vdll result in the ezpiration of this permit.
cooe �, ixsr�cno�Trve
7818 Fiaed System Final Fire Prevenlion
7266 p�l SOa Final
200 Final Re-Rooi
201 Final BIocWRetaining Wall
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition
p� ixmu�s r1Qp� insvEcnox rrre
208 Final Mechanical
208 Final Plumbing
270 FinalElectrical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Builtling/Occupancy
q� ixmu�
—l-�'--�-+-_� � `
,
WORKERS' COMPENSATION DECLARATION: �
I �ereby aRrtn under penalty of perjury one of Ne following declaralions: _
❑ I have and will maintain a certificate of wnsent to self-Insure tor workers'
compensation, as provided fof by seclion 3700 0( the Labor Code, (or the
peRormance of the work for which this permit is issued. '' '
❑ I have and will maintain workers' compensation insu2nce, as requiretl by
section 3700 of the Labor Code. fw the pedortnance of lhe work for which this
permit is issued. My wnrkers' compensation Insurance carner and policy
number are:
Carrier:
(Tna seqqn nee.d rpf Oe cnrnp'etetl athe perm� a valuedat are nuntlreE cUAars (5100) w leu l
Policy Number: '
❑ I certify that in [he perfo�ance of the v.ork for which this permit is
issued, I shall not employ any person in any manner so as to become subjecl
to the workers' compensation lavrs of Califomia, and agree that if I should
become subjecl to the vrorkers' compensation provisions of Seclion 3700 of
ihe Labor Cotle, I shall forthvnlB �omply with these provisions.
Appfimnfs Signalure
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 DOLLAF2S
($100,000), IN ADDITION TO THE CAST OF COMPENSATION, DAMAGES AS
PROVIDED FOR W SECTION 3706 OF THE LABOR CODE, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affrtn tha[ I am licensed under pmvisions of Chapter 9(wmmencing
vrith Seclion 7000) of Division 9 of ihe Business and Professions Cotle, and
my license is in full force and effect.
Lic. # Class #
Com2dor's SignaWre Date
CONSTRUCTION LENDING AGENCY:
❑ I hereby affum that there is a construction lending agency tor the
performance of the woAc ta wfiicn this permit is issuetl. (Sec. 3097, Civil Cotle�.
Lender's Name:
Lentler's Address: .
Date
OW NER-BUILDER DECLARAY�ONS:
I hereby affirm tha[ under penalty o( peryury ihat I am EXEMPT FROM THE
CONTRACTORS LICENSE LA�N for lhe following reason �Sec. 7031.5,
Business and Professions Code: P.ny city or counry which requires a pertnit to
constmct, alter, improve, demolish, or repair any struclure, prior to its
issuance, also requires the applicant for such permit to file a signed slatemenl
[hat he or she is licensed pu�suant ro the provisions o( the Contractors
License Law (Chapter 9(commencing with Section 7000) o( Division 3 of the
Business antl Professions Code) or that he or she is exempt t�erefmm and
lhe basis for lhe alleged exemp�ion. Any violalion of Section 7031.5 by any
applicant for a permil subjects tde applicant to a civil penalry of not more than
fve hundred dollars ($500).):
❑ I, as owner of the pmperty. or my employees with wages as their sole
compensation, WILL DO THE WORK, and the structure is no� intended or
oHered for sale (Sec. 7044, Business antl Professions Code: The Contractors
License Law does not apply lo an ownei of propeny who builds or improves
Ihereon, and who dces such work himself or herself or through his or her own
employees, provided that such improvements are not intended or oftered for
sale. If, however, Ihe 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.). .
,— � Q I, as owner of lhe propeRy. am EXCCUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to constn�ct ihe prqect (Sec. 7644, Business and
Professions Code: The contractas License Law dces not apply to an ovmer of
property wfi0 builds or imprOves lhereon, and wfio contrac[s for such projecl wiN
a contracta�s) license pursuant to the Contractqs License Laws.�.
❑ I am exempt under sec.
Business and Professions Code for ihis reason:
/W 1/'P'� rl- �!/�'1(� ��//�7/��i
Signature-� .�aie- '
309-46 (3I0))
Owner ID verified Dy d/ri� ense. �Yes ❑ No �/ Q / 2
Driver,'sLicense,No. % Expires: � �
Venfication of Ovmership by (type of document, i.e. - property taa bill or deeC):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: .
❑ I hereby cetlify Ihat no excavation frve (5) or mwe feet in aepth into wfiich a
persm is requiretl to descend. will be made in cmnection with work autMrized
by this permit, antl Ihat no building slructure, scafldding, falsrnork, a tlemolition
or dismantling thereof, will be more than thirty-siz (36) feet high. (Chap. 32. Grp
2, Art 2, Sec. 347, Title 8, Califomia Administrative Code�.
❑ As owner-builder, I vrill not employ anyone to tlo work whicb woultl
require a permitfrom the Division ollntlustrial Safety, as noted above, unless
such person has a pertnit lo tlo such work (rom the tlivision.
Apvliranl's SignaWre Oale
Division o( Industrial Safely Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicaN or present or fWure building occupant need to file and
certity a Business Plan for emergency response to release or threatenetl
release of a �azardous material? O 1'es ❑ No
(Section 25505 of the California Healt� antl Safety CoOe requires, wilh some
exceptions, Ihat a Business Plan be filetl with the Costa Mesa Fire
DepartmeN by every business which has at any one time dunng a reporte0
year a quantiry o( ha�artlous materials equal ro or greater ihan a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at standard temperaNre and pressure�.
2. Does or will Ihe applicant or present or future building occupant need lo (le
a registration form tor acutely hazardous matenals? ❑ Yes ❑ No
(Section 25533 0� Ihe Califomia Health and Safety Cotle, with some
ezceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one time has on hand a quantity o( acutely
hazartlous materials equal lo or greater lhan a weight of 500 pountls, or a
volume o! 55 gallons, or 200 cubic (eet of compressed gas aI standard
temperature antl pressure).
3. Does or will the appliwnt or present or future building occupant neetl to
prepare an RMPP (Risk Management and Prevention Program for aculely
hazartlous materials)? ❑ Yes ❑ No
(Section 25534 of Ihe Califomia Health antl Safely Code provides that Ihe
Costa Mesa Fire Department may require ihe preparation, certification and
filing wit� the Fire Depanment of an RMPP by businesses which are requiretl
to register acutely hazartlous materials vrilh t�e Fire Department.
4. If an RMPP is presently required, has Section 25534 0! the California
Health and Safely Code been (ully complietl with? ❑ Yes � No
5. Does or will the appliwnt or present or future building occupant require for
Ihe wark which is lhe subject of Nis appliwtion a pertnit for such wnSWction
or motlification from the South Coast Air Quality Management DisMct or (rom
any other air polWtion control distdcl or agency7 ❑ Yes ❑ No
(Section 658502 of the Califomia Govemment Cotle requires that the requeste0
infortnation be fumishetl on applications fa ran-resitlential building pertnits).
6. Will any part of the faciliry to be constructe0 untler Ihis pertnit be within
1000 feet fmm the outer boundanes o( a school? ❑ Yes ❑ No
(If yes", Ihe facility must meet the requirement of Sections 25534 and 42303
o( the California Health antl Safety Code�.
7. If a permit from the South Coast Air �uality Management District or other
air pollWion control districl or agency is require0 lor Ihe vrork which is Ihe
subject ol this application, have all of I�e disclosures prescribetl by Calitornia
Heallh and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. (If yes", attach certificate of compliance (rom the appropriate air pollution
control oKcer�. � �
CERTIFICA7E OF COMPLIANCE: I certify that under'penalty of perjury the
information given above is correcL I agree to comply with all state lavrs and
city ordinances regarding Hazardous Matenals and Emissions., �
SignaWre
CERTIFICATE OF COMPl1ANCE AND AUTHORIZATION OF ENTRY: 1
certify untler penalty of perjury that I have read this application.antl slate that
the information given is correcl I agree to comply with all state lavrs antl ciry
ordinances relating to builtling construction, and authorize representatives of
the Ciry of Costa Mesa to enter upon lhe above-descnbed property for
inspection purposes. I agree not to occupy or allow occupancy of any building
autho 'zetl y �h/q p�mil til (nal i peclion. // J� r O�
Signature of Lepal wner�s�� Data /
An0/w Aul�onxetl Appl¢anl
PFOJECTPOOPESS: JOO CF.1%� PL
OWNEH'SNAME:RUSSELL, ROBERT LUTHER
aooness: RUSSELL PAULETTE
900 CED�.R PL
COSTA MESA,CA 92627
NBCHIENGINEEB:
AOUflESS:
flEG.NO.:
�N�T �G
UNIT:
PEHMITTEE: LEE ROOFING ( 714 ) 642-7223
aooness: 1653 SUPERIOR
COSTA MESA CA 92627
LICENSED CONTFNCTOF DECUINATION: I hereby aHirm iha� I am IicenSeU unaer pmvisio s of Chap�er 9(cammencing with Section
]000) o� Division 3 0� lhe Dusiness and Pmlessions Code, antl�u.Ji�e e'isin-FOA'lo¢ �J �eci.
ciTvuc.: p8751 sTnreuc.:349686e� cuss:�
�ate: — ' Signa�ure: _
WOHNEHS' COMPENSHTION OECLAflATION: I hereby affirm �hai I �a�e a enifiw�e o� consem to self-insure or a certrticate af Workers'
Compensaiion Insurance, or a certifietl copy thereof (Seciion 3800. laD C)
, voucrNo.:1300948-92 E%P.OATE:OGI3OI93
comvnxr:STATE FUND
� Cetlitietl capY is hereby fumi5hetl. � Certilietl copy is bletl wi e ci�y Building '
Date'. �/� �� /3 ApplicanC
ESEMPTION FRUM WaHHEPS'COMPENSATION OECLAHATI�N: (ihissec�ion ne no�becamplete0ifthe permi�isforone huntlred�$700�or1e55).
I cetli�y Ihat in I�e peAormance o� the work for which �his permi� is issue4 I shall no� employ any person in any manner sa as �o become
sublect Io Ihe Workers' Compensation Laws o� Cah�omia.
�a�e Signature:
NOTICE: It, ailer makmg Ihis aeclaration, you shoultl become sUhlec� ta �he Workers' Compensa�ion D�ovisions of �Ae Labor
Code. you must lohhwith comply wl�h such pmvisions or ihls permit shall 6e deemed revokeA-
CONSTBUCTION LENDING FGENCY: I hereby aifirm that �here is a cons�mction lentling agency for �he pedormance af the wark for
which this permit is issuetl (Seciion 3097, Civ C).
LENOEH:
FDOflESS:
OWNEfl BUILDEH DECLAFATION: I hereby affirm that I am exempl imm ihe Contractors' State License Law �ar the �ollowing reasan
(Section 7031.5 Business antl Pm�essional Cotle'. Any ciry ot coun�y which requires a permi� to cons�mc�, al�er, improve, demolish, or
repair any stmciure, prior to i�s issuance. also repmres Ihe appliwnt �o� such permit �o �ile a signetl s�a�emen� that he/she is licensetl
pursuanno ��e pmvisians a� Ihe Comracmrs' State License Law (Chap�er 9 �commencing wi�h Sec�ion 7000) o� �ivision 3 of �he Business
antl Pmiessions Cotle) or �hat hehhe is exempt therehom an0 Ihe b95i5 �or Ihe allegetl exemption. Any violation o� Section 7031.5 by
any apPlican�for a permil sublacts the applicant b a tivil penalty o� no� more �han �ive huntlretl dollars ($500�.
I, as owner of �he property or my emplayees wi�� wages as �heir sole compensation, will tlo the work, antl the
❑ simcture is not in�enAed or ofiered �or sale (Seclion 7044, Business ana Pmfessional Cotle: The ConVac�ors' $ta�e License Law
tloes no� appty �o an owner oi a Dmpetly who builas Or improves �hereon, and who Ooes SUth work himself/herself or IhfOugh
�is or �er own employees, pmvitled that such impmvement5 are not intendeA or offerea for sale. If, however Ihe buil0ing or
impmvemenl is soltl wilhin ane year af comple�ion, Ihe ownf.� will have �he burden of pmving helshe di� no� 6uild or imDmve
for the purpose of sale).
I, as owner oi �he pmperty, am exclusively contracting with licensed contractors to cons�mct the pmject (Sec�ion 7044, Business
❑ antl Pmtessions Cotle: The Con��aclors' S�ate License Law tloes not appty to an owner o� pmperty who builtls or impmves thereon
antl who cantrac�s �or such pmlec�s wi�h a contraclor(s) 6cense pursuant�o �he Conirac�ors' Sta�e License Law). I am aware
Ihat proa� ot their Warker's Compensation insurance should be pmvidetl �o me.
� I am exempi under Seciion B. 8 P. G.
for Ihis reason.
Daie: Ownec
I tlo �ereby cenity Ihal I am aware o� antl untlers�antl �he requiremen�s of Calitornia Heal�h and Safery Cade Sec�ians 25505. 25533, and
25534 an0 thal I ar any W�uro bulidmg occupanl willlwill no� (circle one) need �o camply with said s�a�e cotles antl �he requlremen�s �or a
permi� lor constmc�ion or motlification from Ihe Air �ualiry Management Oistricl Residenllal cons�mction applications are exempt trom
�he5e pmvisions
�ale'. FpPlicanL
I hereby cenliy ihat I have reatl ihls ap01¢alion antl s�a�e Iha� �he abooe mformallon is carrect I yee �o comply wi�h all ciry antl caunry
ortlmznces antl slaie laws relaiing Io builtling constmciion �g�aoj 6 I o en�er upon �he above-mentioned
property �or mspection purposes.
�ale -�� �� / � Slgnaiure:
orivefs License or Social Secuniy #�
�6at-a6 Wlnte—Bmldmg', Green—Coae EnlorcemenL Canary—APOlicant; Pink—Revenue; Goldenmd—Assessor
CITY OF COSTA MESA — HDILDING PERMIT PERM NO: B 062476
PERMIT NO: B 062976 PLAN CHECK NO; N GOVT; N SUPP; N
CONSTRUCTION TYPE; 5—N PERMIT TYPE; STR PURPOSE; ALT
JOH DESCRIPTION ; T/O COMPO S REROOF W/25YR "ELK" COMPO SQ FT; 3,200
CLAIM VALUE; 3,200.00 CALC—VALUE: 3,200.00 GROUP OCC; R-3 /M-1
COMMENTS; SMOKE DETECTORS RE�UIRED PER THE 1991 EDITION OF TIiE UBC,
*�e�r�r**�r**�r*+��e�r�*�*+r��e***+�*�* �r**�r*�r�+�*x��r**�r*�r��r��r��r�r�**�r��r�**�e**x*�**�r*�****�**
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT; FT IN REAR; FT IN FRNT: FT ZN REAR: FT IN
LEFT; FT IN RGHT; FT IN LEFT: FT IN RGHT; FT IN
PARRING RE • PROV; PARCEL; 42252223 ZNE; REF NO:
PLANNING N 1'ES>
i.
******�r**�r*�r*�,�***���r�r���*�,���******�*�e�+��*�****�**��r*�**�r�***�*****,�**�*x*��r��
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
ZONING APPROVED HY ,
BUILDING APPROVED HY ;
APPLICATION ISSUED BYe
�E �E iF�FiFiFik iE �F�kiF�F k9FiF iF IF �f ik eF iF if df iE iE it if if �E iE 3tif iE iE iE �E �tlE if it if iFif iF1E iF�f {ti/E iF
LEGALIZATION;N F E E S U M M A R Y
BLDG PMT PLUMBING ELECTRIC MECHANIC
PERMIT 63.00 -
DATE:
DATE:
e
iFiF'�F'aPiF'iFiFif IF�If �E �E 3E i! iE iE 1Fi�'IE if
iE iF 1E * iFik �E jk �liFiF�E iE �F �E iE if iF iF1k �k iE �E 3E �F iF iFiF �k
STRUCTURAL SEGMENT:Y
FIRE SMIP/RS� GRADING
SMIP/NON—RES
PLAN -
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PI:AN—CHECK TOTAL PAID DUE
TOTALS----> 63.50 0,00 r 0.00 63.50 127,00 —63.50
.' i
REVENUE DIVISION TOTALS--> COLL'ECTHD: 63.50 OVER/SHORT: 00
BLD63P00 pLUMBING ELECTRIC MECHANIC FIRE SMIP/TOO GRADZNG PLAN—CHECK
{��
1f iE iEit iF1k iF iF �F ikiEik ik iE iE iE ik iE iE iE iE �E 3E iE iE iE iE iE iE if iElE iE iE if df iE Ik iF 1F iE iF iE iE iE IE i! ik iE iF if �E iF iE if if iE iE iE iE 3E iF iE iE 1FlE iFiF iF 3E �E iF iE iE k iF iF 3E iE
I N D I V I D U A�L F E E B R E A K D O W N
TYPE QTY D E 5 C R I P T I O N UNIT COST TOTAL COST
SFR 3200 REROOF BY VALUE RESIDENTIAL NOZONE 1,00 3,200.00
END OF FEES
i
�DUF'i..IC-�TE �:E�:EIF"f'�
010414€f43�-00140435° T�7�T 53.50
DATE� 06/04/93 TSt{E: 11:44
�� ti . ._ __��-�--,
� CClNSTRiJCTibfU AiJD P�ANNING PO4 _& SPA
( APPROVRLS Permit #_, Date dnspector RPPROVAI.S Permit � Qate tnspector
� 7. TemporarY EiectricaS Service.of Poie 52. Pooi & EGuipment Locatian � '
� '
( ?. Sod Pipe�Undrgrnd.- - . ' �- ' � 53. Steel Rein'arcement ;
�"-��'ElecfricaiCondLiiUeiiity�Undrgrnd 54. �arms .
I
��4 fk,2c'�ricai Conduit=0'nd�grnd. - 55. E�ectrir.al @ondsno �
5��St�e',' Re�ntorcemura- 56. Rough Plumbing & Pressure 7est �
�� ��:Elecirical UFER`Grt*.d. �; �v 57. APPROVAL T6 COVER�GUt���TE � �
� L �_„ _ �� ____�y
I_ t7. €orsTinas t,. 58, Electrical Con�uit�Undryrna. � )��
t_ - --1
, �
� F&� foundation . � 59. G2s Pfpe, �1 Undrgrnd., Test � �
� 9 Vzter A�pe-Wndrgrnd. � �� ! 60. Sackwash Linas, P-Trap, � U�Uryrnd. � �
r"------- _ ---i
� 1�t.. Structurai Ploor Systerri �: 61. APPROVAL TC? DECK � �
, � ��
, th, f'ro'nerty Se�,ver Lsne & House Conrtpciion � g2 Eackivash & Rece��;orFina3 � � �
i i2. Seiver Gap .. � � i , G3. Heater 7u Vent-�inal ,
I13. P,00� �rains ., " ,! ' { , -- -"---'-'-"-'--'_._�� -_._..�
�_ E4. Pfumbing System - Fina!_� �
� it. fto� fi (�luml�in � ! _'
g g 1 .;�y, 65. Elecnicel�Fnai ,.� �
r 16 Rough Electri�y=I-Conduii � ��i 66. 5olar SYstem�FiFlal � j
� � . !- 1jj ---�;
, 1 E. Rcagh Eiectric�+iring 67. Feneing & Access Approvai i � �
�ury i �
�;�7. riou9h 1^f�r�ng Siyr, 68. AYPftQVED FOR PLASTER WG
8 Raugh Eleciria36T Bar Cail��ig 69. PQOLISPA SYSTEh15 � INAL, C
�_ �
i9. Re�h f{eaeing ffi A,ir Car+dit�oniny _ . .. �PIFjE t)EPT. REQUIRF�MEN:C � �
. .- 1 . � , f' � .� : ' !',.i v, . � . _ � .' I
26.. P.o��h �� ctolY F-ii'ePiace , �i z R . ��' ��~. r �iPPR�VA? � ._ "oer=�it -.s`r' . i �
<. :o - ..____.-, T ' -= �3.x-z � .. _ ' - � ' .�-`�i.'�i'_ i
� 21 tiiucYs, in. Structure" ,'. �. `_�. e =. �` x-.74. Undergi'oc^ui NYcro .: i I `�
I � r- L. �. S i'. . i
i2..d:U t5, CnY.`i8'i ' ' ' �. S _ l q : : - . • � .- •.
F 1r, R9, < � r' 1' F r: .'C71. ProductrP."r;.�ing � i C�s CLO�i �� i
� 23. Gzs-PiP�-�a:�qh & T�esi r"� " v 4 "'< t-72. U:aderyro'v*i;t rit�sk*'�� .< LL��'-�- I
�r- �- ,i•._ ' k � .. rr '.l x ^ T '^.- Se v. � �V - +� Y T _
.. i- �� i (. r_. . _ ::. ' C' r. ;: : Ti •- T . .S-,
24:`ftoe'f�{�irotny .. _ r' =" �_. :.73: Under9rna.Stcrtl4g'�nk:UGas ��I! � I
�- -----�- � , � E . -,
�25. ftoz�f ShsaYhing ��r c v � p �� � � ,� 74S �Cverheed FiY�1ro- ^ � � i
, � - - � ���� �: ._ �--_-- _. r
26�„�`(-0�; Cc(ling {St¢iG urai; &-Mprlacoaz r. _ _,� 75;_ �y Chemical � y r � I
I---;---' - �z : Y. , : -� -_--: .. - i
27:�F�zr^e dad Fiashin� � .r � r c �- u: < • 76. Dry Stan�= �t.c - ; � +
„- . � ��,� . .. �S err- "- � W� I
'28. Lathnc�-&S:din �-^`: ='�= r K'' `"" i7. FIXEDSI'"1-E���I�vAt; ^ (
• � �-- � _ - o �� ,� y ���� �
4 I� �x I
�?.9. Insufat�on . . ` :� ... � � _�_ ?&.JFiRE °REV. FiN7.�� � ` '" ( � - �
1T30.Orywa;j:Na,ting'''` � u _ v1- "� 7��At-TFi'JEPT.REQ�Gift£i1�iEi`JT
'_�3%_Piaster Br�ivn Ca'<,�', �; i .= . v < n ,�79.�±G11A1. ItVSP-ECTf�^�_ _ :_ -.T� ��-� --�
__�;_�.�_�._
� 32. Electri�^�,j pq�ver�i�7�r-�=:nai� � ,. �� 80: �OOD CER7iF�E;'t-1Tr i5;5ilED � � �---u-`i
l �'Eti T'�_ �-.,-_._�F�� T- .��J�
� 33� i-ir�a' ECFctr�o ._ `� T .'^! � � � x � .�r . �-Nates S�/flG.. .�j4 '�CiIY�'�y / �� �
�______. n .-_ � � �J �-_�
,��3A.,G�n�INtat�ry�&ArCo��tidnii� '�, u�,� �-' �G-%�-�fl�'/1! : �_ �y ----- �,
3, , r
-C`- /-w . -'i '.�_ -"�
"s5� F�nai Gv> PiPe Test< - x•' s; '.^.. i
�_._ _ . _; �. - r _ _I.. �..�r - -- -- -- ---�
536._Ho?Ci or-CanaRY": �� ' -' '� x � �q � ;. � 7 � . '
i
-37.'FirizT i Factory F��� -_ . � `n ., r_ --�- ' � ..-_._...�_.�_ ---- ;
.. �,y�_;5,_ . ..i � �_. �ii� ^ -a._._____..�-__._____.`_ �_ _ __ . _ I
-38. Fir,alPiqfnbing "T.. c- . I ":, � � � A ... �
- - � � i -�----x------------------i
� 39, ;Vater $erwCe-�i(«�lf : i " ,�, : -`- c„�-'� - . _� (
i'�-`-- �
i � dD. G-s Serv_,ce�finai- = - `t ' _ -� - . ' -�
' p. ' � �.' �r `P� a: - ' _ 4
�41. Sc�lar Bome'stic-fii_na� , ._ � .. �I �� % `� r _ .. - �-.+-��'-----� �
1~ 42. Backflotiv PreveniCr � 1 � �' "� � - - • - � �' �. i
r> ru -> n �.
. y . _ -i
43. Bzckfiow Irr�at'tar;; ' ��' . �. . � ' - - � � i
.. .�.e�� - . ��_ , __�_a
'.G4. l.andscc�oe Itr���.tibn SY tem^ �^ � . ,- ' - '� �.�U ': �: •- . � i
- � �.. � . n . i _ ., t r >
r r�;�� - ' �. i
'�'45�So,7d ,�2tGnuar��on .. 'Y. . -�' - - �
. _ x , � s - - ----- -- i
4u.•Handicap ftegulations �- �' • �
�. � ` �
47.'Fi 'AL S7RUC7UFiE & BU!'�DING 1 ,�I� ' _ _
� ��u�3 �- �
� 48. FINP,LP�ANNINt� - - �= � �� " ` -. -�
� i.. . . `
. �� _ t
�?EIeC:ric Ae(ease .o�Edisor. ' � i . � I ; �; . :, 'r '� .. , ' .
' { .�.���`._.�.._.
<54.�Gas�?el,.2se ro Southem Californfa GasCa - � IV��� - _ _ ' = ` ' - _
. - . �
-52. GERTiFiCAiEOFOCCUPANCY " ' �- '-� - �' � ' !
N�� . . Dato . ..... . � � 1
ORANG�7Y BUILDING DEPARYMENT , ' APPLICATION FOR PERMIT
6i$ North.Broadway � � � � � � � � �
SANTA ANA, CALIFORNIA
;I
STREET
PLOT PLAN
Show location ond distances from
property line and between buildings.
�
e - • v
=�. .
• — - � ,