HomeMy WebLinkAbout1257 CONWAY AVE - Building PermitsJob Address: 1257 CONWAY AV
Suite:
Vicinity:
Primary Occ: R3 Type of Construction: V -N
Parcel Number: 14115509 Zoning: R1
Status: ISSUED
Applied: 11/09/2005
Issued: 11/09/2005
Applicant:
MORTON, EVONNE
( Eng
Address:
706 N TUSTIN STREET
- "Address
_
Phone; =714-288-1314
ISSUED'BY
ORANGE, CA _�: ,;..��-
_- -- ,Zip:- -92867.-?.-
� Zip: �
, !!�/
�` -License . - -. _ —.
.
Owner:
SANTANA,;
Address
1257 CONWAY AVE
SCOPE OF PERMIT C
. 256 SQ.FT. PATIO ENCLOSURE 13EHIND�EXISTING SINGLE-FAMILY RESIDENCE.
I
Phone: -714-546=4796_-
.
COSTA MESA, CA
- ,Zip 92626-2714 1
r i7 , r rFEE,SUMMARY.'
Contractor
ALL PRO REMODELING
' '� ! �_—Calc;Valuation.
S5 000.00.
X706
.$72.31
$111.25 $111.25
_ _-' _�''
Claim Valuation: ,'
Address
N TUSTIN ST
$0.50:.
SMIP Com:
Phone: 714-288-1
Other:;, $0.00
,Inspection
ORANGE CA
�J
Zip ',
92887 -
,Licens�
,,Arch'ter
( Eng
Address:
ii, -
- "Address
Phone - ��.. ! Phone:
. -
r
i License.
� Zip: �
, !!�/
�` -License . - -. _ —.
.
SCOPE OF PERMIT C
. 256 SQ.FT. PATIO ENCLOSURE 13EHIND�EXISTING SINGLE-FAMILY RESIDENCE.
-
r i7 , r rFEE,SUMMARY.'
Plan Check
'
' '� ! �_—Calc;Valuation.
S5 000.00.
Permit:
.$72.31
$111.25 $111.25
_ _-' _�''
Claim Valuation: ,'
$5,000.00•
' SMIP Res::
$0.50:.
^s
SMIP Com:
, $0.00
Other:;, $0.00
,Inspection
', $0.00
Total
$184.06
-
.-PLANNING & ZONING
SETBACKS
�.
MAIN STRUCTURE,.Front0 0',
1 Rear!18-b �,- `Left 0 0 �" - Right �00 �`�
ACCESSORY. - Front 0 6'�
Rear 0-0 Left , 0 0 Right 0 0
%
�R�guired.;
PARKING
.- Existing:.i0'�
0 .��Proposed:,
j
NOTICE: The work,authorized. by, this L permit: Shall: comply with. all applicable:handicap:access - requirements under, Califonnia-statuWand related
regulations. (Ord. No: 92=28; §-1; 12-21-92)
EXPIRATION:. This:pennit.shall automatically, expire -and:become void if work iSLnot.commenced.withim180'days; or if work,is s pended or abandoned
for a' period of 180 days:
INSPECTIONS:: In•ordecforlhe work authorized: underthis, permit,Wbe, considered. legal; such.work must:complywith:afll pplicable codes, and all
requited:Inspectlons and1hral'.approvallmust.be. obtainedi.Failure:to obtain inspectionsand.final'approvalvnll result'in theexpiration of this permit.
FOR.INSPECTIONS'CALL:: (714)754.5826
M
DECLARATIONS C-)
WORKERS' COMPENSATION DECLARATION: '- -
I hereby all irm under penalty of perjury one of the following declarations: "" •+ +,
t
❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensate\n, as proyJldd for by section 3700 of the Labor Code. for the performance of the
work for which this permit is issued. -
"'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.
My workers' comp Matiq}n Insur a car' r and policy number are:
,Carrier a t olicy Nube'x-' �_'?L�,s'f/U
(Th�ie;>on ne t be Loniplbtedlthe pannihs valued at one hundred dollars ($100) or less.)
❑ 1 cartity that in the pertor e of tha work for hich'this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of C do Ti., of agree th if I should become subject to the workers' compensation provisions of Section 700 of the Labor Code, I shall forthwith
comply with these(prowsi ns q
Applica Ig �? 1zDat_y A"K - / /
WARNAILURE TO SECURE V (ERSCOMPENS TION C ERAGE IS W FAL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND GVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000). IN ADDITICNTO THE COST OFCOMPENSAT , 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 q&.Signs f he (commencing with Section 7000) of Division 3 ol.the.Business andprofessions Code, and my license Is in full
forcwarld'rMecl2Clc tf Clas �S
.CgmtrectotrslSigrvwre's -''D Ie:.
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 1 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 per , 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 II Isuant 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 per
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 molal n five hu dred dollars ($500).):
❑ I, as owner of the property, or my employees ith 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 Contractorillcanse 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 employeerprovidedlthat-such improvements are not intended or offered for sale. If, however, the building or improvement is
sold within one year of completion, the owner-buildenwill have th liSrabnrpf proving that he or she did not build or improve for purpose of sale.).
/M o
❑ I, as owner of the property, em EXCLUSIVELY CONTRACTING �WlTf1'f I:
CENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions
Code: The contractors License Law does not apply to an cv4W of pro{ arty who builds or improves thereon, and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.). tCyy ` "id
❑ 1 am exempt under sec. Business and Profe�f+�oBgs,C''e for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑ Yes ❑ No Drivers Lic nse No. Expires:
Verification of Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 hereby cartify 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 B, California Administrative Code).
❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
............................................................................................................................................................................................................................................................................................................................................................................................
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
............................................................................................................................................................................................................................................................................................................................................................................................
3 Does or will the appplicant 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 tiling with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
..
.................................................................................................................................................................................................................................................................................... .............................................................................................
4 If en RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No
................................._............................._....................__............._..................................................................................................................................................................................................................................................................................
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication a ffrmit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes u No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
..........................................................................................................................................................................................................................................-.....................-.......................................
8 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 Safely Code).
.........................._.........................._............._...............__...._.._.__..............................................._.._____._._._......_............I......._.....I......_...........................................................
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
..................................................................................... _............ __......................... ............................... -_..-.__._.......................................................................... .............................................................................................. ............... ................
.....
B (II 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 slate 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 props for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Si t e Of Legal wner(s �lD to
AuthonloWplitfaint
CODE t.- INSPECTION TYPE ' - (LATE ^ - INTrr[ALS'w CODE I' INSPECTIONTYPE.IKDBAL$ .
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 BlocIdRetaining Well 212 Final Fire Prevention
202 Final Factory Fire Placa - 220 Final Planning Approval -
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy- 'ice
p�I fi14Gl�rG .
A'q �QO CJ[VNDCfr�
.Qe�vO.►1/.v L, 1. ..1D2 Y PafY� SANrfo�yA
706. At, 7vfTN IT. /Zt 7 La. a ny
d2d.wGd L� S�L�G7 LdpdA� 92676
Iry LffS lTiY 7iY 1"YG 4'7FG
ILs x.l4y AIIM•a-r- S�s..I,a�y, �ntc4.er�cs
iSAFETY
(I r (0 0 14�1 L o +
1(v 3 f} 2_ By Date
.{� This set of plans and s;=cilcalions MUST be kept on this "0 31 all times and it is unlawful to
5� f Pry O 0 'FN c mvke any changas c; r °r=[ s o.t sante e%2hoN rrrA'an °nrisirn from the Division of Building
3�;L, and Safety, Cityn(is;,'.e>a.
�: ! ,i- �' ALL NOT toheiatopermitorlobeanapproval
The stamping of S:L pzn ane �i2crfi;� �.t^ � rl
3(a4. -p -61 L,-4- (uv. of the violation of any prorisi)ns cf @:,,, City of Costa Mesa Ordinance andlor State law.
These plans and p:'A/ -0 expire by limitation and become null and void if the building or
work is not comment ;n and mair lained active per UBC §303 (d) within 160 days of issuance.
a
APPROVED
CITY OF COSTA MESA
PLANNING DIVISION 3y
SUBJECT TO BLDG. DEPT. REG. (� /
NOTE: ADDITIONS, DELETIONS,
OR CORRECTIONS SHALL BE y'1
APPROVED BY THE PLANNING DIV.
B DATE: c
ro 4
Feint «!r 2'
Z� �j�rt""Y $Gales o
14;`7 C�4A4Y
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesaffffCTRICAL PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 1257 CONWAY AV
Suite No
Vicinity: PATIO
Status: ISSUED
Applied: 11/09/2005
' Issued: 11/09/2005
Parcel Nunmber: 42607302
Applicant: MORTON, EVONNE �n ^
Address: 706 N TUSTIN ST _,- ISSUED BY: 'wJ
Phone: 714-288-13141:'-
ORANGE CA+ -moi .Zip 92867-
,3 } i
Owner: KEELER, MICHAEL-PJR TR
Address-22600RANGEAVE�
_'.Phone:'-
-/COSTA MESA CA �� �� Zip: 92627-1854 V�
C6ntr,'actor: ALC�PRO�REMODELING
Address: "r 706 N TUSTIN ST �a\ Phone: '714-288-1314
ORANGE CA I Zip 92867 Q -
License 5746.98
l w
f
SCOPE OF PERMIT �.``�-,_
ELECTRICALPERMIT FOR 256 SQ.FT. PATIO ENCLOSURE BEH STINGSINGLE-FAMILY '
(l"RESIDENCE.
i
REF#: BOS-02028,
.'.,.,• d -;',r -e� -r ;11t� rr.ry r�'-"Y � r.�_.;,-• `.� i," I I �
WORK TO INCLUDE: 2 LIGHTING FIXTS,.5 RECEIPT OUTCETS AND �2 SWITCHES:
`. FEE SUMMARY v/
!Quantity- "'a.� - r=,ti `..;Lrrl .,' QuantitY
ISSUE,FEE ' . $23.50. - - - Temp Dist System / Lighhng �. $0.00 0 j
Temp service test'' -_ $0.00, ' Busway/100,ft - $0.00 0
Res. a/c package $0.00 Standing Section $0.00 0 ;� - „
New Res (1=2 units), $0.00 _ 0 Misc Electrical Equipment , $0.00 0, W
New Res (3+units) $0.00 0 Transformers up to -1 kva/kw $0.00 0 J:
Pool /,Spa $0.00 0 ... up to 10 kva/kw $0.00 10 ;
Lighting FW% $2.20 2 au up to 50 kva/kw$0.00 i 0/ ( / " ' I
Rece t Outlets - /
p �� ' $5.50 5 „K ;1 up to 100 kva/kw $0.00 0 "
Switches w �a a ,, x$2 20 2 ... over.100 kva/kw $0.0011" 0 -
Non Res Apple�$0 00 0 , > y. r Low,Voltage Equipment , $0 00'J'� 0 :-�I ��(, t
Res Appl ti - $0.00,� Oi; Cow Volt Wmng-System / C'kt` $0:00 0
Service t02 00a ,✓-? _$0.00: �� - Oen', _ ; r' Misc. Conduit ,�- $0 00 �� 0
Service to 1000a p / $0-00 .,�. 0 _ MiscfConductor $0 00(/^ `0 ' �r
Service over 1000a- C . $0.00 01,, `- tardus (gen or ride) �-�%% $0 00 , �j0"
Motors to'1hp ;.$0:00'-?. `-0: ter �:� T Circus(mech'rideoclighfs)-' --$0.00 �`�0,,
Motorsto ,l0hp - $0.00 0 - ChristmasTree Stand' $000, 0
Motors to 50hp - $0.00, / f 0 ". Fireworks Stand
Motors to100hp -$0.00 0' , Other Ele_drical'Fee $000
Motors over 100h $0.001. 0 Cn
Communication drops $0.00 =` 0"` I J Investigation Fee-) r $0.00'
Sub panel to 200a $0.00 0Plan Check Fee'" .- $0.00
Pole Light Pkg $0.00 ;0-?"=.- Reinspection Fee$0.00
Sign Circuits $0.00 0�-
Temp Pwr Pole $0.00 0 -TOTAL CALCULATED FEES $33.40
Intermed Pole $0.00 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes anerelated
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 suspend 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 apcable 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
2"6.46 (6100)
DECLARATIONS
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' compensatlon, as provided for by section 3700 of the Labor Code, for the performance of the
work for which this permit is issued. - -
l.t have and will maintain workers' compen Insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
e My workers' co ens tionnsnsti ce car er and policynumber are:
�Carde7:�+0 I1.1 Pfolicy-Number:-Y. 1 ��
-rMis section neednef cn pple e i the permit r`3va7ued at one hundred dollars ($100) or less.) - -
❑ 1 certify that in the performance of the wo or which this permit is issued, I shall not employ any person in any manner so is to became subject to the workers'
compensation laws of California, and agr that if I should be ome subject to the workers' compensation provisions of Section 3700 of the tabor Code, I shall forthwith
comply with these provisions. 1 n^1^� / p�
p Cam:9igrmNVe: V r' Y" I �I �A/� Date: --w.-- 1 J
' r r.
WARNING-FALLURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UN W D SHALL SUBIECT AN EMPLOYER 'TS'CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMA SAS PROVIDED FOR IN SECTION 3706OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
LICENSED CONTRACTORS 0 ARATION:
I hereby affirm that I am liven d u der Provisions of Chapter9 (Com encing ith Section 7000) of Division 3.o -the, Business and Pr a 'ons Code, and my license is in full
force and effect. Lia N LClass N�
Cori ractoE''s Slgnllure: Date:.
:`- T..
CONSTRUCTION LENDING AGENCY: -
❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code).
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 requfrits 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'oryMekls 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 thithe 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 6t not more than five hundred dollars
❑ 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.).
❑ 1, 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 ap 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 Le 'a
❑ I am exempt under Sec. ' ^:Al Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑ Yes ❑ No Driver's License No. Expires:
Verification of Ownership by (type of document, i.e. - property IN or deed):
'K
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: 01
t-
❑ 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, faisework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title B, 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 WIII the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
r building Occupant need to file a registration form for acute) hazardous materials? Yes No
...................................................................................................
2 Does or will the applicant or present or future bu g p g y ❑ ❑
(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 theaDDlicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)?
❑ Yes 11wo
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
............................................................................................._........................................................................................................................................................................................ ............................,......................................... .......................
4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No
................................................................_..........................._..._......................................................—_._._____.._...._......................................................................................................................................_............_.........._..........................
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication a permit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes J No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
..........................._.............._...................................._............._......................................................_......................_................................._........_.......................................................... ......................._............_.......... ............... I.........................
8 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
(it 'yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
..............................................................................................._...........................................................................................................................................................................................................................
7 It a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which 15 the subject of this
application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
.............................................................
e (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 1 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.
ig tura Of al er(s) 1[�ete
70� 11
f AndfOr Aut d Applid
CODE r. INSPECTION TYPE' _ ' gdTE ' IirmALS CODE r -INSPECTIONTYPE 2AM lid$.
1616 Fixed System Final Fire Prevention ' 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing -
200 Final Re -Root ' '' - - 210 Final Electrical' ' Y �U /9r+IL
201 Final Block/Retaining Well 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITUiTS COSTA MESA CONSTRUCTION PERMIT
4�Pyroject Address 1 C�l�r✓
'a.pplicant's Mailing Address A'af to gi�A4 C, A.,
r �,..,.,
Owner's Name f �M� A Phgrae .05-0— !
Address .SAH CGYXsn/
Arch/Eng. License No.
Address
Contractor's Name Phone
Address (mailing)
City License No.
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Charter 9 (commencing
with section 7000) of Division 3 of the Business and Professions Cotle, and
my license is in full force and effect.
License Class License No.
Date Signature
WORKERS' COMPENSATION DECLARATION
' nereby affirm that I have a certificate of consent to self -insure or a certificate
Workers' Compensation Insurance, or a certified copy thereof (Section
0, Lab. C.)
®
,icy No. Company
Certified copy is hereby furnished.
Certified copy is filed with the City Building Division.
Date Applicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section need not be completed if the permit is for one hundred ($100) or
less).
I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any mann as to beco subi6Et to the,
Worker Compens?$.ip L s of Califorp - cP
Date 2__.3-�% I / Sign t r
NOTICE: If, after making this tlCCrd ration, you should be ome subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith
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 performance
of the work for which this permit is issued (Section 3097 Civ. C.)
Lender's Name
Lender's Address
OWNER BUILDER.DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct, alter, improve, demolish or repair
any structure, Prior'toAts issuance, also requires the applicant for such permit
to file a signed statement that he/she is licensed pursuant to the provisions of
the Contractor's License Law (Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code) or that he/she is exempt
herefrom and the basis for the alleged exemption. Any violation of Section
331.5 by any appliCant for a permit subjects the applicant to a civil
—natty of not more than five hundred dollars ($500).
J� 1, as owner of the property '
" will do the work, and the structure is not intended or offered
for sale (Section 7044, Business and Professional Code: The Contractor's
License Law 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 com-
pletion, the owner will have the burden of proving he/she did not build or im-
prove for the purpose of sale).
❑ I, as owner of the property, am exclusively Contracting with licensed con-
tractors to construct the project�(Section 7044, Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who
builds or improves thereon, and who contracts for such projects with a con-
tractors) license pursuant to the Contractor's License Law). Iam aware that
proof of their Worker's Compensation
nncinsurance shoultl be providetl to me.
❑ 1 am exempt order Section 7A—tir=y T B. & P. C. for this reiisOn
Date .9L: d —X2( /Owne
I hereby certify that I have read this application a state
information is correct. I agree to Comply with all city and cou
and state laws relating to building construction, and hereby a
sentatives of this cit venter_ µpgn tl�p a_bovysrrlentioned
inspection pur dfalei 6//ALdI,a'YGLL/'s�
SS =ir
9698 5/02/80 45.50 TL
TYPE OF CONSTRUCTION NEW ADD ALTERATION LJ REPAIR
FEES
IIIII
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
A.P. #
_ Zone _
DESCRIPTION OF WORK/USE OF BLDG.
S
Main Building:
Accessory Building:
Backflow Irrigation Sewer Cap
TYPE OF PERMIT GRADING El FOUNDATION STRUCTURAL
T
Front•
Cooking Unit Meter Cup to 100 amps "
1
O
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
B
Dishwasher Solar Piping
Refrigeration System
❑0-100,000 BTU 0100,000 BTU
N
❑ OTHER
A
Rear
Floor Drains Swimming Pool w/Spa
I
r
C
Right
Fixtures Microwave
Gas Service Outlets Water Closet
PROJECT DESCRIPTION SQ. FT. �h L.�ILr OCCUPANCY
Device Boxes Pole Light
Interceptors Water Heater
G
q
CONSTRUCTION TYPE •LVALUATION t_J V V
S
Left
Lavatories Auto -Wash
R
ZONE GRADING CU. VDS. ACRES
ping. Ref. #
Parking Req'/Provided
E
Roof Drains
Q
Remarks: -
Planning Notes:
N1
T
S
PLUMBING
FEES
Bar Sink Showers
ELECTRICAL FEES
Backflow Preventer Service Sink
$15
Automatic Washer - Transformer ❑ 15-50 KW
Construction Pole Sub.- ❑50+KW
Backflow Irrigation Sewer Cap
AANICAL
Bathtubs Sewer Connection
Cooking Unit Meter Cup to 100 amps "
1
Clarifiers Solar Collectors _
Hood or Type ❑
Canopy Type I1 ❑
Dishwasher - Meter Cover 100 amps
Dishwasher Solar Piping
Refrigeration System
❑0-100,000 BTU 0100,000 BTU
Dryers ❑Gas ❑Electric Sub Panel
Drinking Fountains Solar Tank
BUILDING PERMIT
PLAN CHECK
PLUMBING
PLAN CHECK 25%
ELECTRICAL
PLAN CHECK 50%
MECHANICAL
PLAN CHECK 25%
Fan Motors ❑0-1HP Ell h-8
Floor Drains Swimming Pool w/Spa
System Repair/Alteration
F.A.U. Inc.Solar 09-15 HP ❑16-15+
Floor Sinks Urinal
Fire Dampers -
Fixtures Microwave
Gas Service Outlets Water Closet
Registers
Device Boxes Pole Light
Interceptors Water Heater
Outlets Range
Kitchen Sink Water Service
Switches Sign -
Lavatories Auto -Wash
Issue Fee
Garbage Disposal Standing Sections
P—Trap Laundry Trays
Generator 00-5 KW 05-15 KW Trash Compactor
Roof Drains
Reinspection Fee 1 $15
Boiler
Duct- Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Bit. ICBO 4 -
Heating
Heating System & Ducting
110-100,000 BTU 0100,000
Reinspection Fee 1 $15
CMF 0865-46, rev. 10/84 White - Building; Canary . Applicant; Pink - Accounting; Goldenrod - Assessor
Issue Fee
$ 8
Reinspection Fee
$15
Issue Fee
$ 3
AANICAL
FEES
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By
Building Approved By
Application Issued By
"
Date
Date
Data
Hood or Type ❑
Canopy Type I1 ❑
Refrigeration System
❑0-100,000 BTU 0100,000 BTU
BUILDING PERMIT
PLAN CHECK
PLUMBING
PLAN CHECK 25%
ELECTRICAL
PLAN CHECK 50%
MECHANICAL
PLAN CHECK 25%
SUMMARY
$_
$
$
$
$
$
$
$
OF FEES
SMIP . $
PERMIT
ISSUANCE $
ENERGY P.C. $ _
GRADING $
MICROFILM $ •�
TOTAL FEE $ �J
System Repair/Alteration
Fire Dampers -
Registers
Issue Fee
$ 3
CONSTRUCTION AND PLANNING
APPROVALS 'Permit 916
Date
Inspector
POOL & SPA
APPROVALS Permit #
Date
Inspector
L -Temporary Electrical Service or Pole
52. Pool 8i Equipment Location
2. Soil Pipe-Undrgrnd.
53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd.
54. Forms
,
4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding
5-. Steel Reinforcement
c
56. Rough Plumbing & Pressure Test
6. Electrical LIFER Grnd.
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
8. Foundation
59. Gas Pipe, ❑ Undrgrnd., Test
9. Water Pipe-Undrgrnd. ..
60. Backwash Lines, P -Trap, O Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK
11. Property Sewer Line & House Connection
62. Backwash'& Receptor -Final
'
12. Sewer Cap
63. Heater & Vent -Final
13. Roof Drains
64. Plumbing System - Final
14. Rough Plumbing
65. Electrical -Final
15. Rough Electrical -Conduit
66. Solar System -Final -
16. Rough Electric Wiring
67. Fencing & Access Approval
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough Electrical -T Bar Ceiling
69. POO USPA SYSTEMS FINAL . .
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
20. Rough Factory Fireplace -
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping O Gas ❑ Oil -
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank 13Gas ❑Oil
25. Roof Sheathing
74. Overhead Hydro
26. T -Bar Ceiling (Structural) & Monocoat
75. Dry Chemical t
27. Frame and Flashing
76. Dry Standpipe r
28. Lathing & Siding
77. FIXED SYSTEM FINAL
-
29. Insulation
78. FIRE PREV. FINAL
30. Drywall Nailing
-
HEALTH DEPT. REQUIREMENT -
i v,
31. Plaster Brown Coat
79. FINAL INSPECTION
!.a
32. Electrical Power Meter -Final
80. FOOD CERTIFICATE ISSUED
!r'
33. Final Electric
Notes: .yt
34. Final Heating & Air Conditioning
I L.
35. Final Gas Pipe -Test
36. Hood or Canopy
37. Final Fa 6tory Fireplace
-
38'. Final Plumbing
39. Water Service -Final
,,-
40. Gas Service -Final
. 41. Solar Domestic -Final 1
i
y - -
42.' Backflow Preventer _ ,.
- •,,
43.. Backflow Irrigation;
44. Landscape- Irrigation System
' 45. Sound Attenuation
•' '
I
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48J Special Requirements Completed
i
49. Electric Release to Edison
�r ,
' e
50. Gas Release to Southern California Gas Co
•~J
51. CERTIFICATE OF OCCUPANCY/
I :
No. Date
b'
OWNER COLLEGE --MESA COMPANY DATE 2-1h-57
JOBADDRESS 123x7 rnnway-Avenue BUILDING PERMIT NO. #4312
GENERAL CONTRACTOR The Hale Company VALUE$ 10,2h8.00
LOT BLOCK TRACT M71 Single IPg .w./a++. gar
GROUP T xr .r TYPE 17 ZONE FIRE DISTRICT h388
INSPECTIONS
DATE
SUBCONTRACTOR
PERMITS ISSUED
DATE
NUMBER
Footing Trench �
,> / � -'
Foundation Forms and Grade to Gara 4j
r
Rough Framing _
—3�:S
'6-.z7-
Plumbing, Rough to Slab ug-gSy�
y
- -.�
•7
/ % ,Q6 ✓
Plumbing, Rough Complete
Temporary Pole
Wiring, Rough MAY 13
1957 VC B
�p
'�dL=�Qc .,r:
y-�S-S]
HY R d, &.0 -
Heating,
Heating, Rough 11f# 5
I
'" //j -)7-Irl
1130y ✓
Heating, Final
Sewer,House WL Sewer, St. P)LGS
SepticTan korCesspool
•� ,J
,(' ,� /Y r'- ;
r_, J
G�y�% -
Lathing, In
Plastering _f •
%
Plumbing, Final, Fixtures Complete /l�(f,T
/d -/,5'- 5/
Plumbing, Final Gas Test/_5'- /Fl/fS
-/-.- 7
•-7 „y / /T
?,� '•�
li�
Wiring, Final
_
Ocou nancv Aw !Lf-
_-. i_ -I-
FORM 210 3M 10-•v5 h312
Costa Mesa Building Department
P. O. Box 317
COSTA MESA, CALIFORNIA
APPLICATION FOR PERMIT
4388 BUILDING
FOR APPLICANT TO FILL IN
FOR OFFICE USE ONLY
Receipt No.
Permit No.
4312
Address in1257 Conway Avenue
Costa Mesa, California
Received by
Date Rec' .
_ �g�
Date Issued
FEB 1 4
Nearest
cross St. Fairview & Baker
Building
Address
Owner College Mesa Company
Costa Mesa, California
Mail
Address 1777 W. Lincoln Avenue
Nearest
Cross St.
Tel.
City Anaheim No. KE -3-3161
zone
I No. of
Plans
Type Group
AAy-
Architect or Lie.
Engineer Quigley & Clark No. 08884
Approved
by Date
CORRECTIONS
Address 1323 No.Broadway, Santa Ana
Contractor The Hale Company No. L1O' 3422
Address 1777 W. Lincoln Ave..Anaheim
LegalI
Description
Lot I
No. 6
I
Block Tract 267
_
(Attach Metes and Bounds)
Size of Lot 62 X 100 1
No. of Bldgs.
Now on Lot None
Use of
Existing Bldg.
No. ofI No. of
Families Rooms S
O
A
0
Setback Line fromRear Yard
Center of Street 50, Side Yard 5'
D
DESCRIPTION OF WORK
New X
( Alteration
I
I Addition
Repair
I Moving
I
Demolish
fn
Building No. of
Size 1131 Rooms 5 Stories 1
Exterior WallI
Covering' Stucco
Roof
Covering Shake
—
APPROVALS j
Use of New
Building Single family dwelling with
Foundation Location
Forms, Materials,
Under -Pinning
Inspector
Date
attached garage.
Frame: Fire Stops,
Bracing, Bolts
I hereby acknowledge that I have read this Application
and state that the above is correct and agree to comply
with all City Ordinances and State Laws regulating
building constructio
Signature of
Permitte THE HALE k PA
Authori
Lath. Int.
Lath. Ext.
Plaster, Int.
Plaster, Ext
it
Valuation
$ 10,248.00
Permit Fee $ 26.00
Plan Check $ 13.00
Masonry Reinforced
Bond Beam
Total 39.00
Fee $
FINAL
CD
FORM 20C 1055 O. P. 8 5.
PLOT PLAN
Show location and distances from
property line and between buildings.
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4
L
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Street
PLOT PLAN
Show location and distances from
property line and between buildings.
,
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1
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