HomeMy WebLinkAbout166 CABRILLO ST - Building Permits •
•
• 4`�5tp S - CITY OF COSTA MESA
3 BUILDING DIVISION
}• �,, 4r DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER
l• t
tnefraler PERMIT
ft* 00-01646
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa. .u.sBUILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 166 CABRILLO ST Status: ISSUED
Suite: Applied: 10/12/2000
Vicinity: Issued: 10/12/2000
Parcel Number: 42541404 Zoning:
Applicant: CHILCOTT, WILLARD ISSUED BY: USIA
Address: 167 ROCHESTER
Phone: 949-929-6882
CM,CA Zip:
Owner: HIRAHARA, KENNETH M
Address 10058 LOS CABALLOS CT
Phone:
FOUNTAIN VALLEY,CA Zip: 92708
Contractor:
Address:
Phone:
Zip: License: -
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
60 LINEAL FEET OF A SIX FOOT HIGH BLOCK WALL ON THE REAR PROPERTY LINE
FEE SUMMARY
Plan Check: $29.15 Calc Valuation: $1,200.00
Permit: $44.85 Claim Valuation: Woo
SMIP Res: $0.00
SMIP Corn: $0.00
Other $0.00
Inspection: $0.00
•
Total: $74.00
•
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTES:
til)I 01
DATE iftt—SPIL4
COO
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
WORIIRS'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'sine-tied.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed it the permit is valued at one 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'
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 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 3708 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.# Class#
Contractor's 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).
Lenders Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
^subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
/� I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of properly 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 ono 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 Co .rectors Lica- L. s.).
❑ . :mot d, 5:...• i Business and Professions Code for this reason:
00)
••,n i:d by dnv,es license. mixes ❑No / ( Ex ' s: 7-Ad --.Zan-
Verification of Ownership by(type of document,i.e.-properly 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:
I 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? 0 Yes 0 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 then 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 II an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? D Yes I 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 feel from the outer boundaries of a school? ❑Yes ❑No
(If-yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions. . ', /-, .
•
Signature: - ' , \„ t Date:
Date:
CERTIFICATE OF COMPUANCE 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 or.'nances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for insp@cti.n purpo .a( '.t to occupy or allow occupancy of any building authorized by this permit until final inspection.
re O Le omni (s) Date
/ d/ tfior(z-d Applicant
CODE I, INSPECRONTYPE OM OTTR1ALE CODF4 INSPECTION TYPE Mt RtTTRAU$
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof _ 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
I.: 1
/—
•THIS SKETCH IS FOR INFORMATIONAL PURPC61S •SOLID WALLS/FENCES BETWEEN 2'b•&6'IN HEIGHT SHALL
ONLY. APPLICANT IS RESPONSIBLE FOR PROVIDING BE SETBACK AT LEAST 10' FROM FRONT PROPERTY LINE.
AN ACCURATE REPRESENTATION OF THEIR PROPERTY
IN CASE THE SHAPE AND SITE DO NOT CORRESPOND •SOLID WALLS/FENCES SHALL NOT EXCEED 2'6•IN HEIGHT
WITH THE INFORMATION PROVmIDON THIS SHEET. WITHIN 1U OF THE FRONT PROPERTY LINE(NOT CURB LINE).
L'1 V l JLUIN UC 15U11.Lfl 4U SAi'L IY
CITY OF COSTA MESA •VERIFY DISTANCE FROM CURB TO PROPERIY UNE
• APPROVED AND SHOW ON PLAN. VERIFICATION FROM THE CITY'S
f ENGINEERING DIVISION IS REQUIRED. CALL(711)754,5343
3y— Date IJ I Z POR INFORMATION.
T;1, s 1 of piens arid specifications MUST be kept on the job at all times and it is unlawlui F
;wit; ny changes or alteration on same without written permission from the Divu:ion of Buildin
-,-Id a fety,City of Costa Mesa. 1-19
Tile st-roping of II is plan and^peciF .ticr.;SHI:LLNOT bel"a peen, i6 ap a j4 yfl(!C 1-19
:'the ✓io!alon o any pro*onz I f ark iCi;9 of Costa t'as L..dinance anwor Fiala!ay __ -
11" ' . . :.,d sand sFsl!.pin Fr. 11.i -sn and become cul aid:o d if the bui!' I:�,
19
x I
x RESIDENCE R[S7CNCE
I
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1 RESIDENCE RESIDENCE InCI 4CE Nl90Wu.
it II APPROVED
a CITY CF CJSTA MESA se
PLANN NG DIV.
•
SUB C` TO BLDG. DEPT. REG.
KS---
I
..
Co) itJ cj t STREET •
-
BLOCK WALL LAYOUT FOR BUILDING PERMIT
l
PLANNING DIVISION
' 1 .r
2J - 1i
.,
• r
1
TYPICAL 611 CONCRETE BLOCK FENCE
Cement Clock With Optional-3 >d 111 M, - =ii M ; GENERAL- NOTES
Channel Block With 1.3/8 f
Horizontal Top of all eee�e�
Fences pa l-iMI �. MORTAR: One Part Plastic Cement, and
El Three Parts Sand
For Fences S'or Less i0 GROUT: One Port Cement Three and
Vert.Bars 3/8"95 at 4' 0"O.C. Id� o �_ _ =I II- �'- One HalfrPorts Stand
i COPING: One Part Cement, Three
For Fences Higher Than 5' ± " 0 I SI Parts Sand •
Vert.• Ban 3/8"0 at 32" O.C. Y w - CONCRETE: Well Mixed C2-1/2: 3-1/2
II
a Mar of 7- 1/2 Gallons of
Fill Cells Solid With Grout FYI > z „ •i-I Water Per Sack of Cement
Where Steel Occurs t'�eYY1 > _
Reinforcing Steel Shall !�� I iO �. GROUT MAY BE POURED FROM THE TOP
Conform ltl Sec.A-15.39 1111ftt iiifff w o - OF THE FENCE IN CELLS WHERE STEEL
A.S.T.M. Jilt OCCURS.
L)
~ CELLS AND AREASOF HORIZONTAL REIN
All Steel to be Lapped f�A I w n FREE OF NT SHALL BE CLEAR.CLEAN&
24"or to Code 7M LL I FREE OF ALL MORTAR DEBRIS,ETC.
NATURAL GRwes.ADE Ill " EI '�
o_ s
. TWO 318"0 BARS -eel — " .
CONTINUOUS TOP "
E.BOTTOM I-•••--WIDTH MI 10 16' 0 C MAX111
SEE CHART
HOWZ.STEEL MUST BE TIED IN BELOW • PT
DC HLF EARTHTCOTH
PLACE AT TIME OF TRENCH I/3 Tr1E MEIGTN OF FENCE
INSPECTION.
1 BT^LOW BOTTOM OF FOOTING
Io" 2" SCALE: I/2" = I'
FOOTING REQUIREMENTS CHART
WALL HEIGHT 6 ' 51---------r. 4' 3'
WIDTH . 14 . 14" .. 12". . 12"
THICKNESS . . .10" . . 10" . . . 8" 8 "
DEPTH OF EARTHTOOTH 24" . 20" . . . 16" 12"
SPACING OF EARTHTOOTH 12' 14' . - 16' 16'
-> BUILDING DIVISION
(-11-1r1r
12irS !
DECLARATION OF AUTHORITY Bldg. 'Permit #
FOR AGENTS OF PROPERTY OWNER This Permit # 7300—n ( (, 6
TO APPLY FOR PERMITS
/4 Cc 40 J/o / C s4 ?rick ick c14 "fi`Y) / AP Number
StreetAddress
1. I (we), /t y e M 11 e/ c /f/c,A1 e , declare that I am the Owner of Title
of the above referenced real property, and that I (we) hereby authorize:
%///%rd ex,/Cote 7'!`•ZC/ -le POPZ
Name Telephone No.
/6 2 42c c4i ej A^
Street Address
% /Sr; 7'62,
ity State Zip
to obtain permits in my behalf, as owner/builder, for adruckeiv / ( ' /61ocX
at the above referenced property.
2. Should any person become an employee engaged in the improvement of the property, I (we) shall im-
mediately provide Worker's Compensation Insurance coverage and cause a certificate of that coverage
to be filed with the Building Division of the City of Costa Mesa, as required by State of California laws.
3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other per-
son, company or corporation.
4. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any
claim resulting in damage or personal injury to myself or any other parties as a result of work authorized
by the permits from the City of Costa Mesa.
5. I declare under the penalty of perjury that the foregoing is true and correct.
Co)A Mtn-
. Executed this //(A day ofofV G%&A 1 J 'Ct , at , California.
k�/l/t-�� /"(1 1-/'Pa Mcg Gv /OA/Dui
Printed N
Naa/me
Signature
NOTE: This authorization does not grant authorization to perform the work as owner, it solely provides
for limited power of attorney to secure this permit in any behalf.
077946(Rev.2/91)
s, CITY OF COSTA MESA
q � BUILDING DIVISION
Iear
�'•-'s`� ' DEVELOPMENT SERVICES DEPARTMENT
�• PERMIT PER T BER .
Se/rPorrino#4.
• B98-02042
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
• BUILDING PERMIT
Job Address: 166 CABRILLO ST - Status: ISSUED
Suite: Applied: 11/12/1998
Vicinity: Issued: 11/12/1998
•
Parcel Nunmber: 42541404 Zoning:
Applicant: ISFELD,JOEL
Address:
Phone:
Zip:
Owner: HIRAHARA, KENNETH M
Address 2303 REDLANDS DR
Phone: 949-531-8853
NEWPORT BEACH,CA Zip: 92660
Contractor: CALIFORNIA ROOF LIFE
Address: 8941 MINT AVENUE
Phone: 847-7663 -
WESTMINSTER, CA Zip: 92683
License: 509623
Arch/Eng :
Address:
Phone:
Zip:
License:
SCOPE OF PERMIT •
TEAR OFF INSTALL 2 LAYERS OF 15LBS FELT UNDER 20 YEAR 3 TAB COMP.SHINGLES.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $3,320.00
Permit: $87.25 Claim Valuation: $3,320.00
SMIP Res: $0.50
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $87.75
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTES:
•
•
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
fora 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 •t'
required inspections end 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
f ,
DECLARATIONS V v
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have end 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.
'p \I have end 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.
y workers'compensation Insurance carder and policy number are:
Cartier: Policy Number:
—
(This section need not be completed if the permit is valued et one hundred dollars($100)or less.)
❑ I certify that In the performance of the work for_ hich this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
corn._•_ - '-,_:. • California, tha I should bacon: '.'jest to the workers'compens. '•. :._ •. of Section 3700 of the Labor Code,I shall forthwith
.py with these pro. '•ns.
•plicant Signature: ' ' Date: // Z'•-
•SECURE WORKERS'•• P • ATI•. ••VERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLO - • -IMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION TO • T OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST.AND ATTORNEY'S FEES.
LICEN - • - • •- • CLARATION:
I h: e• : t at I am licensed un•:r provisions • Chapter 9(commencing with Section 7000)of Di . usiness and Professions Code,and my license is in full
•ce and effect.Lie.4 . %' Class A '! y
Contractor's Signature: <, ,/.0 . - _ Date: "(-,'' v/'
CONSTRUCTION LENDING AGENCY
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: Lenders Address:
Signature: Date:
. i
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to Its Issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such Improvements are not intended or offered for sale.If,however,the building or Improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑Yes 0 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? 0 Yes 0 No
(Section 25505 of the Califomia 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? 0 Yes 0 No
(Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time 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 anti 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 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 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? p Yes U No
(Section 65850.2 of the Califomia Government Code requires that the requested information be fumished 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 0 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 Alr 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? 0 Yes 0 No
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the Information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: _ Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
'igna re Of Lama i., iicant ,;,1/
/l.% '�/ ,—1J_.• r!.•'
4 �".... onTr1-,plicant Date
LODE I. : ,II', a v' DAIS .•1111. . LODE gb4PFCTION TYPE DATE gIIIDALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final �_w 208 Final Plumbing
200 Final Re-Roof Eh"/9-9y a`"7 210 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
2446-46
{
{PRDJECTADDRESS..t '.4UNIT:
66 CABRILLO .S CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 058554
hj OWNER'S NAE: HIRAHARA KENNETH M '
ADDRESS: 2303 REDLANDS DR PERMIT NO: E 058554 PLAN CHECK NO: N GOVT: N SUPP: N
NEWPORT BEACH,CA 92660
CONSTRUCTION TYPE: 5—N PERMIT TYPE: ELE PURPOSE: OTH
ARCN/ENGINEER: ( 714 ) 548-9479 REG.NO.:
ADDRESS: UNIT: JOB DESCRIPTION : ELECTRICAL SERVICE UPGRADE/GARAGE REWIRE SQ FT:
PERMITTEE: CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /M-1
ADDRESS:
KENNETH M. HIRAHARA ( 714) 548-9479
2303 REDLANDS DR COMMENTS: *
NEWPORT BEACH CA 92660 **+E+E*+E**4****************************************+E*****************************
LICENSED CONTRACTOR DECLARATION: 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code,and my license is in lull force and effect. SETBACKS
CITY LIC.: STATE LIC.: CLASS:
Date; Signature: • MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent toself-insure or a certificate of Workers' FRNT: - FT - IN- REAR: FT IN FRNT: FT IN REAR: FT IN
Compensation Insurance,or a certified copy thereof(Section 3800.Lab.Cl. LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLICY NO.: EXP.DATE:
XIMPANY: PARKING REQ: PROV: PARCEL: 42541404 ZNE: REF NO:
J Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING NOTES>
>
Date: Applicant: ******************************* ***********************************************
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). DEVELOPMENT ' 'E. R VICES REQUIREMENTS
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 t. _
subject to the Workers'Compensation Laws of California •
��
"— ) //� 92 ZONING APPROVED BY : �. DATE:
Date/ /9 Signator•. — _� XI • _ ,
'
NOTI after nTaking this declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : .�'. - • DATE:
Code. ou must forthwith comply with such provisions or this permit shall be deemed revoked. J
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: DATE. /!/
which this permit is issued(Section 3097.Civ.C). ************************ ** * * . = 4* * *,*, **** ************4**X**********
LENDER: ********************************************* *******************************
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 34 75
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business §0= SHIP/NON—RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN
any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars($5011). ISSUE FEE 1500
00
I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 34 .75 15. 00 0. 00 49.75 49. 75 . 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through
his or her own employees,provided that such improvements are not intended or offered for sale.If,however the building or
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED: 49 . 75 OVER/SHORT: .00
for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 49.75
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to theContractors'State License Law).l am aware *******************************************************************************
that proof of their Worker's Compensation insurance should be provided to me.
la am exempt under Section: BP.704 4 B.&P.C. INDIVIDUAL F E E BREAKDOWN
`3�
for
///this reason:/ NO MPLOYEES � TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
"� Dater L��99F7. Owner � \
I do hereby ily that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and ELE 2 FIXTURES LIGHTING 1 ST 2 0 EA. •75 1 . 50
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a ELE 3 RECEPT/OUTLET 1 ST 20 EA. . 75 2 . 25
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from ELE 2 RECEPT/SWITCH 1 ST 20 EA. . 75 1 . 50
these provisions. ELE 1 SERVICES BELOW 600 V & BELOW 201 AMP 18. 50 18 . 50
ELE 1 SUB—PANEL END OF FEES 11 .00 11 . 00 -
Date: Applicant:
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county
ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above'mentioned
property for inspection purpose&1.y �/�/.// //
�- Date en/Z Signature'.4—>_ {��1,..
Driver's L nse or Social Security
1641-46 White—Bmldinq;Green—Code Enlacement:Canarv—Aooticant:Pink—Revenue:Goldenrod—Assessor
r
-* " - PC & SPA
•
"-CONSTRUCTION AND PLANNING
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole • 52. Pool & Equipment Location "
•
4-2. Soil Pipe•Undrgrnd. 53. Steel Reinforcement
{
T&lactriial CondrS^rfility-Undrgrnd. 54. Forms
w4: Electrical Condtltdrgrnd. 55. Electrical Bonding - .,
4•rrc T -
L�Meal F einforceme!1f 56. Rough Plumbing & Pressure T¢71:...
-4. Elettri al UFElt . 57. APPROVAL TO COVER-GUNCTf
T•FyCi'ti s 1SC1 58. Electrical Conduit-Undrgrnd. r ,
-S:�r.t� rd� -ate
i-a)tFovndation 'P `'• r 59. Gas Pipe, 0 Undrgrnd.,Test '} t
.% 5v-
•
:-t.1zv'. Water Pipe-UndrS(nd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
1tJ. Structural Floor System • 61. APPROVAL TO DECK
1..
11. Property Sewer Line& House Connection / 62. Backwash & Receptor-Final '
12. Safer Cap S
/ 63. Heater & Vent-Final • 4
13, Roof Drains _ 64. Plumbing System • Final I
• 14. Rough Plumbing, '- 65. Electrical-Final ;
15,Rough Electrica•LConduit 66. Solar System-Final
16. Rough Electric•Wiring
9 w 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electricar Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
•
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
C. .-• 1 t-: k -tt i-' rX •' • r,7, T'.ri-ri
20.Rot h Eaton/ Fireplace ZrC-i lc _ =r x M.PPROVA�S?^Giereillt # - »'1
t Q >-,k 5 r r, i * 5 H 7:r tr 0 L 4-20:,--i:- > rc Cr .1-:17, r
z . 'rr :.S ' - '21.
� .-1 t �� �.� C n s: r
21. 1ut,R5,in3tr�etu�U;r ! •, ,• ,-Is * S - t * 40. URdergitc iDd_Hy&o *
2 .•, S... S 1 _ n - .- ^) - -
22. Duct, VehtiDting-n I C S %, w. S Ctt x 71. Product;iling G1.-Ms op,'
CO
23.3as'Pipe51oi?h &'1st S " -" 4‘ rUndergroundr• G.
?S * :rl p. < 0* t 72. F14.51 j * G
Y4.,600i Framing K x i .-;- ••F > , M: X .s73.c4Jndergrnd?Storajank 0 Gas 0 Oir"`-•"-
25. Roo Sh thing E re yr •n '1 a Nx "t` 5/4. verhead Ei j
-�S' G v rtt - :13 1g t t- Hydro
..
?&'J'-Baj Ceiling (Structural) &frlonecoat * co C t1* w 75.Dry Chemical - C r'xa;:geJ
•
27.'fra�ean Flashin z x �!r OF_ s :a x: nXaa
�� Flashing; .J¢s lr : > rpx 76.-bry Stan Ae _m : *:} i
riae.• c- t rr. S • •L',-' + :: ._.- '-
`-28.Latfyng1 Siding 'c :i -,y Y• x * X •• •• ,•t :< 77.:/FIXED SYSTEIvt'-F`4NAL'` a rL L
'29- Insulation •" ' 78.7IRE PR EV. FIIIA - x - 3 -o
*30. Drywall:Nailing 1; w x Y -a HEALTH DEPTtREQCNREME Tr
r r� S ni-. r`, - r• -'
31. Plaster Brow Coat' ` ,79.'fINAL INSP-ECTIQIVI; j - i�- L
! .. a- i ;nr K i' X Z' •1
:32.; lectricat`Power Metel_Final /0;e rt x _s80.•+,=OOD CERTIF.IC'ATfiISSUED -c
s c
X33. inaJtEle��ctric; ,r 1 i � TN°��sw _ -itzri * 0 r,
-iz -� X- � r. I r �; r,.. „J y 4.,r, > r 't
-,34.CFina Heating$ AiraConditiorig9s ^ * I - * 'z .4 •x 0: * S -
35. ginahGas Pip' TestR °C 'i x l • i * :'J o> On a tr C
36.'�loodor'�.'ano 'mss '-'- o R
PY ! erg .z .. !1 I 1 Y }: ^C r .r
_37. inal.Fa ory Fireplace.x ! 7•• .14 s r1 K x <vr Gcc 3 r
i r z .. -< ttoa : .y .v
;38. Final^Plumbing 4. * -V li x = -. .4 et -1
r^ C , I .. T t R
:39. Water See/ice-Final. -t ' s l 4 * 7 ,L ' 2 .ne L
.t }" 7'
,40. Gas Senlice-Final :` ' ! ` • -••.1..' • . . ,
• !- *-4 ; �
`41. Solar Domestic-Final . C',, •• < Ch 'L:- - k
ii n i I •. R ,r :L y r
'42.-BackflovwPreventer: ` " " `` i " • 0...- K
V x 1 I '--- > - 4 _
43. Backflowirrigation*6. e xcS < x * -,i- > J -
744. Landscafle Ir1Y!gatio2 System: .Lg c r - C . >F _t. .0 , -c wi vv .-^o
?45.r3ound Atten➢atio* "Ar- r t E - r* c C' i , o. s��t! r
• ,t !n rr:k * '- t:^ -L r *
.46.`HandicaP RejJlatioZs = C :1-c n 7c ' •; -
47Yr, -IINAL STRUCTURE & BUILDING r� s ai s Z
• 48. INAL PLANNINGi •rr . -v i : a IX
S r
t •t
c49.Electric Release to edison • •v >, ',
,r§0..sGas,3 eleasetil SoutJrern Califorpi4 Gas Co S C • ,m
•$1. CER�7IFICATE OF,OCCUPANCI� : S �: 11;� 4 . .:c
v, t r
No. _ Date
•7'