HomeMy WebLinkAbout2127 COLLEGE AVE - Building Permits .
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CITY OF COSTA MESA
1- 1 ,l� BUILDING DIVISION PERMIT NUMBER
DEVELOPMENT SERVICES DEPARTMENT
PK*
�• PERMIT
, �
/99-00431
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 2127 COLLEGE AV Status: ISSUED
Suite: Applied: 03/30/1999
Vicinity: Issued: 03/30/1999
Parcel Nunmber: 41917116 Zoning:
Applicant: JENSEN, KRIS ISSUED BY: O'L-
Address:
Phone: 714-990-9360
Zip: 92627
Owner: CASTON, BRIAN K TR
Address 2127 COLLEGE AVE
Phone:
COSTA MESA,CA Zip: 92627
Contractor: THE JENSEN COMPANY
Address: 322 HILLTOP LANE
Phone: (714)990-9360
BREA,CA
Zip: 92821 License: 736443
Arch : Eng:
Address: Address:
Phone: Phone:
Zip License: Zip: License:
SCOPE OF PERMIT
14'x 24'patio cover attached to rear of single-family residence. (r-5v I(a fog
FEE SUMMARY
Plan Check: $72.96 Calc Valuation: $5,416.32
Permit: $112.25 Claim Valuation: $0.00
SMIP Res: $0.54
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $185.75
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 26-0 Left 9-6 Right 26-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTES:
EXPIRED
DATE 9(.���o ,Leio etTDn
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)7545626
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'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(T 's section need not be completed if the permit Is valued at one hundred dollars($100)or less.)
e;I: 1 cell. that In the performance of the work for which this permit is issued, I shall not employ any person In any manner so as to become subject to the workers'
pone . laws of California and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
I .se pr•visi•.
r
Applicant Signatu . i i — 2 Date: 3/30759
WARNING:FAIL . T•: RE WORKER COMPENSATION COVERAGE IS UNLAWFUL MD SHALL SUBJECT M EMPLOYER TO CRIMINAL PENALTIES MD CIVIL FINES UP TO ONE HUNDRED
•-n, •• ••E($l00,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,MD ATTORNEYS 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.a 'V 3 Y 3 Class N 1$
Contractors Signature: j-- ' Date: /50/S f
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).):
❑ 1,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,end the structure Is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to en 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 drivers license. 0 Yes 0 No Drivers 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 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 end 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 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 S presently required,has Section 25534 of the Califomia Health and Safety Code been fully complied with? 0 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 akEermit for such construction or modification
from the South Coast Air Quality Management District or from any other elr 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).
8 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 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? 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 at 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,end 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.
SI nature Ot al Owner(s) Date
3/30177
And/Or Authorized Applicant l ��� Date
goDE I INSPECTION TYPE PATE RMS LODE( INSPECTION TYPE UTE IALS
•
1616 Fixed System Final Fire Prevention 208 Final Mechanical
1268 Pool Spa Final _ 208 Final Plumbing
•
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wail 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
4$ _ k CITY OF COSTA MESA
04 1; BUILDING DIVISION .
�^ w ' DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
o• PERMIT
;41•
99-00192
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 2127 COLLEGE AV Status: ISSUED
Suite No Applied: 03/30/1999
Issued: 03/30/1999
Vicinity: //�
Parcel Nunmber: 41917116 ISSUED BY: 1
Applicant: JENSEN,KRIS l
Address: 322 HILLTOP LANE
Phone: (714)990-9360
BREA,CA Zip: 92821
Owner: CASTON, BRIAN K TR
Address 2127 COLLEGE AVE
Phone:
COSTA MESA, CA Zip: 92627
Contractor THE JENSEN COMPANY
Address: 322 HILLTOP LANE
Phone: (714)990-9360 ,
BREA,CA Zip: 92821
License: 736443 FI EE/ )
Arch/Eng: . (0L3c (V
Address: .DATE 61^
Phone: (; ra. YA
Zip: f,l O i'
License: 1'
SCOPE OF PERMIT
REPLACE EXIST. GAS LINE. .
FEE SUMMARY
AMT QTY AMT QTY AMT QTY
ISSUE FEE $22.00 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0
Backflow irrigation. $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0
Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0
Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0
Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0
Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0
Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0
Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0
Drain, Roof $0.00 0 Shower $0.00 0 Water Heater/vent $0.00 0
Drinking Fountain $0.00 0 Sink, bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0
Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0
Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0
Gas(1-4 outlets) $0.00 0 Sink, kitchen $0.00 0 Water Softener $0.00 0
Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00
Gas Repipe $8.75 1 Spa(private) $0.00. 0 VIOLATION $0.00
Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00
Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0
Interceptors(Sand Auto) $0.00 0
TOTAL CALCULATED FEES: $30.75
COMMENTS/SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia 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
DECLAIMTIONS
WORKERS'COMPENSATION DECLARATION: -
I hereby affirm under penalty of perjury one of the following declarations:
0 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'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
('r 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 2/ //' C
T.-Applicant Signature: ? Date: J/ �-i' s
WARNING:FAILURE TO R WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO MINAL PENALTIES AND CML FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(S100,000),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.11itSr r-f '3 Class#
Contractor's Signature: is 7�-^ Date: 3/9D7 SP
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
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.My violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penally 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.).
❑ 1 am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type o.ocument,i.e.-property tax bill or deed):
ir
DIVISION OF INDUSTRIAL SAFETVVPERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more lest 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,scaffoiding,�alsework,or demolition or dismantling thereof,will be more than thirty-six(38)feel 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 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,ora 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 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 Flre 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? 0 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 aQarmit for such construction or modification
from the South Coast Air Duality Management District or from any other air pollution control district or agency? 0 Yes LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 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 Duality 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 penally 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.
��(gnature Of Legal Owner(s) _, > Date
�� 3 /94
And/Or Authorized Applicant Date
CODE I INSPECTION TYPE BATE =AS/ CODE INSPECTION TYPE 09Th INTITIAL$
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 205 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Flre Place • 220 Final Planning Approval •
203 Final Sign 222 Final Site
204 Final Demolition • 250 Final Building/Occupancy
2446-46
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PROJECT ADDRESS: 2127 COLLEGE AV • UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO: P 065631
OWNER'S NAME: CASTON, BRIAN K
ADDRESS: 2127 COLLEGE AVE PERMIT NO: P 065631 PLAN CHECK NO: N GOVT: N SUPP: N
COSTA MESA, CA 92627
• CONSTRUCTION TYPE: PERMIT TYPE: PLU PURPOSE: OTH
645-4273
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : CHANGE OUT INSTALL HOUSE GAS PIPING SQ FT:
ADDRESS: UNIT:
• CLAIM VALUE: CALC-VALUE: GROUP OCC: R-3 /
PERMITTEE: C. C . COLE PLUMBING 6 HTG ( 714 ) 645-1161
ADDRESS: 2280 NEWPORT BL COMMENTS: NO OTHER WORK AUTHORIZED BY THIS PERMIT
COSTA MESA CA 92627 *******x***********+k**************err***********+tit*+r****x***********************
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACKS
CITY uc.: 006748 sTATEuc.:275585 {� CLASS: C-36 '
9
Date:_/— (o- Y Signature:—,...04 rv47 _.,./?ade--e„a MAIN BUILDING ACCESSORY BUILDING
r1IORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to selbinsure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Compensation Insurance.or a certified cop thereof(Section 3800.lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLICYND.: NWC25108700 EXP.DATE: 01 /01 /95
GOMPANY: GOLDEN EAGLE PARKING REQ: PROV: PARCEL : 41917116 ZNE: REF NO:
A Certified copy is hereby furnished. ® Certified copy is filed with the city Building Division. PLANNING NOTES>
p J
D e: 1—/0-9// Applicant: iL_ //�Lp >
y I *******************************************************************************
EXEMPTION FROM WORKERS'COMPENSATION DECORATION: (This section need not be completed it the perms N to one hafted(5100)or less). D -E V E L O P M E N T SERVICES REQUIREMENTS
I certify that in the penormance 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 01 California. ZONING APPROVED BY
DATE:
Date: Signature:
NOTICE:It.alter making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE:
Code.you must cpnhwilh comply with such provisions or this permit Shall be deemed revoked. ` •
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the perormance of the work for APPLICATION ISSUED B Y: * - - . DATE- /"/O i*R*
which this permit is issued(Section 3097,Civ.C). *********************** *** * ** *********************************** ***
LENDER: • ********************************** *** ****************************************
ADDRESS: LEGALIZATION:N FEE UMMARY STRUCTURAL SEGMENT: N
OWNER BUILDER DECORATION: I hereby affirm that l am exempt from the Contractors'State License Law tor 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 5,00
repair any structure.prior to its issuance,also requires the applicant for such permit to life 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 25% SM I P/NON-RES
and Processions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by PLAN
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(S500). ISSUE FEE 20 . 00
I, as owner of the property 01 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 sate(Section 7044,Business and Professional Code: The Contractors'Slate License Law TOTALS----> 5 . 00 20 . 00 0 . 00 25 . 00 25 . 00 . 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himsell/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 wit have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED : 25.00 OVER/SHORT: , 00
for the purpose ofsale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 25 . 00
❑ 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 the Contractors'State License Law). l am aware **,********.***,**.**,.x,*,.****,**,****,*****,**,*,*,**,**,*,***,*,********************************
that proof of their Worker's Compensation Insurance should be provided to me. I N D I V I D U A L F E E B R E A K D O W N
❑ I am exempt under Section: B.8 P.C.
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Dale: OwnerPLU 1 GAS PIPING SYS OF 1 TO 4 OUTLETS 5 . 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safely Code Sections 25505,25533,and END OF FEES 5 . 00
25534 and that I or any future building occupant wilUwill not(circle one)need to comply with said state codes and the requirements for a
permit lar construction or modification from the Air Duality Management District.Residential construction applications are exempt from
these provisions.
Date: Applicant:
I hereby cerlily that I have read this application and state that the above information is correct.1 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.meniioned
property tar inspection purposes, n 01 00153469-00153459 T 0T 25.00
Dale.• i - 10-x14 Signature: Oa A /�`7/ 1 Cbi�-L' DATE: 01710/94 TI0E: 13:56
Driver's License or Social Security b:
1641.46 White—Budding;Green—Code Enforcement:Canary—Applicant:Pink—Revenue;Goldenrod—Assessor
i
CONSTRUCTION AND PLANNING PC tit SPA I
APPROVALS Permit -A= Datu Irspec:or I APPROVALS Permit I Dote • tn,pectar
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1 48. FINIAL PLANNING
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50. Co. ?;lease to Souutern ::,rtorma ti.s 1 1 ,
51. CEiITII--ICATE Of- OCCUPANCy 1 - ---I - - 1�� - - - - - - - - - - - - - - - - -
OWNER DIKE & COLEOROVE, INC. DATE 5-8-57
JOB ADDRESS 2127 College Avenue BUILDING PERMIT NO. #SO 3
GENERAL CONTRACTOR Owner Bldr. VALUE $ 10,008.00
AP. No. LOT 13, TRACT 3207 FIRE ZONE DESCRIPTION OF WORK Res. w/att. gar.
GROUP I & J TYPE V ZONE M.I. PLAN NO. 4952
-
PERMITS ISSUED-
INSPECTIONS DATE SUBCONTRACTOR
DATE NUMBER _
Trenches 1,1-17 orals Steel .f/7.-677 _
Floor System
Steel Reinforce Chimney Re-Rod
Bond Beam
Frame and Flashing 6 -.2.,-5-7
Lathing, In Out 7 . *. Y
Plaster, brown coat -/6 -47'
Underground soiWh'S W/G Pipe Test/pfla S--ii S7
Top Out S'ten •
Furnace 49 A? ,4 Nc 6-a' sr-itc!%Lirt�2i7J 4keeJ 4--,/-S•7 /0/9 0 ✓
Gas Vents M#S 9-//-S7 // I�
Rough Plumbing 405 > /S-z 7 iti. aL�t l t1.-J t t tW✓t.0 . vim- 99-57-. V341 f/
Cesspool Septic Tank
Prop. Swr. LinU/j House Con.//HSSt. Swr. 7-//-3-) ¢(.U-2t.QRni (/a . '7 -3-5-7 , 76 3/
Sprinkling System
Heating Final • 4N44,f 9-11-5-7
Plumbing Fixtures, Final/3— /YI/Ah�J' 4-/i-57 �y' / - 1
Final Gas Test � N'S //-S7 C �ff 9 pc • /J^. �I/Z 3% /7e.4
Construction Pole
Underground Power -t fi _
Rough Wiring GS �- r_Z4_� p"4'-a•7 'iU .'j-i ✓
Fixtures, Final �¢Q� -C -���
OCCUPANCY 'L i cg:/7-.7441 (!c/"7�i�/- /y2o '7 //i/-5-7 7/v��
Form 210-5M-1-57 - / / '
- T T -
- 4952 FEE RECEIVED
COSTA MESA BUILDING DEPARTMENT 0 7'C/ 1 i Cly; I•
P.O. BOX 3IT FINANCE DEPT.
COSTA MESA. CALIFORNIA CITY OF COSTA MESA
FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT
BUILDING BUILDING
ADDRESS 2)27 Coll P. - avenne
COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY
n RECEIPT NO, PS0®3
OWNER mike & col A-]Y]ve� The Jv u
MAIL RECEIVED BY TE RECEIVED ,ppT, ISSUED
ADDRESS 419F.. /
. 17th Street ' - -s7 MAY 8 1957
TEL. BUILDING
CITY Costa Mesa NO. IA R-1159 ADDRESS
ARCHITECT LIC. COSTA MESA. CALIFORNIA
OR ENGINEER Carlson & Middlebrook
FIRE
ADDRESS Garden Grove ZONE
ZON NO.OF TYPE GROUP
1� CITY LIC. I [ _ /$I'� PLANS
CONTRACTOR Dike and Colegrove NO. 4615 •
ZONA
1 ���
419 E. 17th St., TEL +APPROVED
ADDRESS ;octa Moaa NO. Li 8-1159 BY DATE
LEGAL LOT CORRECTIONS
DESCRIPTION NO. 11 BLOCK TRACT 3207
A.P.NO.
SIZE In NO.OF BLOCS.
10
OF LOT 60 Y 5 NOW ON LOT now,
USE OF •A^ /�I
EXISTING BLDG. [LOj]E � 411LII11
SETBACK LINE FROM
CENTER OF STREET 501 REAR YARD 301
SIDE YARD RIGHT 51 LEFT 51 4:
DESCRIPTION OF WORK 47
NEW ][ ALTERATION ADDITION y
Y
REPAIR MOVING DEMOLISH www.
BUILDING, NO.OF .
SIZE J1)..6 Sq. Ft. ROOMS 5A STORIES 1
EXTERIOR WqQ I4.L ROOF
COVERING J4nCCO COVERING Como. ,
USE OF NEW •
1
BUILDING Single Family Residence
Plan No. Z620PR (11-ed. y
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND 'SF
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL a
CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUC,
TION. n /� ♦ VALUATION
SIGNATURE OF ` / ./ . a,.� .,//A PERMIT FEE $ 26.00
PERMITTEE ` t l/ ����(i(� lY
$ 10�008�00 PLAN CHECK S 13.00
AUTHORIZED AGENT Dike and Colegrove TOTAL FEE $ 39.00 .1/49 Air