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Home My WebLink About186 COSTA MESA ST - Building Permits Pili r 4` a MF 9 • CITY OF COSTA MESA 666pp BUILDING DIVISION brl DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER rah j PERMIT B01-01898 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 186 COSTA MESA ST Status: ISSUED Suite: Applied: 12/03/2001 Vicinity: HOUSE&ATTACHED GARAGE Issued: 12/03/2001 Parcel Number: 42603209 Zoning: • Applicant: PATOCKA, NICOLE ISSUED BY: Address: 1653 SUPERIOR AVE Phone: (949)642-7222 COSTA MESA,CA ' - Zip: 92627 Owner: KNIGHT, PATRICIA W TR Address PO BOX 813 Phone: MENTONE,CA Zip: 92359 • Contractor: LEE ROOFING OF COSTA MESA Address: 1653 SUPERIOR AVE N Phone: (949)642-7222 COSTA MESA,CA Zip: 92627 License: 349686 Arch : Eng: Address: - Address: Phone: Phone: Zip: License: • License: SCOPE OF PERMIT REROOF EXISTING SINGLE FAMILY RESIDENCE&ATTACHED GARAGE(10 SO).TEAR OFF EXISTING SHINGLES, INSTALL 15#FELT UNDERLAYMENT,&REROOF WITH 25 YEAR COMPOSITION SHINGLES. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $2,500.00 Permit: $83.25 Claim Valuation: $2,500.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $83.75 . 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 24443-48(woo) r DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the -ork for which this permit is issued. 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' sation Insurance(mer antl pot y number are: Carrier: � � 'i'l� ✓ICO' I -Policy Number: 2a(/ ! G (This section need not be completed i/ the permit Is valued at one hundred dollars ($100) or less.) 1---- - ❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that If I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these provisions. �` Applicant Signature: �� : f ` r -Date: - a' V 3 - WARNING: FAILURE TO SECURE WORKERS' COMPENSA COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL PINES UP TO ONE HUNDRED THOUSAND 601 -1 -ARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am liced u r�grov l9 slo ? Chapter 9 (commencing with Section 7000) of Division 3 of the Business an Prof ssipns Code, and my license Is in full force and effect.60 8 'S rl � 9 Class N �� `7 Contractors Signal Cate: — 0 :5 J CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or Improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑ Yes ❑ 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: ❑ 1 hereby certify that no excavation live (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, talsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, California Administrative Code). ❑ As owner -builder, 1 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). ...................................................................................................................................................................................................................................................................................................................................................................... .............prey. t 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materiels? C] Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .........................-.................__......................_................_.... ....-._........................................ __............................ _...................................... ........ ...................................................................... ........ ........ __.............. _........... ___.............. _ 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No Rection 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 partment of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. .......................................................................................-.....................-....................................................................................................................................................................... ...... ... ............. I.......................................................................... 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 plication apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency! Byes 15 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ................................................................. ...................... ............ __.._........................................... _.._................ _.... _..... ....... ....................................... ...............I....................... ......... _...... ..........._................ _............ _........... _._... 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 ...........................................................................................-_............................................................................................................................................................................................................................................._........................... B (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. ( Signature .O�f Legal Owner(s)) -Z - GOale _U' Anci/Or.Authodzed Applicant + •Daate CODE t. INSPECTION TYPE gAjE ItIIMALS CODE# INSPECTION TYPE PATE IKTITLAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final_ %� O 208 Final Plumbing -. 200 Final Re -Root � 210 Final Electrical 201 Final Block/Retalning 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 %Applicant to 1111 In all spaces except those within heavy border linea and syn all appropriate declarations CITY OF COSTA MESA CONSTRUCTION PERMIT PERM N , TRACT NO. LOT NO. BL 7162 I C/ I';/F.:i I Psi Applicant's Mailing A rens Project Address I I• Q. Owners Name hone 5q TYPE OF CONSTRUCTION LJ NEW ❑ CONVERSION ❑ DEMOLISH DESCRIPTION OF WORK U ADD LJ ALTERATION LJ ❑ OTHER REPAIR ZONING REGULATIONS TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL LUMBING �Iv1ECHANICAL ❑ OTHER PROJECT DESCRIPTION SG. FT. OCCUPANCY CONSTRVCTION TYPE VALUATION $� ZONF - GRADINGCU.YDS. ACRES A. P. �W ZONE AddraA - --1 [ Arch/En . L&QG o� 9+3 8 Address PLNG. REF. BUILDING TO BUILDING REAR YARD (TO P/L) PROPERTY 0..CJ...�a.c� �T`a-QQt'.� Jr �-3 �-g r N � COptra<tdOne - LEFT SIDE YARD RIGHT SIDE YARD r I' /1 Address ln.: l'nnl nWn. A AiYYl��— -4. 14 License No. 0_ 11R-1� FYI PKG.SPACE REG. PROVIDED LICENSED CONTRACTOR DECLARATION Remarks: STREET WIDTH PARK FEES I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and .SPECIAL CONDITIONS: ' my license Is In full force an fact. LicenSo License PLUMBING h Signature - ID1on0N.�R "'ORKERS' COMPENSATION DECLARATION veby affirm that 1 have a Certificate of consent to self -Insure or a Certificate Workers' Compensation Insurance, or a cert4ged copy thereof (Section J800, Lab. C.) �() 1 (J Policy No, l Y� Company.Cooking ❑Ler tilled copy is hereby furnished. Certifletl op s filed with the city Buildlpg Dlbydlilon,sr � Date Applicant "• XLlon X" A Bar Sink Sewer Cap - - ELECTRICAL — — Backflow Preventer Sewer Connection - Automatic Washer ry Meter over 100 amps .- Backflow Irrigation Solar_ Collector$ Construction Pole Sub Panes Bathtubs Soler Piping Unit ' . $cab Pole Clarifiers Solar Tank Dish Washer Motors ❑0.1 HP ❑1114$ EXEMPTIO�M WORKERS' COMPENSATION DECLARATIONDryers (This section need not be completed If the permit Is for one hundred ($100) or less). less) that In the performance of the work for which this permit Is Issued I Dishwasher Swimming Pool w/$pa ❑Gas ❑Electric Inc.$olar ❑9-15 HP ❑i6-15+ - Drinking Fountains I Urinal Fen Microwave FIOOr Drains - Water Closet f F.A.U. Pole Light shall not employ any person in any manner so as to become subject.to the Workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration, you should become subject to the - Floor Sinks - Water Heater - Fixtures Range Workers' Compensation provisions of the Labor Code, you must forthwith comply with, such provisions or this Permit shall be deemed revoked. Gas Service Outlets Water Service Device Boxes Sign, CONSTRUCTION LENDING AGENCY 1 hereby affirm that there Is a construction lending agency for the performance of the work fon which this permit Is Issuetl (Section 3097 Civ. C.) Lender's Name Interceptors — Outlets Standing Sections g Kitchen Sink Switches . Compactor Trashp Lender's Address OWNER. BUILDER DECLARATION I hereby affirm that I am exempt' from they 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 to its issuance, also requires the applicant for such permit to fila a signed statement that he/she Is licensed pursuant to the provisions of he Contractor's License Law (Chapter 9 (commencing with Section 7000) of vision 3 of the 'Business antl Protesslons Cotle) or that he//she is'exempt afrom and the basis for the alleged exemption: Any violation of Section 0A.5 by any applicant for a permit subjects the applicant to a civil nasty of not more than live hundred dollars ($500). Lavatories Garbage Disposal p—Trap - p _ Generates ❑D-5 KW ❑5-15 KW Roof Drains - Transformer ❑15.50 KW 05U + KW Reinspection Fee $15 Reinspection Fee $15 Showers spa Meter ❑up to 100 amps Issue Fee -$ 3 Service Sink Issue Foe $ 3 Zoning Approved By Date 1, '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 (Secilon 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 y sale. If, however, the building or Improvement Is sold within one year of <om- pletlon, the owner will have the burden of proving he/she did not build or Im- Frove for the purpose of sale). I, as owner of the property, am exclusively contracting'with licensed con- tractorsto construct the project (Section 7044, Business. and Professions Code: The Contractor's License Law sees not apply to an owner of property who builds or Improves thereon, and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's License Law):PLAN ❑ I -am exempt under Section B. & P. C. for this reason Application Approved By Date Application Issued By `�� Data ��/2'�`•--� MECHANICAL I Boiler .. Refrigeration System Duct = Under Grounrl ❑0.10D,000BTU ❑100,OODBTU BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ CHECK $ ELECTRICAL $ PLAN CHECK $ MECHANICAL $ PLAN CHECK $ � SUMMARY OF FEES SMIP PERMIT ,y�,}s.�f� SSUANCE •�C 1"'I^ 1 GRADING , 1 MICROFILM r� . L_ p 1. Tulcy TOTAL FEE LESS s ADVANCED PC FINAL FEE, , $ $ . $ $ $ $ ' I ' $Slgnat' $ O Duct -Structural System Repair/Alteration �e� Duct -Ventilating, Z' :.LN Q. Exhaust System ❑ Multiple ❑' Q Firepl/Fact. Bit. ICBO 516 Date Owner' and state-thatunty the above ,- P hereby certify that i have read this y with all Information is correct. I agree di comply with all city and county ordinances and state laws relating to building - construction, and hereby authorize repro- Inspe lves of . this .. ! to Doter upon the above-mentioned property for Inspection purposes. Date/ O (0 g, Drivers' j Drivers' Licansa orSE V Heating System & Ducting ❑0.100,000 BTU 0100,000 -- - Hood °r Type 1 ❑ Reinspection Fee $15 Reno T e II ❑ Registers Issue Fee $ 3 CMF 0865-46 rev. 12/82 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor TI. '? CONSTRUCTIONAND;PCAN ING _ •� - '- -{Inspector' x� .' :_' ..-POOL�tPA- �' •' /!1'`10 S -_. Dates D �•'.-APPROVALS Permit:# -APPROVALS_ Permit#, -Date Inspector n 'r �1Temporery,Electrical Ser0ce or, Pole t ," 152.' Pool &'Equipment Location " N2: Soil Pipe-Undrgrnds -- -e' -: t - ?i - 53:-SteelReinfotcement V 3: ElecBical Conduit Utilitv-Undrgrnd., � ; ".' -_ •54:, Forms - J 4: Electrical Conduit-Undrgrrid�_- �' - -" �9 E + 55. Electrical Bonding - - - 5: Steel Reinforcement- I !; ' 56.• Rough Plumbingessure Test B: Electrical UFER Grnd. '% = = = 57. APP.ROVALTO'COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrarnd. 8. Foundation _ ' i -'� ; - . -59. Gas Pipe,\0 Undrgrnd:; Test ; 9. Water Pipe-Undrgind. ... _ '60. Backwash Lines, P -Trap, 0 Undrgrnd. + 10. Structural•Floor System 61. APPROVAL,TO DECK - 11. Property Sewer Line ,& HouseConnection. v' 62. Backwash'& Receptor -Final 12. Sewer Cap 63. Heater &Vent -Final. _ 13. Roof 0rains 64. Plumbing System-= Final 14. Rough Plumbing: - - "65. Electrical Final ' 15: Rough'Electrical:Conduit') T r �- T - `;-(� -66.' Solar System -Final :-16.:Rough.Electric:Jj,Wiring •• �, _ _ 67. Fencing & Acce#'Approval 1i�17:•R6u6h Wirin'g'Sign'j 7: 68. APPROVED FOR.PLASTERING - 16: RoughElectriF&IlT Bar. Ceiling; ! 69., POOUSPA SYSTEMS FINAL 19.'Rough Heating &iAir;Conditioning 1 - FIRE DEPT. REQUIREMENT- - _ APPROVALS Permit # _ 20.'Wough Factory Fireplace I I "K 21Dur.{s, in Structure,, r' 70., Underground Hydro ,1,22. Ducts, Ventilating ' " ( 71. Product Piping 0 Gas 0 Oil X523. Gas`.Pipe-Rough & Test Llt II ( Y 72.' Underground Flush A'24. (Roof Framing I r= ' 11;- I• + I z t - 73.1 Undergrri.d. Storage Tank 0 Gas 0 Oil � , 25. Roof Sheathing I i 1 a 1, 74. Overhead Hydro - 26. T -Bar Ceiling (Structural) & Monocoat� ! • >; �- j , i 75. Dry Chemical - ,,_27, �Frarrje and Flashing r ( 76. Dry Standpipe 28. 11 Lathing & Siding 77.1 FIXED SYSTEM FINAL 29.;11nsulatior ;78. FIRE PREV. FINAL 30. Diywall Nailing ( I Notes: 31. Plaster Brown Coat 32. Electrical'Power Meter, -Final 1 , 33. Final Electric k 34. Final Heating So-,4i+�COrtditforrtfRJ i1 1 i 35. Final Gas Pipe -Test i - �! r 'r - - 1 _ 36. Hood or �CanoPY3•j 4 i �: t ;: ( i ,} - - 1 - - _ 37. Final FY,actory Fireplace. - 38. Final PluImbing' ' I i t� Ij • I '- ` r e I 39. Water Selvice-Final' 40. Gas Service -Final 41. Solar Do nestic-Final r 42. Backflow P, r' , , ±• '_ i I I _ __ 43. Backflow, Irrigation F i 1 I 1 i,... 1 •_ ' : - - 44. Landscape Irrigation System; '^I -• I - _ , 1 - - - - 45. Sound! Attenuation 46. HandiwR Regulations 47. FINAL STRUCTURE&BUILDING ! ; 48. Special Requirements Completed r, II 11 49. Electric kelease,to Edison) i + 50. Gas ReleaseJ 1 to Southe �1n California Gas Co j f v 51. CERTIFICATE'OF1 OCCUPANCY U.411 I No, ' Date , n 1 ( i Y .