HomeMy WebLinkAbout165 COSTA MESA ST - Building Permitsf N
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CITY OF COSTA MESA
BUILDING DIVISION
F77 FAIR DRIVE, COSTA MESA, CA 92626 - (714) 754.5273 - Fax (714) 754-4856 • w .ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER: B09-00030
PERMIT TYPE B_ROOF2 STATUS: ISSUED
APN: 42603123 DATE ISSUED: 02/20/2009
ISSUED BY:
JOB ADDRESS: 165 COSTA MESA ST CM Suite/Unit:
Vicinity: RESIDENCE AND DETACHED GARAGE
Squares: 1700 Valuation: $4,000.00
SCOPE OF WORK: REROOF RESIDENCE AND DETACHED GARAGE: TIO EXISTING COMP ROOF, REPAIR/REPLACE SHTG AS NEEDED,
1 LAYER 30# FELT, APPLY '40 -YEAR ELK GAF SHINGLES.- PITCH 4.5:12 RES 12.5 SQUARES, GARAGE 4.5
SQUARES
OWNER: PARISE, NANCY JORDENING
PHONE:
APPLICANT: BRANNON, TOM -
PHONE: 714-897-8147
CONTRACTOR: BRANNONS ROOFING
Address: 4400 PARK NEWPORTUnit:
City/State/Zip: NEWPORT BEACH, CA 92660
ARCHITECT:
ENGINEER:
FEE SUMMARY
Reroof Plan Check:.
$0.00
Reroof Permit Fee:
$97.25
Reinspection Fee:
$0.00
Bldg Std Admin Fund
$1.00
TOTAL FEES $98.25
.Address: 4707 POLO VIEW DR Unit:
City/Stale/Zip: BAKERSFIELD, CA
Address: 15161 LAFAYETTE ST Unit:
City/State/Zip: WESTMINSTER, CA
License No, 609940
PHONE: 714-897.8147'
CELL:
License No.
License No.
PHONE: .
PHONE:
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 vrill result
in the expiration of this permit.
CODE r• Ixsvrcnow Trrr: prig INTmaLS CODE IRSKCnoM lrrE
DATE IxTMAS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof—�'-N`-t 210 Final Electrical
201 Final elock/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demlition 250 Final Building/Occupancy
f
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 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:9�
Carrier. \\ �j
(this anion need, naEa wmp^1bteOemN B value]tl a1 me nunEretl OWars (5100) len)
n.)
Policy Number: 1—JC2Op/l�ejro7l—Cp7Z0%
❑ 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 Lab e, I shall forthwith comply with these proviV n �/�
Applicara's Sicnature o� Date >
i
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($700,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3705 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/aQ)d effect. 7
Lic.-#
4,1 lam' �V Class #, J
`.- (0
Coatracta's Signature Date )
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).
Lender's Name:
Lender's Address:
Sigwtum Date
OWNER -BUILDER DECLARATIONS:
1 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
❑ 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 conimctor(s) license pursuant to the Contractors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
3057A613107)
Owner ID verified by driAnse. ❑ Yes ❑ No f
Driver's License No. Expires:
Verification of Ownership by (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: • '
❑ I hereby certify that no excavation five (5) or more feet in depth into which a
person is required to descend, will be made in connection with work authorized
by this permit, and that no building structure. scaffolding, falsework, a demolition
or dismantling thereof, will be more than thirty-six (36) feel high. (Chap. 3.2. Grp
2, An 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.
Appliranfs Signature Dale
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 might of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
temperature and pressure).
3. Does of 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 is presently required, has Section 25534 of the California
Health and Safety Code been fully complied with? ❑ Yes ❑ No
S. Does m will the applicant or present or future building occupant require for
the work which is the subject of this application 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 ❑ No
(Section 65850.2 of the California Government Code requires that the requested
information be furnished on applications for ncr1-residential building permits).
6. Will any part of the facility to be Constructed under this permit be within
1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
(if "yes". the facility must meet the requirement of Sections 25534 and 42303
of the California Health and Safety Code).
7. If a permit from the South Coast Air Quality Management District or other
air pollution control district or agency is required for the work which is the
subject of this application, have all of the disclosures prescribed by California
Health and Safety Code Section 42303 been made? ❑ Yes ❑ 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.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penally 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 undl final inspection. .
Ancor Autnonzed AppiCent �Da1
PROJECT AITONESS: 165 COSTA MESA ST UNIT:
16 OWNER(`NAME: BODENHOEFER WILLIAM
ADDRESS: 165 COSTA MtSA ST
COSTA MESA,CA 92627
6455165
ARCHIENGINEER: REG.NO.:
ADDRESS: UNIT:
PERMITTEE: TOM'S CONSTRUCTION CO. (714)894-9524
ADDRESS: 14722 JEFFERSON ST
MIDWAY CITY CA 92655
LICENSED CONTRACTOR 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 eUecl.
CITY UC.: 5�5••J9�83 TATE Lic.: 576679/ uss:
Date: ' !ti/ZZ - Signature: —
WORKERS' COMPENSATION! DECLARATION: I hereby affirm that I have a certificate consent to self -insure or a certificate of Workers'
Compensation Insurance. or a certdied corny thereof (Section 3800, Lab. Q.
POLICY NO.: EXP. DATE:
COMPANY:
❑ Codified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division,
Gate: ApplicanC
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This section need not be completed it the permit is for one h ndred ($100) or less).
I penny that in the p rformance the work for which this permit is la I empl an erson in any �oer so as 1 ome
subject to t e rs'�mpon Laws ofCalifornia/7
Date: yygnat/—/
ROTI If, alter m nil this declaration, you should
d become subject to the Compensation provisions of the Labor
Code. you must to hwith comply with such provisions or this permit shall bea 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, Car. C).
LENDER:
ADDRESS:
OWNER BUILDER DECLARATION: I hereby affirm that 1 am exempt from the Contractors' State License Law for the following reason
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, improve. demolish, or
repair any structure. prior to is issuance. also requires the applicant for such permit to file a signed statement that he/she is licensed
pursuant to the provisions of the ContractorsSlate License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or that he/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 (ESOO1.
I. as owner of the property or my empDloyees with wages as their sole compensation, will do the work, and the
E) structure is not intended or offered for sale(Seclion 7044, Business and Professional Cade: The Contractors' State License Law
does not apply to an owner of a properly who builds or improves thereon, and who does such work himselflherself or through
his or her own employees, provided that such improvements are not intended or offered for sale. II, however the building or
improvement is sold within one year of completion. the owner will have the burden of proving he/she aid not build or improve
for the purpose of sale).
I. as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business
❑ and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon
and who conlracls for such projects with a contractors) license pursuant to the Contractors' Stale License Law). I am aware
that proof of (heir Worker's Compensation insurance shouts be provided to me.
❑ I am exempt under Section: B. 8 P. C.
for this reason:
nno
Owner:
I do hereby cemfy that I am aware of and understand the requirements of California Health and Safety Code Sections 25505, 25533, and
25534 and that I or any future building Occupant wilUwill not (circle one) need to comply with said state codes and the requirements tar a
permit for construction or modification from the Air Duality Management District. Residential construction applications are exempt from
these provisions.
Date: Applicant:
I hereby certify that I have read this application and state that the above information is correct. i agree to comply with all city and county
ordinances and State laws relating to building construction and hereby authorue re esentatives of this city to enter pon the above.mentionetl
progeny I - spection pur eses. s
Date: �` Signature:
Driver's License or Social Security p:
164146 White—Building: Green—Code Enforcement: Canary—Applicant; Pink—Revenue; Goldenrod—Assessor
CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 05/0/1
PERMIT NO: B 057070 PLAN CHECK NO: N GOVT: N SUPP: N
CONSTRUCTION TYPE: V -N PERMIT TYPE: STR PURPOSE: ALT
JOB DESCRIPTION : T/OFF REROOF W/ COMP SQ FT: 2,300
CLAIM VALUE: 2,300.00 CALC-VALUE: 2,300,00 GROUP OCC: R-3 /
COMMENTS: T/OFF REROOF W/ COMP
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ACCESSORY BUILDING---------
FRNT:
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REAR:
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FRNT:
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APPLICATION ISSUED BY:
LEGALIZATION:N F E E F
BLDG PMT PLUMBING ELEC IC
PERMIT 54.00
PLAN
ISSUE FEE
BUILDING—DIV—>
TOTALS ---- >
DATE:
DATE:
I
DATE
**##****##******#***#*#*************##*
M M A R Y STRUCTURAL SEGMENT:Y
MECHANIC FIRE SMIP/RES GRADING
.50
SMIP/NON—RES
PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
54,50 0,00 0,00 54.50 54.50 .00
REVENUE DIVISION TOTALS--> COLLECTED:
54,50 OVER/SHORT:
,00
BLDG PMT
PLUMBING ELECTRIC MECHANIC
FIRE SMIP/TOT GRADING
PLAN—CHECK
54.00
,50
I N D I V I D U A L F E E
B R E A K D O W N
TYPE QTY
D E S C R I P T I O N
UNIT COST
TOTAL COST
SFR 2300
REROOF BY VALUE RESIDENTIAL
NOZONE 1.00
2,300.00
END OF FEES
--'CONSTRUCTION AND PLANNING
Date
APPROVALS Permit #
Inspector
POOL PA
APPROVALS Permit #
Date
Inspector
1. Temporary.Electrical ServiceorPole
52. Pool & Equipment Location
/ r
�. Soil Pipe-Undrgrnd.
53. Steel Reinforcement
3. Elect,ical Conduit Utility-Undtgrnd.
54. Forms '
4. Electiical Conduit-Undrgrnd.
55. Electrical Bonding
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
6- Electrical LIFER Grnd.
57, APPROVAL TO COVE R-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
8. Foundation
59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe•Undrgrnd.
f
60. Backwash Lines, P -Trap, 0 Undrgrnd.
10. Structural Floor System
i
61. APPROVAL TO DECK
11. Property Sewer Line & House gonnection
62. Backwash & Receptor -Final
{
12. Sewer Cap
' r
i
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. POOL/SPA 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 0Gas 00il
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank 0 Gas 0 Oil
25. Roof Sheathing
74. Overhead Hydro
26. T -Bar Ceiling (Structural) & Monocoat
75. Dry Chemical
27. Frame and Flashing
76. Dry Standpipe
28. Lathing & Siding
77. FIXED SYSTEM FINAL
29. Insulation
!
78. FIRE PREV. FINAL
30. Drywall Nailing
HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat
79. FINAL INSPECTION
32. Electrical Power Meter -Final
80, FOOD CERTIFICATE ISSUED
33. Final Electric
Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe -Test
36. Hood or Canopy
37. Final Factory Fireplace
.
38. Final Plumbing
39. Water Service -Final
40. Gas Service -Final
41. Solar Domestic -Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
CITY Of COSTA MESA
CALIFORNIA 92628.1200 P. O. BOX 1200
DEVELOPMENT SERVICES DEPARTMENT
January 1, 1990
TO COMPANIES & CONTRACTORS WHO RENOVATE OR
DEMOLISH BUILDINGS THAT MAY CONTAIN ASBESTOS
Rule 1403 -
Recently the South Coast Au Quality Management District adopted Rule 1403 -
Asbestos Emissions from Demolition/Renovation Activities. It became effective
January 1,'1990.
This rule specifies work practice requirements for demolition and renovation
activities and the associated disturbance of asbestos -containing waste material.
Demolition or renovation operators must meet the following requirements:
G notification
o removal techniques for asbestos -containing material
o clean-up procedures, and
0 waste storage and disposal requirement.
Failure to comp➢y with the provisions of this rule may result in it
penalty of up to 525,000 per day.
Enclosed are copies of a fact sheet, which describes the major features of Rule 1403,
the Notification form, and the Notification form instruction sheet.
Should you have any questions, please call AQMD staff at (818) 572-6283.
I hereby acknowledge I have read the above.
DAT SI ATURE
PROJECT ADDRESS: 165 COSTA MESA ST UNIT:
OWNERS NAME: BODENHOEFER WILLIAM
Z A)kTRESS: 165 COSTA MkSA ST
COSTA MESA,CA 92627
6455165
ARCH/ENGINEER: REG.NO.:
ADDRESS: UNIT:
PERMITTEE: TOM'S CONSTRUCTION CO, (714)894-9524
ADDRESS: 14722 JEFFERSON ST
MIDWAY CITY CA 92655
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 01 the Business and Professions Code. and my license is in fuH force and effect.
CITY LIC.: 0 83,PATE uc.:57IS.
Date: �� Signature:
WORKERS' MPENSANDECLARATION: I hereby affirm that l have a certificat consent to sell- insure or a cetlificate of Workers'
Compensation Insuranc or a certified copy thereof (Section 3800, Lab. Q.
POLICY NO.: EXP. DATE:
COMPANY:
,:. ❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division.
�_, I
Date: Applicant:
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This section need not be completed if the permitis for one hunpred ($100) or ass),
cenify tial in the pe rmant I the werk for which this permit is issued, shall not employ any person inn any n 4�r so as 1 me
subject to the W r s' Co ensalien Laws of California.
Date: Signature:
NOTIC O, aft¢ making I declaration. you should become subject to the Wor Compensation provisions of the Labor
Cotle, you must forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENOING AGENCY: 1 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:
ADDRESS:
OWNER BUILDER DECLARATION: I hereby allirm that I am exempt from the Contractors' State License Law for the following reason
(Section 7031.5 Business and Professional Code: Any city of county wWon requires a permit to construct, alter, improve, demolish, or
repair any structure. prim to its issuance. also requires the applicant for such permit to file a signed statement that he/she is licensed
pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or that he/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 (3500).
I,as Owner of the property or my Con even with wages as their sole Compensation, will do the work, ane the
1-1atnlcture is not intended or offered for sale(Mion 7044, Business and Professional Code: The Contractors* Stale License Law
does not apply to an Owner of a property who builds or improves thereon, and who does such work hirnselflhersell or through
his Or her own employees, provided that such improvements are not intended or offered for sale. It, however the building or
improvement is sold within one year of completion, the owner will have the burden of proving he/she did not build or improve
for the purpose of sale).
1. as owner of the property. am exclusively contracting with licensed contractors m construct the project (Section 7044, Business
❑ and Professions Code: The Contractors' Slate License Law does not apply to an owner of groperry who bolds car improves thereon
and who contracts ler such projects with a contractor(s) license pursuant to the Contractors' State License Law). I am aware
that proof of their Worker's Compensation insurance should be provided to me.
❑ I am exempt under Section: B. 8 P. C.
for this reason:
Date'. Owner:
I do hereby cenify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505, 25533, and
25534 and that I or any lulure building occupant will/will not (circle one) need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Duality Management District. Residential construction applications are exempt from
these provisions,
Date: Applicant:
I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county
ordinances and state laws relatlp o bpilding construction and hereby authorize representatives of this city to on don the ab entioned
Properly for inspe ion purp s.
Dale: Signature'.
Driver's t ense or Social Security 0:
1641-46 White—BwldinO: Green—Code Enforcement: Canary—AOphrant: Pink—Revenue: Goldenrod—Assessor
CITY OF COSTA MESA — BUILDING PERMIT PERM NO;
PERMIT NO: B 057071 PLAN CHECK NO: N i': UPP: N
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: ALT
JOB DESCRIPTION T/OFF REROOF W/ COMP SQ FT: '700
CLAIM VALUE; 700,00 CALL—VALUE; 700.00 GROUP OCC: R-3 /
COMMENTS: GARAGE ONLY REF PMT #57070—DWELLING
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Z O N I N G S E T B A C K S R E Q U I R E M E N T S
------------ MAIN BUILDING
----------
---------
ACCESSORY BUILDING---------
FRNT; FT IN
REAR:
FT IN
FRNT:
FT
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LEFT: FT IN
RGHT;
FT IN
LEFT:
FT
IN RGHT; FT IN
PARKING REQ:
PROV:
PARCEL;
42603123
ZNE;
REF NO:
PLANNING NOTES>
19.50 OVER/SHORT:00
BLDG PMT
PLUMBING
ELECTRIC MECHANIC
FIRE SMIP/TUT GRADING
PLAN—CHECK
19.00
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PERMIT 19.00
DATE:
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M M A R Y STRUCTURAL SEGMENT:Y
MECHANIC FIRE SMIP/RES GRADING
.50
SMIP/NON—RES
PLAN
ISSUE FEE
BUILDING—DIV—>
PERMIT
ISSUE PLAN—CHECK
TOTAL PAID
DUE
TOTALS ---- >
19.50
0,00 0.00
19.50 19.50
.00
REVENUE DIVISION TOTALS--> COLLECTED:
19.50 OVER/SHORT:00
BLDG PMT
PLUMBING
ELECTRIC MECHANIC
FIRE SMIP/TUT GRADING
PLAN—CHECK
19.00
,50
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I N D I
V I D U A L F E E
B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 700 REROOF BY VALUE RESIDENTIAL NOZONE 1.00 '700.00
END OF FEES
DATE; 0;, .'t ',"± Till-: `: ,,
,bONSTRUCTION AND PLANNING
APPROVALS Permit #
Date
Inspector
POOL & SPA
APPROVALS Permit #
Date
Inspector
t.y"emporary ElectricalServiceoF Pole
52. Pool & 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
56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd.
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
8. Foundation
59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P -Trap, 0 Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK
11. Property Sewer Line & House Connection
62. Backwash & Receptor -Final
c
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 �`r
"
67. Fencing & Access Approval
17. Rough Wiring Sign -
68. APPROVED FOR PLASTERING
18. Rough Electrical -T Bar Ceiling
69. POOL/SPA 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 0Gas 000
23. Gas Pipe -Rough & Test
72, Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank O Gas 0 Oil
25. Roof Sheathing
74. Overhead Hydro
26. T -Bar Ceiling (Structural) & Monocoat
75. Dry Chemical
27. Frame and Flashing
76. Dry Standpipe
28. Lathing & Siding
77. FIXED SYSTEM FINAL
29. Insulation
78. FIRE PREY. FINAL
30. Drywall Nailing
HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat
t
79. FINAL INSPECTION
32. Electrical Power Meter -Final
i
80.. FOOD CERTIFICATE ISSUED
33. Final Electric
Notes:
34, Final Heating & Air Conditioning
t
35. Final Gas Pipe -Test
1
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39- Water Service -Final
40. Gas Service -Final
41. Solar Domestic -Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irriqation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING
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6 [
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
OWNER BODENHOEFER, JAC013 DATE 7-10-61
JOB ADDRESS 165 Costa Mesa St" BUILDING PERMIT NO. 1 M3,311
GENERAL CONTRACTOR 06moa VALUE S l_f1M M
AP. No. 11 A-051-18 LOT TRACT FIRE ZONE DESCRIPTION OF WORK Rel nn „gaR (mrn.a
INSPECTIONS I DATE I GROUP J TYPE V ZONE a -I,
U^nergrouna aou U.u. water
aground Gas
SUBCONTRACTOR PERMITS ISSUED
DATE NUMBER
-G..shead 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-
r
Rough Wiring
t
Trenches Forms Steel
—
Floor System
Steel Reinforce Chimney Re -Rod
Bond Ream
/
Sheathing
Frame and Flashing
I,:ring. In Out
— - -
7�,-i4+.er, brown coat
Pil&bing Fixtures, Final
Electric Fixtures, Final v
Building, Final 6 - -
OCCUPANCY 16 7 —Ci
d
Form 210-5M-11-59 5-B P 1L{833
COSTA MESA BUILDING -SAFETY DEPARTMENT
P. O. BOX 917 COSTA MESA. CALIFORNIA
For Applicant to Fill In Completely
TYPE OR PRINT
FEE RECEIVED,
�i JUL 101961
FINANCE DEPT.
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
COSTA MESA, CALIFORNIA ' For Office Use Only
r
RBCEI" NO.
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ERM T
OWNER C � c
MAIL/�
RHC81V80 BY
ATE RECEIVED
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ADDRESS 2'D
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ADDRESS
ARCHITECT TEL.
- COSTA MESA. CALIFORNIA
OR ENGINEER NO.
FIRE
ADDRESS
ZONE
TYPE GROUP
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APPRO
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BY
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ZONING
ADDRESS
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NO. OF j
USE OP NEW 7__P)
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STATE TEL.
LEGAL
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LIC. NO. NO.
DESCRIPTION
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SIZE �1 /,S/t3ii'
OF LOT L
NOW ON Ldf
A. P. NO.
OF C
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EXILIS
EXISTING BLDG.
APPROVED
ALLOWED
SETBACK LIN(CeNTMR
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FRONT
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DESCRIPTION OF WORK
L. SIDE
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NEW I ALTERATION I I ADDITION I
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IN.
REPAIR I (MOVING Ix (DEMOLISH I
PROVE\,
ABY.rl.l
ilv\DATE
L%J
BUILDINGNO. OF
SIZE 2-0 ROOMS STORIES
EXTERIOR WALLROOF
ICOVERING
COVERING
USE OF B ILDING AND WORK TO BE RF RMED
F C
O
1 HER 88Y ACKNOWLEDGE THAT I HAVE READ THIS APPLIWTION
THE AMOUNT BROWN UNDER VALUATION IB FOR THE
AND STATE THAT THE ABOVE IB CORRECT AND AGREE TO COM-
PUR OS8 OF
ESTABLISHING A PERMIT
FEE ONLY.
PLV WITH ALL CITY ORDINANCES AND STATS LAWS REGULATING
VALUATION
BUILDING CONBTRU ON.
SIGNATURE OP /�
PERMIT FEE $
6• Rp
PERMITTE
$ Y �_j-(9
-PLAC� ��
NK HECK S
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AUTHORIZED AGENT
TOTAL FEE
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OWNER RODENHOEM T " DATE 7-10-71
JOB ADDRESS 165 Costa Mesa Street BUILDING PERMIT NO. l i817
GENERAL CONTRACTOR Owner VALUE $ 3-500.00
AP. No. 118-051-18 LOT TRACT FIRE ZONE DESCRIPTION OF WORK RPl nr rail
INSPECTIONS /,� -I DATE I GROUP j TYPE V ZONE R-1,
—rr
-frgruuuu auu •/, y,/u.V. water
'i', `'"'ssrground Gases
ai -.,
/-{w.riL
//
SUBCONTRACTOR
PERMITS ISSUED
DATE NUMBER
O 'rhead Water and Gas
Rough Heating
tz, .1/
C
^6f
Rough Plumbing
iii
-6 I
Miscellaneous
Prop. Swr. Line House Con. SkI
4%W
L
Sprinkling System
40,'
Heating, Final
/.t/ _ ,./
Plumbing Fixtures / _
ii/ ✓'_C
Final Gas Test 5 ,G-
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Construction Pole - '
Underground Power
Rough Wiring
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Trenches ✓Forms Steel
�-
1
Floor System
R -
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G f
Steel Reinforce Chimney Re -Rod
1 yl
Bond Beam
Sheathing
Frame and Flashing
Ita„>';yng, In Out
'r""er, brown coat
Plumbing Fixtures, Final
�.�� !i !; ,f'i
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Electric Fixtures, Final
Building, Final
_ a-/ ,
cam:
OCCUPANCY
Form 410-5M-11-59 5-B P 14832
- FEE RECEIVED
't.*s JL4832 JUL 101361 !{Gc15E
,COSTA MESA BUILDING -SAFETY DEPARTMENT FINANCE DEPT.
P. O. BOX 917 COSTA MESA. CALIFORNIA CITY OF COSTA MESA
For Applicant to Fill In CompletelyI APPLICATION FOR PERMIT
TYPE OR PRINT f BUILDING
COSTA MESA CALIFORNIA ' For Office Use Only
N
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RECEIPT NO.
PERMIT tJ0^
OWNER • '�
MAIL
I
7VY
OTE RECEIVED
DATE ISSUE D
ADDRESSnn
}- TEL
BUILDING
CITY ! NO
ADDRESS
ARCHITECT TEL.
COSTA MESA. CALIFORNIA
OR ENGINEER NO.
FIRE
q
ADDRESS
ZONE
TYPE GROUP YI
CONTRACTOR
APPROVEJV
BY
DATE
IZ
ZONING
ADDRESS
CITY
ZONE
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NG.OP
PLANE
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I BUILDI �
STATE TEL. -
LEGAL Ir T'
LIC. NO. NO.
DESCRIPTION
PC/C. LorSIZE
OF LOT IS / ��
HO. OP SLDOS.
NOW ON LOT
A. P. NO.
,/ �/ 1. C
a� J
USE OF L..
YARDS
EVES
EXISTING S DG
APPROVED
ALLOWED
IIKTDACCHNTERKO OFNSTRlETM ' / REAR YARD
IGEHTER LINE
FRONT
1 FT. �.AL , 3C� IQ,
�% V1
IN.
ILEFT
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SIDE YARD
ft. HIDE
FT. '—
IN.
DESCRIPTION OF WORK
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L. SIDE
. FT.
IN.
NEW I II ALTERATION I II ADDITION I
REAR
f �
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IN/.
REPAIR I II MOVING Ix II DEMOLISH I
APPROVEBY
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BUILDING / A / O.
y
SIZE _ ROOMS STORIES
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EXTERIOR WALL (COVERING
COVERING COVERING
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T,(
`
2.
USE OF BUILDING AND WORK TO BE PERFORMED
. E OCR o YF USF
1HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
THE AMOUNT SHOWN UNDER VALUATION 18 FOR THE
AND STATE THAT THE ABOVE IB CORRECT AND AGREE TO COM.
PURPOSE
OF EBTABLISHINO A PERMIT
PEE ONLY.
PLY WITHALL CITY ORDINANCES AND STATE LAWS REGULATING
VALUATION
Rp
BUILDING CONSTRUCTION. '
/
SIGNATURE OF /j,G.t
PERMIT FEE $
j � _L`(i� Y^
PERMITTE
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PL CHECK $
AUTHORIZED AGENT
TOTAL FEE
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