HomeMy WebLinkAbout1283 CONWAY AVE - Building Permits CITY OF COSTA MESA •
BUILDING DIVISION •
F4 ; 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
�• l FOR INSPECTIONS CALL:(714)754-5626
d'
PERMIT NUMBER: E09-00027 •
PERMIT TYPE ELEC STATUS: ISSUED
APN: 14115533 DATE ISSUED: 01/27/2009
• ISSUED BY: RMD
•
JOB ADDRESS: 1283 CONWAY AV CM Suite/Unit
Vicinity: SIDE OF HOUSE
SCOPE OF WORK: ELECTRICALPERMIT FORA SERVICE PANEL UPGRADE TO 200A,-SAME LOCATION SIDE OF HOUSE.
511
OWNER: JIN,JAMES)AND VANESSA/R, ',Address: 1283,CONWAY,AVE?•,Unit: •
PHONE: 714-222-2401 - - City/State/Zip: . COSTA MESA:CA '
APPLICANT: JIN,JAMES J AND VANESSA-R, ' Address: - •1283.CONWAY AVE'-Unit:
PHONE: 714-222.2401 -iy = -- City/State/zZip: 'COSTA-MESA-CA
CONTRACTOR: OWNER BUILDER License No. 000000
Address: '.,
City/State: ZipCode "-- - - CELL:
•
ELECTRICAL PERMIT FEES
Electrical Plan Check Fee $0.00
Electrical Permit Fee: = $54.00 •
Reinspection Fee $0 00
TOTAL FEES $54:00
•
•
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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work 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.
CODES. INSPECTION EITE DATE iNTTALS CODES INSPECTION TYPE DATE INTITALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical 2.-2D-0/ (5C .
201
'5_-
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 -
WORKERS'COMPENSATION DECLARATION. Owner ID verified by driv, ..ense. ❑Yes ❑No
I hereby affirm under penalty of perjury one of the following declarations: Dr ev ra- Se No. Exgr' t t12411-2-
❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed):,
compensation, as provided for by section 3700 of•the Labor Code, for the -
performance of the viork 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. My workers' compensation Insurance carrier and policy ❑ I hereby certify that no excavation five(5)or more feet in depth into which a
number are: person is required to descend,will be made in connection with work authorized
by this permit,and that no building structure,scaffdding,falsework,or demolition
Carrier: or dismantling thereof,will be more than thirty-six(36)feet high. (Chap.3.2,Grp
(Thissertion need not be completed dShe permit tS valued at onehundred dollars(El ee)or less.)
2,Art 2Sec 341 Title B,California Administrative Cale).
Policy Number:
❑ As owner-builder, I will not employ anyone to do work which would
Iiircertify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
issued,I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
to the workers' compensation laws of California, and agree that if I should
become subject to the workers'compensation provisions of Section 3700 of
Applicant's Signature Date
the Labor Code, I shall forthwi • comply with these provisions.
�j / /� — O 7 ( Division of Industrial Safety Permit Number:
/' •• on-r: ' 1Of HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
• G: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes 0 No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST,AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. 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
LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is in full force and effect. a registration form for acutely hazardous materials? 0 Yes 0 No
Lic.# Class# (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
Contractor's Signature Date 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
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? 0 Yes 0 No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: 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.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes 0 No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5. the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? ❑Yes ❑No
issuance,also requires the applicant for Such permit to file a signed statement
(Section 65850.2 of the California Government Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits).
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 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes ❑ No
applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes",the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
CI?as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec.7044,Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made?. ❑Yes 0 No
thereon,and who does such work himself or herself or through his or her own
8. (If"yes", attach certificate of compliancefrom the appropriate air pollution
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of control officer). - ,
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). • information given above is correct. I agreeto comply with all state laws and
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH •
city ordinances regarding Hazardous Materials and Emissions. . • '
LICENSED CONTRACTORS to construct the project(Sec.7044, Business and
Professions Code: The contractors License Law does not apply to ari owner of Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contracta(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
❑ am exempt under sec. •
the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: 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
/1 q au 'id by Ihi- .ermit(u final inspection. r ./ .
11 L///tel/j_S JI
l(3/071tg]I And/or Authonzed Applicant Date
ty of Costa Mesa Bu, ing Division
{-a 77 Fair Drive, Costa Mesa, CA 92626
714-754-5273 / Fax 714-75
Cos a Mesa 714-754-4856
OWNER BUILDER VERIFICATION
Permit # €6g
Disclosures & Forms for Owner- Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the
property improvements specified at 1295 conatiAA%JEt)tt&- rot'['R- t' SA- CA- of-24,2.Za
We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you
aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the
Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of
each provision, signed, and returned this form to us at our official address indicated. An agent of the
owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting
authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
DIRECTIONS: Read and initial each statement below to signify you understand or verify this information.
ri1. I,understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-
uil er" building permit that erroneously implies that the property owner is providing his or her own labor and
a erial personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any
injuries sustained by an unlicensed person and his or her employees'while working on my property. My
homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder
and am aware of the limits of my insurance coverage for injuries to workers on my property.
2. •
.1 understand building permits are not required to be signed by property owners unless they are
onsible for the construction and are not hiring a licensed Contractor to assume this responsibility.
r3. I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand,that
y protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his
er name instead of my own.
4* 4. I understand Contractors are required by law to be licensed and bonded in California and to list their
I! - se numbers on permits and contracts. ,
A♦ .. I understand if I employ or otherwise engage any persons, other than California licensed Contractors,
-ti'. he total value of my construction is at least five hundred dollars ($500), including labor and materials,.I may
b- considered an "employer" under state and federal law.
•
6. I understand if I am considered an "employer" under state and federal law, I must register with the state
federal government, withhold payroll taxes, provide workers' compensation disability insurance, and
`$d
contribute to unemployment compensation for each "employee." I also understand my failure to abide by these
laws may subject me to serious financial risk.
as a 7, I understand under California Contractors' State License Law, an Owner-Builder who builds single-family
f•si.ential structures cannot legally build them with the intent to offer them for sale, unless all work is performed
by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of
the work is performed under contract with a licensed general building Contractor.
4 A §, (,understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable
fd. ony financial or personal injuries sustained by any subsequent owner(s) that result from any latent
construction defects in the workmanship or materials.
1 of 2
a - ... - ♦
.Y f l 9, I understand I may obtain more information regarding my obligations as an "employer" from the Internal
V
enue Service, the United States Small Business Administration, the California Department of Benefit
Payments, and the California Division of Industrial Accidents. I also understand I may contact the California
Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information
about licensed contractors.
' " 10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand
t at I am the party legally and financially responsible for proposed construction activity at the following address:
I1 . ♦ PsV',A 0 A, •• G A _. .
A I 1: I agree that, as the party legally and financially responsible for this:proposed construction activity, I will
1:d- by all applicable laws and requirements that govern Owner-Builders as well as employers.
/A 12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
ii •r -ation I have provided on this form. Licensed contractors are regulated by laws designed to protect the
. blic. If you contract with someone who does not have a license, the Contractors' State License Board may be
unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against
unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed
Contractor or employee of that individual or firm is injured while working on your property, you may be held
liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors, you will be resporisible
for verifying whether or not those Contractors are properly licensed and the status of their worke'rs'
compensation insurance coverage.
Before a building permit can be issued, this form must be completed and signed by the property owner
and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's
driver's license, form notarization, or other verification acceptable to the agency is required to be
presented when the permit is issued to verify he property owner's signature. /
Signature of property owner /f 1 42( Date: (/27/Z00
I
Note: The following Authorization Form is required to be completed by the property owner ly when.,:
designating an agent of the property owner to apply for a construction permit for the 0 er-Builder.
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNE BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is ersonal responsibility, I .1-!c,'
hereby authorize the following person(s) to act as my agent(s) to apply for, si; , and file the documents
necessary to obtain an Owner-Builder Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent: Tel No
Address of Authorized Agent:
I declare under penalty of perjury that I am e property owner for the address listed above and I personally filled
out the above information and certify it accuracy. Note:A copy of the owner's driver's license, form . ._
notarization, or other verification ac -ptable to the agency is required to be presented when the permit is issued
to verify the property owner's si.♦.ture.
Property Owner's Signat -: Date:
2 of 2
p00 bF
4 q CITY OF COSTA MESA
F ' �) BUILDING DIVISION PERMIT NUMBER
ol4,. DEVELOPMENT SERVICES DEPARTMENT
•
PERMIT B99-01910
..no
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 1283 CONWAY AV Status: ISSUED
Suite: Applied: 12/1/1999
Vicinity: HOUSE&ATTACHED GARAGE Issued: 12/1/1999
Parcel Number: 14115533 Zoning: R1 R1
Applicant: EATON, JEFF
Address: 260 E.ALTON AV ISSUED BY:
Phone: (714)557-7440
SANTA ANA, CA Zip: 92707
Owner: KALLAS, JAMES A TR
Address 2520 IRIS WAY
Phone:
LAGUNA BEACH,CA Zip: 92651" -
Contractor: "ROSS & BARROWS INC.
Address: 260 E.ALTON AV
Phone: (714)557-7440
SANTA ANA, CA •
Zip: 92707 - License: 327802
-
Arch : ' • Eng:
Address: Address:
- -Phone: Phone:
• Zip: License: License:
SCOPE OF PERMIT
REROOF EXISTING SINGLE FAMILY RESIDENCE&ATTACHED GARAGE(29 SO).TEAR OFF EXISTING COMPOSITION
SHINGLES WITH EXISTING SHEATHING TO REMAIN. INSTALL 1-LAYER OF 15#FELT UNDERLAYMENT&REROOF WITH
25 YEAR COMPOSITION SHINGLES.
FEE SUMMARY
Plan Check: ' $0.00 Calc Valuation: $3,594.00
Permit: $97.25 _ Claim Valuation: $3,594.00
SMIP Res: $0.50
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $97.75
• 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:
•
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord. No.92-28,§ 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
DECLARATIONS . �� i
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations: '
O 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.
XI 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:
T'' Fr-t vo PolicyNumber: 19 000
Carrier: 5 �G 6 70 2
(This section need not be completed if 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 shell forthwith
comply with these provisions.��J//////"///��
WARNIApplicNntG Signature: J� �t Date: I�' /— 5',
WARNING:FAILURE TO S))�E W ERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000) A DITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND 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.# ,r3 d (-'1 2 Class# C — 'j 5
Contractor's Signature: — ////f///�� Date: /2 — / — 9 5
4",
i
CONSTRUCTION LENDING AGEN Y: •
❑ 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.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. 0 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:
O 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,Califomia 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 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 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 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 0 No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 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 a plication appermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes U No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 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 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.
_ /"-r-lure Of Legal Owner(s) Date c
And/•i:uthorized Applicant Date
CODE I. INSPECTION TYPE DATE ' INTRIALS CODEC INSPECTION TYPE DATE INTITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof /2.`q-r 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
OWNER COLLEGE MESA COMPANY DATE 11-20-58 _
JOB ADDRESS 1283 Conway -Avenue BUILDING PERMIT NO. #8002
GENERAL CONTRACTOR The Hal e Company VALUE $ 12.890,00
AP. No. LOT 13 TRACT 2671 FIRE ZONE DESCRIPTION OF WORK Res. w/att. gar.
GROUP I at J TYPE V ZONE R1 PLAN NO.
INSPECTIONS DATE PERMITS ISSUED
SUBCONTRACTOR DATE NUMBER
Trenches Forms Steel .- IF 2A' 4 k
Floor System L✓R4 )i •sr_A-a'
Steel Reinforce Chimney Re-Rod _
Bond Beam ¢/J.iA n n `-5'1
Frame and Flashing r:iys'/z ]) ^J/ -3-31
Lathing, In Out fa.- ...E / -AA-- 5 J
Plaster, brown coat, L2 -fa, -.f7
Underground soil PP WIG Pipe Test l4 12-'f"ct
Top Out /2-6"-SS _
Furnace ,�V /---t-0-_64 cJwi. My1y -Yht-ca/ti.lt:1 -a-6-.5Q /6 y u_1---- /
Gas Vents z
Rough Plumbing 1.WI-Q-4 A' i'eir-P,0 ' UV 2 0 1958 1 Fi4M7
E
Cesspool Septic Tank _
Prop. Swr. "y,i4\ Hofer('Con. St. Swr. �rry��� f��— I IJ v.4-1 fl (›-5--5- �\
Sprinkling System - \\
I-IV g
i.
Heating Final � -/0-AV 1
Plumbing Fixtures, Final / {y A .14.-k0't/ V
Final Gas Test i EI/ 2-ie-tto
Construction Pole
Underground Power
Rough Wiring tL7 L. /r v? M. C. l-L-_-n-4-n_. /a -3o-J 77 q --c,
Fixtures, Final /2":4-. 9 G 3.y ��
OCCUPANCY ,L.W 7--initQ i v\
Form 210-5M-1-57 i
_- 8002 RECEIVED
COSTA MESA BUILDING DEPARTMENT I I I•
Is
P.O. BOX 317 FlC\ANC.,E„ DEPT.
COSTA MESA. CALIFORNIA CITY OF COSTA £ ESA '
' FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT
ADDRESS 1283 Conway Avenue BUILDING
COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY
RECEIPT NO. 68 2
OWNER COLLEGE MESA COMPANY c..�\/V��I
MAIL P. 0. Box 2277, Brookhurst Station RECEIVED BY DATE RECEJIVED DATE ISSUED
ADDRESS ,...o...._„7.2.2Z�- �,/—J�'I NOV 2 0 195
TEL. BUILDING -
CITY Anaheim NO. ICE 3-3161 ADDRESS
ARCHITECT Bulot, Quigley LIC.
OR ENGINEER and Clark NO. RE 7191 COSTA MESA. CALIFORNIA
ADDRESS 1102 W. 17th St. , Santa Ana FIRE
ZONE
ZONE NO.OF TYPE GROUP/ /�
CITY LIC. PLANS Y/ U(/\]/6,1/-
CONTRACTOR The Hale Company No. 7350 U'
ADDRESS 1777 W. Lincoln,Anahei. ICE 3-3161 BYPROVED DATE
LEGAL CORRECTIONS
DESCRIPTION NO 13 BLOCK TRACT 2671
Ilan #2-B
A.P.NO.
SIZE NO.OF SLOGS.
OF LOT 62 x 100 NOW ON LOT None
USE OF
EXISTING BLDG. -- 1
SETBACK LINE FROM
CENTER OF STREET 50' REAR YARD 33'
SIDE YARD RIGHT 6' LEFT 61
DESCRIPTION OF WORK
NEW X ALTERATION ADDITION
REPAIR ii
X101 JdaOrs DEMOLISH
li NO.OF
SIZE BUILDING 12531 - Liv. ROOMS 5 STORIES 1
EXTERIOR WALL ROOF
COVERING .StuCCO COVERING - Compo.
USE OF NEW
BUILDING Single dwelling w/attached garage
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 CONSTRUC-
TION_ COLLEGE MESA COMPANY VALUATION
SIGNATURE OFBCompany,y. The Hale Gen. •:rtnf r PERMIT FEE 830.00
PERMITTE
$ 12,890 PLAN CHECK $ 15.00
� Al � TOTAL FEE $4'S•00 „Brs
i
AurlHo-I �-xl
OWNER KINDIG, DON C. • DATE 5-6-59
JOB ADDRESS 1283 Conway Ave. BUILDING PERMIT NO. 9218
GENERAL CONTRACTOR Owner-Builder VALUE $ 260.00
AP. No. LOT 13 TRACT 2671 FIRE ZONE DESCRIPTION OF WORK Block Wall
INSPECTIONS DATE I GROUP TYPE ZONE R
Underground Soil U.G. Water PERMITS ISSUED
Underground Gas — SUBCONTRACTOR DATE NUMBER
Overhead Water and Gas
Rough Heating
Rough Plumbing
Miscellaneous
Prop. Swr. Line House Con. St. Swr.
Sprinkling System •
Heating, Final
Plumbing Fixtures
Final Gas Test
Construction Pole
Underground Power
Rough Wiring
Trenchesfl4 Forms Steel MA 5"r/3,SN
Floor System
Steel Reinforce Chimney Re-Rod
Bond Beam
Sheathing
Frame and Flashing
Lathing, In Out
Plaster, brown coat
Plumbing Fixtures, Final _
Electric Fixtures, Final
Building, Final '4t- ie
OCCUPANCY J '
Form 210-3M-4-59 9218
9218 FEE RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT -SI G /s1 V LL
P.O.BOX 317 COSTA MESA, CALIFORNIA FINANCE DEPT.
FOR APPLICANT TO F/LL /N COMPLETELY APPLICATION-"EORMPERMIT
TYPE OR PRINT BUILDING
BUILDING /J 7 /y
ADDRESS%2,c ��/Y(/44'Ff�Le.
j
COSTA
✓M•ES/A,, CALIFORNIA FOR OFF/CE USE ONLY
.QJE?G ea R 411 [ RECEIPT NO. PERM ./
1' OWNER X=2/1
MAIL /WY
��/ REC�EIVVED BY DATE b RECEIVED_fl I `DATE}75551,
' ADDRESS /.JCO�j EsCare,y 1✓� 67
CITY TEL. `may BUILDING
-Ii1A2.t/., EL:4_ .,�,Xg ADDRESS
ARCHITECT LID. +4COSTA4MESA, CALIFORNIA
'- OR ENGINEER illgt . � ZONE
FIRE type group
ADDRESSyo e#0 v.F,2� /✓!y(//'
STATE /7t?2f BBYPROVED DATE
CONTRACTOR // l�fA.0-- LIC. TE 6 J
ADDRESS L/0�c.-L' ,- ZONING
II LEGAL LOT ] 9-67/ LONE 0NO.OF USE OF NEW
, DESCRIPTION NO. ./../ BLOCK TRACT A 1 /(f/,024.PLANS I BUILDING - /
1
APPROVED / ,I DATE. icli-1�
w OIZEe/ /'//O• I NO. O BLYARDS EVES •
REQUIRED / ALLOWED
Tt OF LOT x NOWW ON LOT
OT
USE OF d./n (CENTER LINE ST.)
''. EXISTING BLDG. /r tel/ ��-• _b FRONT n FT. IN.
SETBACK LINE FROM / / //
' CENTER OF STREET '.5Q -IL' REAR YARD C R.SIDE FT. 0 IN.
I '/ 0
SIDE YARD LEFT [) RIGHT e PL.SIDE FT. IN.
DESCRIPTION OF WORK
REAR ----7- FT. IN.
n NEW I ALTERATION II ADDITION -- '... _
REPAIR I II MOVING II DEMOLISH A.pipp '1 p
BUILDING NO.
SIZEROOMS.OFOF STORIES CITY OF COSTA MESA
• EXTERIOR WALL ROOF PLANNING DEPT.
c COVERING COVERING ciLLJJZCI Tu :LUG. Lcr'T. NEG.' USE OF BUILDING AND WORK TO BE PERFORMED -
4Z'nit, 7,0 ( it, BY ?4'i <Lr,.- DATE S--E_SN
6/ /!t PLAN TECH.
JEr
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONSTRUCTION. VALUATION
SIGNATURE OF slat/6;0 RPERMIT FEE $
PERMITTEE
$ ,.,'/{/� ✓4' PLAN CHECK $
-. AUTHORIZED AGENT `'
TOTAL FEE $ _�
•
APR 9 1962
OWNER UNDID, DONALD C. _ DATE 10-23-61
JOB ADDRESS 1_283 C_o_n lay Aye BUILDING PERMIT NO...15703
GENERAL CONTRACTOR Amer VALUES 300.00
AP No. 113-271-211 LOT TRACT FIRE ZONE DESCRIPTION OF WORK Add £rplc.to r€
INSPECTIONS Signature DATE GROUP TYPE ZONE R-1
Soil PERMITS ISSUED
Gas SUBCONTRACTOR DATE NUMBER
Water
Rough Corn. Refrig. ❑ Air Cond. D
Rough Heating
Rough Plumbing
Miscellaneous
Prop.Swr.Line 0 House Con. ❑ St.Swr. ❑
Sprinkling System
Construction Pole _
Underground 0 Power ❑
Rough Wiring
Trenches Forms 0 Steel Reinf. 459 AL3-6/
Floor System
Bond Beam ❑ Steel Reinforce 0 _ QQ`'�
Sheathing
Frame and Flashing
Lathing — In ❑ Out 0
Plaster, brown coat
Refrig. 0 Air Cond. 0 Final
Heating, Final
Plumbing Fixtures, Final
Final Gas Test
Electric Fixtures, Final
Building, Final 4. -(2_•-4,
OCCUPANCY
FORM BU4•5M - 7.61 1,(U3
•
FEE RECEIVED
_ 1570y VOCT23l^.31
COSTA MESA BUILDING-SAFETY DEPARTMENT 'FINANCE DEPT.
P. 0. BOX 917 COSTA MESA. CALIFORNIA
CITY OF COSTA MESA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
ADTTYPE OR PRINT [7 BUILDING
DRESS /2 93 C#4,w9 /7
/ Ws
COSTA MESA. CALIFORNIA For Office Use Only
AA/407 C. / / /' I RECEIPT NO. I Ira '3 OWNER 6Al /N(/_//�1 /,J / I J
MAIL /'�TT �j / RECEIVED BY DATE RECEIVED DATE ISSUEQ-
ADDRESS /2Y .� C-o/✓VI//9y ffv�t ft_ i0 -7.3 "t'j Jo -7.3 1
cITY a-03erl9 AlE5-4r / N0`<(/Sv.Tzz BUILDING V �j
ADDRESS l 7 j� 3 C01A,WaM V Q 11.
ARCHITECT ` TEL. COSTA MESA. CALIFOA
OR ENGINEER -S.9A'lt NO.
ADDRESS FIRE
/J ZONE TYPE A G OUP ///)))/
CONTRACTOR (14/M APPROVED __w%� ATE/Oy�(J )
ADDRESS '(� �NIgNINN D^ �f. eich�
CITY It
Z0f, I NO.OF���•. USE NEW
./ ( PLANE BUILDING e
STATEIC.NO. TEL. DEGAR .1 /3 tie
LIC. �/"� NO. LEGAL
Lv 9C •:).-0,; r
OF LOT �Q O'x !➢2,So I
NOW ON B OTB I . A.P.NO. I r 3 - /' /— a
USE OF YARDS EVES
EXISTING BLDG. APPROVED ALLOWED
SETBACK LINE FROM / 1/ (CENTER LINE BT.)
CENTER OF STREET ,�O REAR YARD FRONT FT. IN.
SIDE YARD I LEFT y I RIGHT 4 R.SIDE I.ig 7:7 .97 IN.
DESCRIPTION OF WORKII
L.SIDE ^ 3 FT. I / IN.
NEW I II ALTERATION I II ADDITION I '
x REAR P f FT.
1N./
II MOVING II DEMOLISH I APPROVED (A / A� DATE �b ->
REPAIRI /I��/, 0....--
��
BUILDING $0. OF /
fB` J
SIZE ROOMS O STORIES I PP
EXTERIOR WAL yy ROOF &P
COVERING p/4S/EN COVERING a1 9.
USE OF BUILDING AND WORK TO BE PERFORMED
watt C.osT SBA •/n y ,Onix.
I HEREBY ACKNOWLEDGE THAT I HAVE REA/THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS POR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE4LATING
BUILDING CONSION. VALUATION OD
SIGNATURE OF /,0 PERMIT FEE $ 7 i D
PERMITTEF V--'L¢( ppI
S 3./H U do PLAN CHECK $ __ %
AUTHORIZED AGENT 1. 1! D�' o
.. ..> c. TOTAL FEE - _ y