HomeMy WebLinkAbout3221 DAKOTA AVE - Building Permits� �
CITY OF COSTA MESA
BUILDING DIVISION
�77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
PERMIT TYPE: B COMBO
Sub Type: RES_ALT
FOR INSPECTIONS CALL: (714) 754-5626
�oe a��Ress: 3221 DAKOTA AV CM
APN: 13908413 - - �
Vicinity: MASTER BEDROOM AND BATH
Const Type: V-B , SQ. FT:
PERMIT NUMBER: BC09-00320
STATUS: ISSUED
DATE ISSUED: 08/1812009
ISSUED BY: BJK
� Suite/Unit:.
Zoning: , ,
Primary Occ: R3
429 Valuation: $45,895.80
SCOPE OF WORK: REVISION TO PERMIT TO INCLUDE LEGALIZATION OF 100A SVC PANEL INSTALLED WITHOUT PERMITS
BY PREVIOUS OWNERS.
FIRE DAMAGE REPAIR TO THE MASTER BEDROOM AND BATH IN AN EXISTING SFD. WORK INCLUDES INSULATION,
DRYWALL, 2 WINDOWS, AFCI (ELEC). ELEC: 6 LIGHT FIXTURES (INCLUDES HARD-WIRED SMOKE DETECTOR), 5 OUTLETS,
4 SWITCHES, 1 MOTOR'f0 1 HP; MECH: 1 REPAIR ALT/COOL HEAT, 1 VENT FAN SINGLE DUCT; PLUMBING: 1
BATHTUB, 1 SHOWER,:1 WASH BASIN, 1 WATER CLOSET �
OWNER: RIZZO, ROBERT - - Address: 3221 DAKOTA AV Unit:
Phone: City/State/Zip: COSTA MESA, CA
APPLICANT: ROBERTSON,SCOTT � Address: 10840TALBERTAV
Phone: 714-965-7900 - City/State/zZip: FOUNTAIN VALLEY CA
cON7RnC70R: BARTWOOD CONSTRUCTION INC License No. 592681
Phone: 714-965-7900 Address: 10840 TALBERT AVUnit:
Cell: � City/State: FOUNTAIN VALLEY, CA
ARCHITECT:
ENGINEER:
- License No.
License No.
COMBINATION PERMIT FEE SUMMARY
Building Plan Check: . � -, $0.00
Building Fees: � . ", $603.85
Electrical Fees: $7525
Mechanical Fees: � - . $44.45
Plumbing Fees: $62J0
SMIP Residential: $4.59
SMIP Commercial: $0.00
Bldg Std Admin Fund $2.00
TOTAL FEES: $792.84
••Refer to fee receipfs for all fees paid tor project
Unit:
ZipCode 92708
l
,.,, , ; i �` �� �i � 1
�
. /` �
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California stat�tes 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 authonzed 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 fnal approval will result in the expiration of this permit.
LOOEt. INSGECTIONTYiE �RTE INIITIALS COOE� INSPECTONTVPE q DR q INTITIRLS
1616 Fixed System Final Fire Prevention 206 Final MeUanical / 2 / '��,/1 !l�OI'
1266 Pool Spa Final 208 Final Plumbing � J/� yLiy
200 Final Re-Roof 210 Final Electrical � ��
207 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 FinalSign
204 Final Demolilion
222 Final Site 1
250 FinalBuilding/Occupancy Z"✓ � _�
�
WORKERS' COMPENSATION DECLARATION:
I hereby aHirm under penalty of perjury one of the tollowing declarations:
❑ I have and will maintain a certificate of consen� to self-Insure for vrorkers'
compensation, as providetl for by section 3700 0( Ihe Labor Cotle, for the
peAormance of the work for which ihis permit is issued.
❑ I have and will maintain wnrkers' compensation insurance, as required by
sec[ion 3700 0( the Labor Code, (or the peAormance of the work (or which this
permit is issued. My workers' compensation Insurance carrier and policy
number a�?
�mev l;t�Q(�� .��-UJS i�0�v�i/��
his sec need irof be mmpleted il fhe permrt Is aluatl a[ one hunOred tlollars (8100J or less)
P lic IJ mber: �J�JDO � j y�__�,�r
❑ I ce � y tha� in the performance o! ihe work !or which this permi� is
issued, I II not employ any person in any manner so as to become subject
to the wo k rs' compen i laws ! California, antl agree that if I should
become ject to the or rs' com ensation provisions of Section 3700 of
the Labor e I shall th co ly with ihese provisions.
�-1S�d�j
n Signa re �Qyjg.7
WARNI G: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE
IS WFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($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 ffirm that I am licensed under provisions of Chapter 9(commencing
with S cti n 7000) of Division 3 of �he Business and Professions Code, and
my lic nse is in full force and eftect.
CIas5E7F^.F>
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>TRUCTION LENDING AGENCY:
I hereby affrm that there is a construcibn lending agency for the
mance o( the work fa which this pertnit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address: ..-w�
i' ' " y
u . "� k f�`„&...
SignaWre�•^"' ' - Date
�Y `
OWNER-BUILDER DECLARATIONS: ' � � �
I hereby affrm that untler Oenally of perjury Ihal I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5,
Business and Professions Code: Any city or counry which requires a permit to
consVuct, alter, improve, demolish, or repair any structure, prior to its
issuance, also requires Ihe applicant for such permit to file a signetl statement
[hat he or she is licensetl pursuant [o the provisions of the Contractors
License Law (Chapter 9(commencing with Section 7000) o( Division 3 0( the
Business and Professions Code) or that he or she is exempl there(rom and
the basis !or [he alleged exemption. Any viola[ion of Section 7031.5 by any
applicant for a permit subjects the applicant [o a civil penalty of not more than
fve hundred dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and the stmcture 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 6uilds or improves
thereon, and who does such work himself or herself or ihrough his or her own
employees, pmvided that such improvements are not intended or oftered for
sale. If, however, the building or improvement is soltl 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 ovmer of Ihe property, am EXCLUSIVELY CONTRACTING WITH
UCENSED CONTRACTORS to consWct the project (Sec. 7044, Business antl
Professions Code: The contractors License Law dces not apply to an ovmer of
.' property who builtls or improves thereon, and who contracts for such project with
�, �a'contractor(s) license pursuant to Ihe Cont2ctors License Laws.).
❑, I am exempl untler sec.
Business and Pro(essions Code for ihis reason:
305]-46(3I01)
Owner ID verified by driver�e. ❑ Yes ❑ No
Driver's License No. Expires:
Verification of Ownership by (type of tlocument, i.e. - prop@rty tax bill or tleed�:
�
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify Ihat no excava[ion frve (5) or more feet in deplh into which a
person is required to descend, will be made in ccnnection with work authorizetl
by Ihis permit, and that no builtling struc[ure, scaffolding, (alsework, or demolition
or dismantling �hereot, will be more than thirty-six (36) (ee[ high. (Chap. 3.2, Grp
2, Art 2, Sec. 341, rtle 8, Cali(ornia Administra�ive Code).
❑ As owner-builder, I will not employ anyone [o do work which would
require a permit (rom the Division of IndusVial Safety, as no�ed above, unless
such person has a permi[ to do such work (rom the division.
Ap0licanfs SgnaWre Date
Division of Industrial Safety Permit Number.
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future building occupant need to (le and
certify a Business Plan (or emergency response to release or threatenetl
release of a hazardous malerial? ❑ Yes ❑ No
(Section 25505 ot the Califomia Health antl Safery Code requires, with some
eaceptions, ihat a Business Plan be fled with the Costa Mesa Fire
Department by every business which has at any one lime during a reportetl
year a quantity of hazardous matenals equal to or greater than a weight of
500 pountls, or a volume o( 55 gallons, or 200 cubic feet o( compressetl gas
at standard lemperature and pressure).
2. Does or will the applicant or present or future building occupant neetl to file
a regislra�ion (orm for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the Califomia Health and Safery Code, with some
exceptions, requires regis[ration with Ihe Costa Mesa Fire Department by
each business which a[ any one time has on hand a quaMity of acutely
hazardous materials equal to or greater Ihan a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic fee[ of compressed gas at standard
tempereture and pressure).
3. Does or will the applicanl or present or fu[ure builtling occupant need to
prepare an RMPP (Risk Management and Prevention Program for awtely
hazardous materials)? ❑ Yes ❑ No
(Seclion 25534 of [he Califomia Health antl Safety Code provides that the
Costa Mesa Fire Department may require the preparation, certifcation and
fling with the Fire Department of an RMPP by businesses which are required
to register awtely hazardous materials with the Fire Depariment.
4. If an RMPP is presenlly required, has Section 25534 of the California
Health and Sa(ety Code been fully complied with? ❑ Yes ❑ No
5. Does or vnll the applicaM or present or future builtlinq occupanl require for
the work which is the subject of Ihis application a permil for such constmction
or motlifcation from the South Coas[ Air Qualiry Management District or from
any other air pollution contml disirict or agency? ❑ Ves ❑ No
(Section 658502 of Ihe Califomia Govemment Code requires Ihat the requested
infortnation be fumished on appliwtions fa non-residential building pertnits).
6. Will any part of the facility [o be constructed under Ihis permit be within
1000 (eel from !he outer bountlaries of a school? ❑ Yes ❑ No
(I( "yes", the facility must meet ihe requirement of Sec[ions 25534 and 42303
of the California Heal[h 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 ihe
subject of this application, have all of the disclosures prescribed by Cali(ornia
Heallh and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. Qf "yes", attach certificate of compliance from the appropriate air pollution
control oKcer).
CERTIFICATE OF COMPLIANCE: I cenify [hat under penatry of perjury the
information given above is correct I agree to comply with all state lavus and
city ordinances regarding Hazardous Materials and Emissions.
5ignaWre Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury that I have read this application and state that
the inlormation given is wrrect I agree to comply with all state laws and city
ortlinances relating to building construction, and authonze representatives of
the City� of Costa Mesa to enter upon the above-described property for
inspecti purposes. I agree not to occupy or allow occupancy of any building
aWhoriz by this perm'YGt il fnal inspection.
wre o ar n Date
- �" �S'��
A Nor,Au orsseGAppll t= �i` - � / Date .
CITY OF COSTA MESA -�
�'SpMFSy BYILDING DIVISION
>4 .,,,,„.,.;. � j 77 FAIR DRIVE, COSTA MESA, CA 92626 • p14) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
r �
�, FOR INSPECTIONS CALL: (714) 754-5626
`�'�e.ow� o°
PERMIT NUMBER: BC09-00320
PERMIT TYPE: B_COMBO ������ STATUS: ISSUED
Sub Type: RES_ALT �{Tb °� "� DATE ISSUED: 08/1812009
ISSUED BY: BJK
�06 AooRess: 3221 DAKOTA AV CM Suite/Unit:
APN: 13908413 ' ZOning: , , ' � .
Vicinity: MASTER BEDROOM AND"BATH � � �-- �. Primary Occ: R3
ConstType: V-B � , SQ.'FT: 429 , Valuation: $45,895.80
SCOPE OF WORK: FIRE DAMAGE REPAIR TO THE MASTER BEDROOM AND BATH IN AN EXISTING SFD. WORK INCLUDES
WSULATION, DRYWALL, 2�WINDOWS, AFCI (ELEC). ELEC: 6 LIGHT FIXTURES (INCLUDES HARD-WIRED SMOKE DETECTOR),
5 OUTLETS, 4 SWITCHES, 1 MOTOR TO 1 HP; MECH: 1 REPAIR ALT/COOL HEAT, 1 VENT FAN SINGLE DUCT; PLUMBING: 1
BATHTUB, 1 SHOWER, ,1 WASH BASIN, 1 WATER CLOSET ' .
OWNER: RIZZO, ROBERT
Phone:
APPLICANT: ROBERTSON,SCOTT
Phone: 714-965-7900
Address: 3221 DAKOTA AV
City/State/Zip: COSTA MESA, CA
Address: 10840 TALBERT AV .
City/State/zZip: FOUNTAIN VALLEY CA
CONTRACTOR: � BARTWOOD CONSTRUCTION INC License No. 592681
Phone: 714-965-7900 � Address: 10840 TALBERT AVUnit:
Cell: . City/Stale: FOUNTAIN VALLEY, CA '
ARCHITECT:
ENGINEER:
COMBINATION PERMIT FEE SUMMARY
Building Plan Check: , � �
Building Fees: �
Electrical Fees:
Mechanical Fees: � ;�
Plumbing Fees:
SMIP ResidentiaC
SMIP Commercial:
Bldg Std Admin Fund
TOTAL FEES:
"Reter to fee receipts for all fees paitl for project
License No.
License No.
$0.00
$603.85
$44.75
$44.45
$62.70
$4.59
$0:00.
$2.00
$762.34
Unit:
Unit: :
ZipCode 92708
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 will result in the expiration of this permit.
CO�E p. INSPEGTON TYPE
1616 Fixed System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Roof
DATE INTI77AL5 COOE% INSPECTIONTYPE
206 Final Mechanical
2oe Final Plumbing
210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Pianning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
DATE IN1111ALS
WORKERS' COMPENSATION DECLARATION:
I hereby aNirm under penalty of perjury one of the tollowing declarations:
❑ I have antl will maintain a certifcate ot consent to self-Insure for workers'
compensation, as pmvided for by section 3700 of the Labor Code, for Ihe
performance of the work for which this permit is issued.
� I have and will maintain workers' compensation insurance, as required by
s' n 3700 0( the Labor Code, for the peAormance o( the work for which this
permit is issued. My workers' compensation Insurance carrier and policy
number are: _ , ,
(This secfion neee nof be Wmple(ed A ihe peimR is valued a( one hvntlietl dollaro (3100) orless.)h
PolicyNumber.' �ZEIt�P �j�Q � .`�`�'�
❑ I certify Ihat in the performance of the work for which this permdRis,-_,
issued, I shall not employ any person in any manner so as to become subject
to the work �' compen sfiAi laws o( Califomia, and agree that if I should
become su j c[ to the or�Cyls' c mpensation provisions of Section 3700 of
the Labor o, I hal foK ,vdh c m ly with ihese provisions.
- _�S • 1 �S �� I
pplican ignaWre � -'�ate'r�
WARNIN : FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UN WFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL
PENA IES AND CIVIL FWES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SEC710N 3706 OF THE LABOR CODE, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby Nrm that I am licensed under provisions o( Chapter 9(commencing
with Sect� 7000) of Division 3 of Ihe Business and Professions Code, and
my licens s in full force �nd effect.
C�zs"s'u �-1� c�y
�'.��-�%/
Date
'RUCTION LENDING AGENCY:
hereby aKrtn that ihere is a consWc[ion lending agency for the
ance of the work fOr which this permit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Address:
OWNER-BUILDER DECLqRqTIONS:
I hereby aKrm that under penalty of perjury that I am EXEMPT FROM THE
CON7RACTORS LICENSE LAW for the following reason (Sec. 7031.5,
Business and Pmfessions Code: Any ciry or county which requires a permit to
constmct, alter, improve, demolish, or repair any structure, prior to its
issuance, also requires the applicant for such permit to fle a signed statement
Ihat he or she is licen,ed pureuant to the provisions of Ihe ConVactors
License Law (Chapter 9(commencing with Seclion 7000) of Division 3 of the
Business and Pro(essions Code) or that he or she is exempt Iherefrom and
the basis tor the alleged exemption. Any violation of Section 7031.5 by any
applicant for a permit subjects Ihe applican[ to a civil penalty of not more than
fve hundred dollars ($5oD).):
❑ I, as owner of the pmperty, or my employees with wages as their sole
compensation, WILL Dp THE WORK, and the s[ructure is not intended or
offered for sale (Sec. 7044, Business and Professions Code: The Conhactors
License Law does no[ apply to an owner of pmperty who builds or improves
[hereon, 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 impmvement is sold within one year of
completion, �he owner-builder will have Ihe burden of proving that he or she
did not build or improve for purpose of sale.).
❑ I, as owner of [he property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS [o construct [he project (Sec. 7044, Business and
Professions Code: The contractors License Law dces not apply to an owner of
property who builds or improves thereon, and who contracts for such projec[ vdth
a contractor(s) license pursuant tothe Contrectors License Laws.).
❑ I am exempt under sec.
Business antl Professions Code for [his reason:
309�66�3/0])
Owner ID verified by driver s license. ❑ Yes ❑ No
Driver's License No. Ezpires:
Verification of Ownership by ([ype of tlocument, i.e. - property [ax bill or deed):
�'
DIVISION OF INDUSTRIAL SAFETY PERMI7 CERTIFICATION:
❑ I hereby certrfy tha[ no excava[ion Frve (5) or more fee[ in depth into which a
person is required to descentl, will be matle in connec[ion with work authonzed
by this permiL and that no building structure, scaffolding, falsework, a demolition
�or dismantling�tliereof, will be more [han ihirty-six (36) teet high. (Chap. 32, Grp
2,'rArl2; Sec'.�34A„Ttle 8, Califomia Administrative Code�.
❑ As owner-builder, I will not employ anyone to do work which would
,require a permit from the Division o( IndusVial Safety, as noted above, unless
such person has a permit to do such work from the tlivision.
Applicanfs SgnaWre
Division of Industrial Safety Permit Number _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applican[ or present or future building occupan[ need to (ile and
certify a Business Plan for emergency response to release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the California Heal[h and Safety Code requires, with some
exceptions, that a Business Plan be fled with Ihe Cos[a 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 weigM of
500 pounds, or a volume of 55 gallons, or 200 cu6ic feet of compressed gas
at stantlard temperature and pressure).
2. Does or will the applicant or presen� or tuture building occupant need to fle
a registration form for acutery hazartlous materials? ❑ Yes ❑ No
(Section 25533 of the Califomia Health and Safety Code, with some
excep[ions, requires registretion wi[h [he Costa Mesa Fire Department by
each business which at any one time has on hand a.quantity of acutely
hazardous materials equal to or grea[er Iban a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at s[andard
temperature and pressure).
3. Does or will the applicant or present or future building occupant need to
prepare an RMPP (Risk Management and Prevention Pmgram for awtely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of [he Califomia Health and Safety Code provides that the
Costa Mesa Fire Department may require the preparation, certifcation and
fling with Ihe Fire Department of an RMPP by businesses which are required
to register acutety hazardous materials with the Fire Department.
4. If an RMPP is presently required, has Sec[ion 25534 of the Califomia
Heal[h and Safety Code been fully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or fu[ure buitding occupan[ require for
[he work which is the subject of this application a permit for such construc[ion
or modifcation fmm the South Coast Air Quality Management DisUict or from
any other air polWtion control disirict or agency? ❑ Yes ❑ No
(Section 658502 of the Califomia Govemment Code requires that the requested
infortnation be tumished on applica[ions tor non-resitlential builtling permits).
6. Will any part of [he facility to be constructed under Ihis permit be within
1000 feet from Ihe ou[er boundaries of a schooi? ❑ Yes ❑ No
Qf "yes", the facility must meet the requirement oi Sections 25534 and 42303
of [he Califomia Health and Satery Code).
7. If a permi[ from the South Coast Air Qualiry Management District or other
air pollution control district or agency is requiretl for the work which is the
subject oi this application, have all ot the disclosures prescribed by California
Heal[h and Safe�y Code Section 42303 been made? ❑ Yes ❑ No
8. Qi "yes", attach certifica[e of compllance from the appropriate air pollution
control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury lhe
information given above is correct 1 agree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
SgnaWre 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 correcL I agree to comply with all state laws and ciry
ordinances relaf g to building cons[tuction, and authorize representatives of
the Ciry of C�� Mesa to enter upon the above-described property for
inspection purp s s. t agree oeFio ocwpy or allow occupancy of any building
authorized by t i permit urki�fnpl�ns�ection.
Date Q
��/�
Date_. i^- .
, _ ,
,
BUILDING PERMIT
Job Address: 3221 DAKOTA AV
Suite:
Vicinity: RESIDENCE AND ATTACHED GARAGE
Parcel Number: 13908413
Applicant: SHEATZ, JOHN
Address:
Owner: DOOLEY, MICHAEL
Address 216 AGATE AVE
NEWPORT BEACH, CA
Contractor: THE ROOF GUY
Address: 9781 EASTWOOD CI
VILLA PARK, CA
Zip: 9286�
Arch :
Address:
Zoning:
�SSUED BY:
Phone: 714-921-1500
Zip:
Phane:
Zip: 92662-1029
Status: ISSUED
Applied: 09/23/2004
Issued: 09/23/2004
Phone: 714-921-1500 , ,
License: 638593
Eng:
Address:
Phone: Phone:
, Zip: , License: � . License:
SCOPE OF PERM�T
REROOF RESIDENCE AND ATTACHED GARAGE: T/O EXISTING 1 LAYER C.OMP ROOF, R , 1 LAYER 30#
FELT, APPLY "40-YEAR COMP SHINGLES." 2300 SQ FT � ' _ Z„ � T51 I��Lb p i �I .- .
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: Sa,ioo.00
Permit $11125 - - - - - - Claim Valuation: Sa;ioo.00
SMIP Res:
SMIP Com:
Other:
Inspection:
� Total:
$0.50
$0.00
$0.00
$0.00
$111.75
SETBACKS .,
MAINSTRUCTURE�Front 0-0-�
�
ACCESSORY Front D-0�
PARKING Existin : o
.i �
.. . �
PLANNING & ZONING
Rear 0- 0 ��LeR 0- 0
' Rear 0- 0 - Left . "0--0 `
Re uired: 0 'Proposed: 0
Ri9ht '0- 0 - -
Right � 0- 0 -
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 permlt 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
requlred inspectlons and finel epproval must be obtained. Failure to obtain Inspections and final approval will result in the expiration of this permit.
POR INSPECTIONS CALL: (714) 754-5826
?148�48(8�00)
WORKERS'COMPENSAnON DECLARAnON: � - . - �
I hereby eHirm under penalty of perjury one of the tollowing declarations: '
❑ I heve and will maintain a cahiticate ot consent to self�lnsure for workers' compensation, as provided for by section 3700 ot the Labor Code, for the peMormence of the
work tor which this permil i5 issuetl.
I have and will maintain workers' compensation Insurance, as required by sectlon 3700 ot ihe Lebor Cotle, for the pertortnance of tha work for which this permit is issued.
<My worke c p,efn�sation I uran carriar antl policy number are: �%p ,q
Cartier: � �� I / �/I(� Policy Number:� /��3 f / � ��V �
(This section n e� d nof �ple�ed d the permif is velued et one hundred dollars ($100) or less.)
❑ I certiry ihat in the peAor nca of the work tor which Ihis permit is issued, I shell not employ any person in eny manner so as to become subject to ihe workers'
compensetion laws of �e If m and agrqqq��� ihat If I OulQ become subject to the workers' compensetlon provisions of Section 3700 oi Ihe Labor Cotla, I shall forthwith
comply with th} se pr9 is s � // /. � /� `� 7
' 9 �y
Applicaot5ignaNre: �� /6 � n ���i. �ace�. �
WARNING FAILURE TO SEC WORKERS' CAMPENSATIQY CO GE IS UNLAWFUL AND SHAIL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNDRED
THOUSAND DOLLARE (E100,000�, IN PDOITIQY TO THE CQST OF COMPENSATIIXJ, OAMAGES AS PROVIOED FOR IN SECiION 37060F THE LABOR CODE, INTEREST, AND ATTORNEV'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aflirm that I am licenyady e YI}ions of Chapter 9(commencing with Saction 7000) of Division 3 of the Business nd �p(essions Code, antl my licensa is in full
force and effecL Lic. # n /> 3 S 7 S � Class a f� ��y
Coniractor's Signature: � J ,�_ Date: �7
_ �g f
CONSTRUCTION LENDING AGENCY:
❑ I hereby aflirm ihat Ihera is a cons�ruction lending agency for the pedormance of Ihe work for which t�is permii is issued. (Sec. 3097, Civil Code).
LentlelsName: __ ___ Lender'sAddress:
SignaWre:
OWNER•BUILDER DECLARA7IONS:
�ate:
1 herehy eNirm that untler penelty o� perjury Ihat I em EXEMP7 FROM THE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, eusiness end Proiessions
Cotle: Any ciry or counry which rpquires a permit to constmct, alter, improve, demolish, or repair any siructure, pnor to its issuance, elso requires the applicant tor such permit
to tile a signed statement that he or she is licensetl pursuent to tha provisions ot the Contrectors License Lew (ChaD�er 9(wmmencing with Section 7000) of Division 3 of Ihe
Business and Professions Cotle) or ihat he or she is exempt iherefrom and the basis for the alleged exemption. Any violation of Sectlon 7031.5 by eny appliwnt tor a permit
subjects Ihe applicant to a civil penalry of not more ihen five hundretl dollars ($500).):
❑ I, as owner ot the propeny, or my employees with wages as their sole compensation, WILL DO 7ME WORK, antl ihe structure is not intentletl or oflered for sale (Sec.
7044, Business and Profes9ions Code: The Con�rectors License Law does not apply to an owner of propetly who builds or improves thereon, and who does such work
himself or herself or thwu9M his or her own employaes, provitled that such improvements are not intendetl or oNered for sale. tl, however, ihe building or improvement is
::oltl within one yeer of completion, ihe owner-builtler will have ihe 6urdan of proving that he or she did not 6uild or improve for purpose ot sale.). '
❑ I, as owner of ihe property, em E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business antl Professions
Cotle: The con�rectors License Law does not apply to an owner of propehy who builds or improves iharaon, and who contracis for such prqect with a con�redor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. ,
SignaWre�.
Owner ID venfied by driver s license.
Veriflcation of Ownership by pype oi
Business and Professions Code for this reason:
❑ No
i.e. - propeny [ax bill or tleetl):
DIVISION OF INDUSTRIAL SAPETY PERMIT CERTIFICATION:
Drivers License No.
Date.
Expires:
❑ I hereby certify that no exca�a�ion five (5) or more tee� in depth into which e person is requiretl �o tlescend, will 6e made in connec�ion with work euthorizetl by ihis
permiL and ihat no 6uiltling structure, scaHolding, talsework, or demolition or dismantling thereoi, will be more than Ihirty-sia (36) fee� high. (Chap. 32, Gry 2, Ad 2, Sec.
341, Title 8, Califomla Atlministra�ive Code).
❑ As owner-builder, I will not employ anyona to tlo work which would require a permit irom ihe Division ot Indusirial Safery, as notetl above, unless such person has a
permit to do such work irom �he tlivision. �
Signeture: Date:
Division of Industrial Setety Permit Number:
CERTIFlCA7E OF COMPLIANCE �D AUTHORIZA710N OF ENTRY: I certify under penalry of peryury that I have read this appliwtion end state that the information 9iven is
correcL I agree to comply with all state laws and ciry ordinances relating to builtling construction, anG authonze representatives of Ihe Ciry oi Costa Mesa to enter upon the
ebove-described propehy fw inspectian puryoses. l agrea fwt to occupy or allow occupaacy of aay buiWing authorized by this permit uMil tinal inspectio�.
COOE �, INSPECTIONttPE
1616 Fixetl System Final Fire Prevention
1266 Pool Spe Finel
200 Final Re-Root
201 Final Block/Reteining Well
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition
PAIE 1ti�Lfl
B' '�� �
9/z�/o�f8
ate '
CO�E� INSVECTONTYPE
206 Final Mechanical
208 Final Plumbing .
210 Finel Elecirical
212 Finel Fire Prevention
220 Final Planning Approval
222 Final Sita
250 '-Final Building/Occupancy
PdIE �NllilALS
Appllcan� to fill in all spaces exce0� those witltin heavy bar0er Iines anE sign all apOroD�iale Geclarations.
CITL' OF COSTA'MESA CONSTRUCTION PERMIT • PER N TRACT NO. LOT NO. UNIT NO.
! Project Address � 3Z21 DdICOtd (
�ApPiicanYsMailingAiltl�ess 126 Commercial, C.M. 92627
Owner's Name Cl0 Mlk2 D0012y Phone 546-2313
Address 216 Agate Ave.. Balboa Island 92662
Arch/Eng. _ License No.
Address
Convactor's Name���j�_BY'nc Rnnf�_,_,00,i.n.�n (�n._.phone �3�9
Addresslmaiiingl 196 Commarc`ial �_C.M, 9262�
Ciry,License No. " ��5993
LICENSED CONTRACTOR DECLARATION
1 M1ereby affirm that I am licensetl untler provislons of Charter 9(commencin9
with section �000) of Dlvision 3 of the Business antl Professlons Cotle, antl
my license is in full f rc tl elfect.
�icen iass �—�� License 8677
�Dat�� � Sign t r �'�'�� �
VORKERS'COMPENSATION LARATION
. hereby attirm that I liave a c i cate of consent l0 581LIn5ure or a certiflcate
= of Workers' Compensation rance, or a certltletl copY tnereof (Sectlon
3800, Lab. C.)
� Policy No. Z$S�Z2�I—H% Compan _ Stdt2 Fl1�IC� '
�Certified copy is hereb t nizhetl.
Ce� f' cop eG i the city g I is
�ate � Pplicant
EXE ION R RKERS'C PENSATION DECLARATI
(Thi55eG[ion neetl not be compleletl if the p¢rmit i5 (or one huntl�eC ($100) o�
less).
I C¢rtify lha[ in the performance ot Ihe work for wnlch lhis OermR I5 issued, Y
shall not employ any p¢�son in any manner So a5 to becOme subject to the
Workers' Compensation Lawz of Cali/ornia. .
Oate Signalure
NOTICE: If, atter making thiz tleclaration, you snOuld Decome subject to tne
Workerz' CompenzatiOn provisions of tne Labo� Cotle, you must rorcnwun
comply with such provision5 or this permit Shall be tleem¢tl revoketl.
CONSTRUCTION LENDING AGENCV '
1 nereby affirm tha[ [hare, is a constructlon lentlin9 agency for [�a performance
ot Ne work for whlcn lhis Oermil is issuetl (Seclion 309] Civ. CJ
Lentler's Name
lentler's Aatlrezs
OWNERBUILDEft OECLARATION
I hereby atfirm that I.zm exempt irom the Contractor's License L.aw for the
(ollowinq reason (Sectton 7031.5 Business and Professional Cotle: Any city or
counry w�icn requires�a permit to conztruct, alter, improve, aemolish or repair
any Slru<tur¢, ptior to' Il5 i55uancn, also �equires the applicant fo� such permit
b tile a signetl statement [hat he/ihe i5 licensetl pu�suant to [he prOvi5ion5'o�
ie Contracior's License Law (Chapter 9(commencing with Sectlon 7000) of
ilvlsion 3 ot the Business antl Professions Cotle) o� that h¢/She is exem0�
. �herefrom antl the basis for the allegetl exemption. Any violatlon of Section
� ]031.5 by any applican[ for a permit 5ubjeC[s Ihe ap0licant to d civil
' eendlty of not more than five huntlretl tlollars (5500).
tJ I, as owner of the prooerty or my employees with wa9es as their sole
� compensa[ion, will Oo'the work, and tne structure is not intentletl or otferetl
� tor sale (Section ]044, Business antl Professional Cotle: The Contractor's
. License Law tloes not apply t0 an owner ot a p�operty wbo builtlz Or improves
thereon, antl wno Eoes such work himselt/herself or through his or her own
employ ee5, provitletl fhat such imprOvemenf5 ar¢ n0[ intentletl o� otte�etl 1or
sale. If, howev¢r, the builOing or improvement is soltl wllhin one year o1 com-
pletion, Ihe owner will nave Ihe burtlen of provin9 he/she tlid not builtl or im-
��ov0 1or the purpose ot zale).
I, as owner of the property, am excluzively contracting wi[h licensetl con-
Vacto�s to construct [he D/oje[t ($ection 7044, Business antl Protessions CoOe:
� The Contractor's License Law tloes not apply to an owner ot-oroperty who
builas or improves thereon, antl who mntracis for such Drojects with a con-
trac[or(S) bcense pursuan[ to the Cont�actor'S Licenie Law). I am aware that
proof o( their Worke�'S Compensa[ion inwranc¢ shoultl be provitletl [o me.
❑ 1 am exempt untler Section B. & P. C. for this rea5on
Date Owner
I hereby cerpi(y that I have rea
Signature
Drivers'
CMF OB6:tP6
or55�
Q3/S�D
TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
'DESCRIPTION OF WOFK/USE OF BLDG. Tnctal l�40# °Cl acs A"
TVPEOFPERMIT LIGRADING LJ FOVNDATION LJSTRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANIGAL
❑ OTHER
PRQIECT DESCRIPTION SQ. FT. 3,236 oCCUaANCv 511
CONSTRUCTIONTVPE Y2S. V,ALUATIONS�an.�
ZONE G0.ADING CU. VDS. ACRES_
Remarks:
Sink
Preventer
Irrigation
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service OuUets
Interceptors
Kitchen Sink
Lavatories
P—Trap
ROOf Drains
Reinspection Fee � $15
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Blt. ICBO #
Heating $ystem & Ducting
❑ ai oo,oao sTu O i oo,000
Reinspectian Fae � $15
rev. 30/84 WM1ite - Bulltling; Canary - Applitanp Pink - Accounting; Goltlenrotl - Assessor
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping �
Solar Tank
Swimming Pool w
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
laue Fee
Hood or Typel ❑
Canopy Type 11 ❑
Re(rigeration System
❑4100,OOOBTU ❑100,000
System Repair/Alteration
Fire Dampers '
Regiscers
Issue Fee
FEES
A.P. #
S Main Building:
E
T Front
e Rear
A
C Right
K Left
S
Ping. Ref. # �
Planning Notes:
1428 12/14/87
2one
Accessory Building:
Parking Req./Provided '
ELECTRICAL --, �
Automatic Washer' Transformer ❑ 15�50 KW
Construction Pole Sub. � 50 + KW
Cooking Unii Meter �up to 100 amps
Dishwasher Meter ❑over 100 amps
Dryers �Gas ❑Eleccric Sub Panel
Fan Motors �0.7 HP 01 h- 8
F.A.U. Inc.Solar 09-15 HP �1615+
Fixtures Microwave
Device Boxes Pole light
Outlets Range
Switches Si9n -
Garbage Disposal
Generator �0.5 KW �515 KW
Standing Sections
Trash Compactor
$ 3 I
�— Reinspection Fee $15 Issue Fea
FEES
DEVELOPMENTSERVICESRE�UIREMENTS:
Zoning APProvetl By
Building Approved By
Appliration Issued Bv �
$ 3
33, 50 ' TL
FEES
$ 3
SU RY F FEES
BUILDING PERMI7 $ � SMIP , ' $ rS�
PLAN CHECK $ � PERMIT �
PLUMBING $ ISSUANCE $�:
PLAN CHECK 25% $ ENERGV P.C. $ �
ELECTRICAL ' $ GRADING $
PLANCHECK 50% $ MICROFILM $
MECHANICAL $ � TOTALFEE $ 3•S
PLAN CHECK 25% $
Z
O
N
I
N
G
R
E
�
M
T
S
�CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permi(,# Date Inspector qppROVALS Permit# ' Date Inspector
1��Temporary Electrical Se'rvice or 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, O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains . 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final �
15. Rough Electrical-Conduit 66. Solar SYstem-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit # _
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.StorageTankOGas ❑Oil �
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Freme and Flashing 76. Dry Standpipe .
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT �
i
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTFFICATE ISSUED ,.,
33. Final Electric Notes: [(o �� �
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 pomestic-Final .
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations .
47. FINALSTRUCTURE&BUILDING 8 P/ ��� 303 �9P'' ��r
48. Special Requirements Completed - ' �
49. Electric Release to Edison '
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY f� .
No. Date
.'
�or 65 - TRACT 3625
� � L��v�
COSTA MESA BUILDIIJG-SAFETY DEPARTMENT
P. O. BOX 917 COBTA MEBA. CALIFOitNIA
For Applieanf to Fill In Complefely
TYPE OR PRINT
BUILDING 22� �pFCOTA AVENUE
ADDRESS
COSTA MESA CALIFORNIA
KENKOL CONSTRUCTION C0.
� MAIL
NEWPORT BEACH Np; MI E>-
� TEL.
I:A^�
BUILDING
FEE RECEIVED
C�.` S- i3-(� �,
/�fINA E pEPT.
APPLICATION'�FOf�'PERM��fA M��
� BUILDING
For Office Use Only
COSTA MESA. CALIFORNIA
ADDRE55 � PIACENTIA AVENUE ZONING
NEWPORT BEACM zorve I Ho. ov�, / I uae ov
C�7y runsv am�om
�;�TNo. 6t�95 NEO. MI 6-322� LE6AL /_� _
/ DBBCqlPT10 �l�
$2E..._ OQ X �QQ INO.•oP-eLDGe. Q
B6TBACK LINe FRON I p�eR VARn 2O�
,.�...se ... ��P. 50
I LEFT I� I RIGHT /�
DESCRIPTION OF WORK
I X I ALTERATION I II ADOITIO
BUILOING � 8 SF NO. OF 6 �
SIZE 5 5 ROOMS STORIE6
EXTERIOR WALL ROOF ��D H-NG ES
COVERING STUCLO COVERING
USE OF BIJILDING AND WORK TO BE PERFORMEO
SINGLE-FAMILY RESIDENCE AND ATTACHED
GARAGE PLAN 3-AR �
(CeM6R
J
�ssu¢o
�
� X¢PEBY �GIWOWl.EOGe TNAT I HAVE RHAD TXIB MPLIGTION }H8 AMOUNT BXOWN UNDER VALUATION IS FOF THE
AND eThTE THAT THB ABOV¢ IB CONRECT AND AGREB TO CON-
PUPP08E OP 88TABLIBN�N6 A PEqMIT FE6 ONLY.
PLT WITH ALL CI]Y O�INANC¢e AND HTATE 1.�W8 RH6l1LATINO
ButtnlNc CONeTfw N. VALUATION /
91GNATURE OF PERMIT FEE $ � "`�
PERM17'fE IG � �� / �/
/ . ., S PLAN CHECK $
� AUTNORIZED
r
.�'a
k