HomeMy WebLinkAbout292 PALMER ST - Building Permits (4)�A
enopessaemiw+c 292 PALMER $T uxt: C-2 CITY OF COSTA MESA — BUILDING PERMIT
ameaswwciriv+axx: BOUDREAU, SHARON FERM r10: P 0740F1�
�ooness 292 PALMER ST C-2
C`�� PERMIT NO: P 074085 PLAN CHECK NO: N GOVT: N SUPP: N
COSTA MESA, CA 92626 646-8606
wvi.YuuNc�oox�ss CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: REP
ApCNRECTOPEIM�NFEH: LIC.ND.: JOB DESCRIPTION . CHANGE OUT DISHWASHER SQ FT:
AfMN.ON ENO.'S /iWPE55: UNi:
CLAIM VALUE: CALC—VALUE: GROUP OCC: /
camucrarsxu� NOCI( PLUMBING ( 714 ) 895-1246
COHfRACiOR'SYYIRlG 11610 SEABOARD CIR COMMENTS: NO OTHER WORK AUTHORIZED BY THIS PERMIT
�oo�ss: STANTON CA uc.xo.: 511971 f�******�*�*rt****�x-**�*********�t�-�-��+�*�*********�tx�+�*****+�*****+�tE�t�***+�******�****
90680 �M, Z O N I N G R E Q U I R E M E N T S
110EN5ED COMHACTOfl3 DECLAN�TION: 1 Mreby eflim uMx penelly d pe�ury Ihet I em Ikemed urder pwidona d Cheqx 8 S E T B A C K S
(oommendrq xi�A Section ]000) d Oivoun � d ihe &mroa� dy Pmleseiona COEe. anC mY limnee ie in full laca eM eHed.
cmuc.r+o.:0 03 6 uc.cuss: C-36 uc.,No.\: -51 971 EXP: 02�/y96r ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
oma: /�L c�,v,ea IVCJ� PL(i���.E � LEFT: FT IN RGHT: FT IN LEFT• FT IN RGHT: . FT IN
OWNERBIIILUENDECLAflATON:IMmCyelfirmunderpMyydprWrY��lememmplromlMCaNratlaelironselewlatM PARXING REQ: PROV: PARCEL: 0�000000 ZNE: REF NO:
Idbxiq rmvm (Sedion )W 1.5 &aiwas end Rdeasons Code: AnY c�Y a cauMY whidi �eqwe� e V�^�4 to muwct. eliar. imqow.
-�nd'nh. a repar ury emxwre, pua u b eauvKa, ebo rey� �M epqimp Iv ach paniw b fiIs e eynW nmameN tlut he a ehe P LANN I NG NOT E S>
IiceneeE W�wem to tM pwiume d the CaNreawe Liq��s �w �Cheqs 8(mmmend'p wilh Seaion lam) d DM'sion 9 d tM
�uaineva vd Prdmbne Cadel or Ihel he a ehe u exmmq Owelmm uM iM beia lar tM elki� exemqon. MY violelion W Setlion 1 �� �
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❑ i.,,�.dinap�«��cbr.e.�,+n,�mm,:.w,�,o,�w;o,,.�;naom,,.a�,,,�em,.wn„�.o����.�eaa D E V E L O P M E N T S E R V I C E S'- R E Q U I R E M E N T S
w olleraE Im We �Secian ]W<. Bwiiap end Pm/aasio�� Coda: TM Comraeon Lioanee lewtloea �wt nppFy lo en owriar ol propeM
who buid+or inprov» IMreon, xd v.fio do» euM wal� 1imeM1 w henetl a Nraph hi+ w Mr own amployess, qoviEeA �Mt such
impwemenu ere nol inleMed a WareE la sab. X.Iwwevy, �M buiNiip a inpro.emem ic voM wnhin ms ymr d complaiion, �he Z ON I NG AP P RO V ED B Y '"/ DAT E:
ownerbuikx will heve �he Wken d pravin0 he or sM db � y�iM a im0�* �a iM W�e d eele).
❑ i,.. o.,« d me wow�r, .m .=aw�r �vw�w �.nn rw�.ea canreao�+a w,mw in. wa� (sw� rou. an�e �a
Pmlerima Cotla: TM Comrepm lironw Lew doa na eWN b en oxw G M�Y Wa WiMe a inWa'a Iheraan uM who
conlrecL+/a aiM pqecla wil� a wnrma�5) IcenseE pynuenl lo IM Conlrotlm Licenee Lex�.
� I em exemq wder Seaion: B. 8 P.C.. br Nu reexn:
Dale: �+Nr:
i m n.�nv �v �nm i�, a.�e a.m �.�,e ��saw�«m a cwo� �en.oa smar cae sea�. uws. zssa�..m
Y55J1. enE IMi I u arry Muro b ldirp oaapeni ll / wil rq (�b one) mad to compy �'t� eeiE wNs mM� eM IM rtpuiiamend br
a peemtl IwmnVueton amodifiW ionkaniM Rk�iie 1y7�'ayp�p�t Ditlrid. ReeMeniid emmiupion epplieeiianw eumq Irom tMes
provieians.
om.: now�c
WONKER'S COYPEN9ATION DECL�FATION: I hereEy afl� uMr perolly d perjury one d Na tdbwinp Estluetiom:
� 1 heve enE wJ meiMan e eanAiuw d wiw�i ta setlieq�n �p ��' �pp�y��. u pay� la by Setlion 9)00 d IM lebar
Coda, br fM pa.iormanee d tM xwk fw xfich this permit is ivued.
[� in...�a»a�m�.�w.•�o�o��rep�co.m..�,�.a��ear�W�vsw��rarooameimo�coa..ro��,.w�«m.�o.am.
wo�kt«wnaihuo«meu�oued.urworYere'GVLUEN tAlaL��'. �Y�m��e: EXPIRES
Cemer.
aaryN�mw: 09 /O1 /96
(IM1ia eMion mW nd b mmplero! / iM pormt's M one hundrW Edlere �SI00/ a Inn.)
� I ce�ily IM1et in the parlormenca d Ihe work br wfic� Ihie peim� Is ieeued, I Mdl iwl empby any pereon In eny mennm w ea to
became wM� Io 1 xvhen' camDemubn leMs d celibmu. tlw il I �ecome wdb to IM v.o'ken•
cpnpenaetpn o� � ons d dion 3� d iM Labor �e. I ahdl 1 ' awnqy wiN t p' ons.
or.: /� . iwa�,c
Wunlnp: F�Nun b ucun Mort�n' mn�vwvs0on eoverp� li unl�M�l. �ntl ahtll �Wf�ef en.mplqw M erlMml p�
c/vll nnu rq ro a�s n,nCr�d tho�untl0oll�n lsiPqOWI, M.y��yon ro M. cwt ot rompxwtron ��p� .� p�hded ror In
S�ctlon ]]G6 0l !ha LWor Cob, InfwL Ntl attomry i fw.
CONSiRUCT10N LENOINO A6ENCY: I hsroby elfirm unrya pyiyy d perjury thet �Mra w s aonq�udion bMi�p epercy tor tM
pa�formerce W Ihe xwk la which ihe paml u uwed (�ion 908). CH. C).
LEN�EH'S NAME:
LENOEN'9 �DUflE49:
I cenity tlim I heve neE Ihu applcmion W pde thel �M ebwa iniwmalbn u cortw.l.1 epres �o cpnyy wnh ell cNy enE oounry adirorion
eM ows kwa eelefvq lo WJEvp eanW Wion ud hereby eNjqr¢a repa�ente�rves ot Ihia aly to eMx upon iM eEwa.msnlioned popxly
�«�°'°°"�°`i`°°'°'. RON NOCK
PM w�. '�y //1 �
� � Dab: � %
Spnetum l� eepa
(St51<B.WP) While-Buikip 8 StlNy: Greerv-Flp: Cenuy-rlppirenl: Pink-Rmmue:OdEanm6-Nsneor
BUILDZNG APPROVED BY ; w� DATE:
APPLICATION ISSUED BY: t� DATE: r��'"'�S
iE1fiE1ElEdElElE1ElEIElEiElEifiE1E�(-iFiEiEiE _ �F iEi(�1Eif-iF�[-iEifiE3E7�3F�F1E�E
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N
'e
BLDG PMT PLUMBING ELECTRIC MECHANZC FIRE SMIP/RES GRADING
PERMIT 7.00
25R _, r SMIP/NON—RES
PLAN `�
ISSUE FEE 20.00 � •�^'
BUILDING—DIV—> PERMIT ISSUE PLAN=CHECK TOTAL PAID DUE
TOTALS----> 7.00 20.00 0.00 27.00 27.00 ,00
.�
REC'ENUE DIVISION TOTALS--> COLLi£C'FED: 27.00 OVER/SHORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIR£ SMIP/TOT GRADING PLAN—CHECK
27.00 = r
A
'x-***�if****ieie*x'i�'*if�itifif'rt*if*it�*�if**ieiE*i�'it*aE*'ie***�fifiti�"�*'�i�'****'�'ie*'�**�*'��-*i�*'�rtiE+��c-iE�*�-iF
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 Z O•,N_, UNIT COST TOTAL COST
PLU 1 DISHWASHER 7.00 7.U0
END�OF FEES
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, CONSTRUCTION AND PLANNING POO. . SPA
HPPROVALS Permit � � Oate l�spector qppROVALS Permit # Oate lnspector
1, Temporary Electrical Service or Poie 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. $teei Reinforcement 56. Rough Pfum6ing & Pressure Tes[ _
6. Electrical UFER Grnd. 57. APPROVAL TO COVER GUNITE
7, Footings . 58. Elearical Conduit�Undrgrnd.
8. Foundation ' S9. Gas Pipe, O Undrgrnd.. Test �
9. Water Pipe-Undrgrnd. -- , 60. Backwaeh �ines, P•Trap, � Undrgrnd.
10. $tructural Floor System ' 67. APPROVAL 70 DECK �.
11, property Sewer line & House Connection 62, Backwash & Receptor-Final
12. 5ewer Cap 63. Heater & VenbFina! I
13. Roof Drains , �' 64. Plumbin9 System - Fina6 �
74. Rough Plumbin9 65. Electriral�Final
15. pough Electrical-Conduit ' 66. Solar Svstem�Final
16. flough EleMric Wiring - 67, Fe�cinc� & Acca:s Approval /`
i7. Rough Wiring Sign � . 68. APPROVED FDR PLASTERING
18. Rough Electriral•T Bar Ceiling � 69. POOL/SPA SYSTEA9S FINAL
19, Rough Heating & Air Condicioning RRE DEPT. REQUIREMENT
20. Rough Factory Firepiace ', � APPIjOVALS Permit #
21, Ouas, in Structure 70. Underground Hydro
22, DuMs, Ventilating , . . 77, Product Piping O Gas ❑ Oil
23. Gas Pipe�Rough & Test � � 72. Underground Flush
24. Roof Praming . , 73. Undergmd. Storage Tank t7 Gas ❑ Oii
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Cei�ing (Structural) & Monocoat 75. Dry Chemical
27. �rame and Flashing � I6. Dry Standpipe
28. Lathing & Siding '� '� ' 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Orywall Nailing - � HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat • J9. FINAL INSPECTION
32. Electncal Power Meter-Final ' 80. FOOD CEFTIPICATE ISSUED
33. Final Electric • � ' Notes: ' j
9-.�-�-9f-�-v_�u.xr✓_c �ucx.p�' _
34. Pinal Heating & Air Conditioning .
_6_Z�f�? �u� -
35. Finai Gas Pipe•Test
36. Hood or CanoPy ' �
37. Final FactorY Fireplace .
38. Final Plumb;n9 - ..I b�._� �
39. Water Service-Finai
�
40. Gas Service-Final � i � ,
41. Sotar pomesticFinal � � .
42, gackf�ow Preventer
43. Backflow Irrigation
44. t,andscape Irrigation SYstem , � , , .
45. Sound Attenuation . � . .
46. Handicap Regulations , ,
47. FINAL STRUCTUfi,E & BUILDING � 4;' -
48. FINAL PLANNING �
49. E�ectric Release to Edison
50. Gas Release to Southern California-Gas Co ' � . -
51. CEFTIPICATE OF OCCUPANCY •
No Date
�.' " ;�_^' _ yL�ll, t7 �l17o I�6eJJ TL
COSTA MESA BUILDINGSAFETY DEPARTMENT • APPUCATION FOR STR'U�'�'URA'L PERMIT .
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
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For A
BUILDIN
T�ENANT�R �� �U� l�-1� 1 �
ADDRE S I��� 5.�(��� � S�
CITV /'�IiYIGIM.W `�IC�Qb NOL��1�
BRANCH �VL"V f'QfC 1
ADDRESS �"�D ��✓�Y[,T �.�GN 11��'(y[� �1G..
OR ENGINE R' , ry�ly���� NOL N1 ��"+
ADDRESS �I U� ,1y N HFL.WAy /-'yJt C� M
CONTRACTOR ( C{C '�W[JCqay V.��.
ADDFESS ��J� J• ✓lJU(��,ji� �(,��S7-�7C�
CITV
Y�'_Q��M �� � GDi/� NOL 77I�O.JV I
l C Na. �5157 IICyN� 4'�'
OF LOT f S� S rS NO.OF BLDGS. 1
NOW ON LOT �
VSE OF "7�r . _ .� .
Separate perrttits are required for
electric, plumbing and hea[ing work.
USE OF BUILDING AND WORK TO BE PERFORMED
I hereby eeknowledge thai I have �eetl this application antl nate
that the above informetion is corract end aBrea to comply with
all laws regulatin8 builtlin8 �onstruction, antl I shall not employ
any Oerwn in violatlon of ihe workmen's compensallon laws of
tha State of California.
I haraby cartify that I am properly Iieenutl as a contractor untler
ihe State of Caiifornia eusiness entl Professions Cotle, Oivision 3,
Chapter 9, antl that such licenses are in full torce antl effect, or I
am axempt from t Orovisions f ihe Sta t Californta Businesa
antl Professions C , DivCsion ptar .
SIB�ature of
Parmlttea
or f
Authorizetl ABant Date
A.P. NO.
BUILDING
ADDRESSi
UNIT OR
SPACE NO.
TR.NO.
/D �O
NEW �AI
OwNER
USE
APPROVED
2 � -/(o .2 -O � /O
9a ��� --srt: .,
�._ G_z � —
LOT BLK.
APPROVEDSETBACKS
FROM GLSTR
annir / / /
REAR /O FT. O
PLANNING ACTION
REPAIR
VALUE
DATE
— %y'/�
DATE
APPROVED
nnrc � /'
rfOLD FOR SPECiAL REQU1REMtN"P5 1I �
THE AMOUNTSHOWN UNDER VALUATION IS FOR
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV:
VALUATION PERMIT FEE S
L�S7S9 � PLAN CHECK E � 3 � <
,1^� � ,�
$ �y;� TA% E � 'Z�
,.� . -,
TOTALPAID
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COSTA MESA BUILD�NG•SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
BUILDING /��j �/y, __��...�/ �/,�'
ADDRESS /�/!� ��LrrrC�� / 1��
OWNEROR ��� �1.I��^ �
TENANT y ��„�� �y
MAILING I�^ JS• ���
ADDRE55 � ��
GTV
/tTJ� M NOL 7 �%'C�S�L'
BFANCH '/Q:( j
ADDPESS QO �,�h
ARCHITECT
OP ENGINEE O�I'
u�/ l
ADDRESS �/n / � n
CONTRACTOR TLI'i I�
AD�RESS E
• TEL.
CITV � r{I� � NO.
� STATE CITY .{
� LIC. NO. LIC. Np�,�� -j
{,y SIZE NO.OFBIOGS.
L OF LOT 1S � NOW ON LOT
Q USE OF L��nn
� EXISf1NG BLDG. C� / � �O
�
F" Separate permits are required for
q electric, plumbing and heating work.
�.W. USE OF BUILDING AND WORK TO BE PERPOFiMED
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a M��I l U 4^�l - nl� �.�.l57Y!�ct'i,
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a� I hereby acknowletlpa thet I heva reatl this appllcation entl state
ihet the above informetion Is correct end agree to comply with
�+ all laws regulating builtlinB �onstruction, entl I shell not employ
Z eny pe�wn In violetlon of Me workmen's compenution laws of
W the State of California.
3 I hereby certify thet I em properly Iicensetl as a contrector untler
the State of Caiifornia Busineas antl Protessions Cotle, Division 3,
Chapter 9, antl that auc� lic naes are in full force entl eftect, or I
am axay�p� LNmBTSiAof Galitornl�9usineu
entl Pr �¶1�� ����;��`'
.._t.:. 'ti�-�
�.N!%L�iI���/�//7
APPLICATION
RECEI V ED ��'
A.P. NO.
BUILDING ��� /
ADDRE55
UNIT OR ^
SPACE NO. — /.t
TR.NO. LOT
NEW DD LTER
OWNER ', /J. �
USECJ OS '
20NE � �TV
APPROVED
BV
APPROVEDSETBACKS
(FROM C/L STREET)
PLANNING ACTION
APPROVED
"NRALPERMIT 00 TL.
/�I 1H11 I %�
/ a� –..
� � Ad — 2..
BLK.
3 MOVING DEMOLISH
x��
VALVE
GROUP � "J
DATE 3—�d�!]J
DATE
APPROVED
n
i
0
SQ. FT. 1 � ^+
THE AMOUNTSHOWN UNDER VALUATION IS FOR m
THE PURPOSE OF ESTABLISMING A PERMR FEE ONLV: �
VALUATION PERMIT FEE E v
N
m
^ PLAN CHECK S �- m
0
/ / � I
$ � �� TAX E �' f
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f � '
- CITY OF COSTA MESA �
BDILDING DIVISION
77 FAIR ORIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax Qt4) 754-4856 • www.ci.costa-mesa.ra.us ,
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT TYPE: B COMBO
Sub Type: RES_ALT
PERMlT NUMBER: BC08-00�6&
STATUS: ISSUED
DATE ISSUED: 0810712008
= ISSUED BY: YH
�os aooRess: 292 PALMER ST CM�. .�''l. .. Suite/Unif:� _
APN: 93808002 � • � Zoning: , , � �.
Vicinity: KITCHEN, GUEST BATH.&�GARAGE � .� � .Primary�Occ:� R3 ,
Const Type: V-B �`r'�. "' � SQ: FT::' '� 0 Valuation: $12,500.00
��, :" :.
SCOPE OF WORK: REPAIR DAMAGE TO,GARAGE, KITCHEN 8 GUEST BATHROOM1'CAUSED BY VEHICLE IMPACT TO
STRUCTURE-REPAIR SHEER WALLS, FRAMING, DRYWALL, SIDING & DOORS PER INSP. GAFtY-HOOK. MISC. WORK IS FOR
KITCHEN HOOD, VENT FAN, 3 FIXTURES, 8 OUTLETS, 3 SW ITCHES, 1 DISHWASHER, 2 P-TRAP, KITCHEN SINK, 1 WASH
BASIN. & 1 �`, - . . � , - .
TOILET. � 1•% � - � ' � ' "
:. .-: j • �. — , ' .
,. . . . .. �-.,�
OWNER: HARRIS GEORGE JOHN I - � Address: 292 PALMER ST At � � ' Unit:
Phone: � ���' `� � � .1� City/State/Zip: COS7AMESA. CA � , .. , � `.3i,� ?(i�
APPLICANT: AND�RSON, LAWRENCE
Phone: 562822-5342�� �� �
;'r i
CONTRACTOR: HAR-BROINC ��-��'
Phone: 562-528-8000 �_ - ,_,
CeIL
� �-Address:
�Ciry/§tate/zZip:
Adaress:
Ciry/State:
` - License No. 258441'
2750 SIGNAL PARKWAYUnit:
SIGNAL HILL, CA �
ARCHITECT: � License No.
ENGINEER: � License No.
COMBINTATION PERMIT FEE SUMMARY
Building Plan Check: �. . , $0.00 �
Building Fees: $223.25
Electrical Fees: $38.90
Mechanical Fees ' , , $41.40 . � '
Plumbing Fees: $82.30
SMIP Residential: $1.25' '"
SMIP Commercial: $0.00 � �
TOTAL FEES; $387.10
••Refer to fee recelpts for a�l fees paid for project
. . _.>��"'�
Unit: :
ZipCode 90755-2207
PHONE:
PHONE:
':)
_ -'.:Z
..::.:,ti
NOTICE: The work authorized by this permit shall wmply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No, 92-28, § t, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF IAST 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 inspectfons and final approval must be obtained. Failure to obtain inspections and final approval will result in the ezpirafion of this pertnft.
OC pEt, INSPEC710N7YVE Q� INTITIRL COOEt INSPECiIONTYPE DAIE I TITIRI
1616 Fixed System Final Fire Prevention ' 206 Final Mechanical I' Z.'0
7266 Pool Spa Final . 208 Final Plumbing 1!' Z�QA
200 Final Ra-Roof 210 Final Electrital / � V
201 Final Blak/Reteining Wall 212 Final Fire Prevenlion
202 Final Fattory Fi�¢ place 2T0 Final Planning Approval
203
�4�
Final Sign
Fnal Dertqlili0q
222 Final Site p Y'+—
250 Final Building/Occupancy — Z� V
WORKERS' COMPENSA710N DECLARATION:»
I hereby aNirm under penalty of perjury one of the following declaretions:
❑ I have and will maintain a certifcata of consent to self•Insure for vrorkere'
compensation, as provided for by section 3700 of the Labor Code, for the
peAortnance of Ihe work for which ihis permit is issued.
� I have and vrill maintain v.orkers' compensal'an insurance, as requiretl by
section 3700 of the Labor Code, fw the peRwmance o/ 1he �+ork (w which Ihis
pertnit is issuetl. My v,nrkers' compensation Insurance wrrier and policy
number are: / n
Camer: Z tsifh /Tmri�.«�rls,.v Co
(ihis secfion neetl �af be mmpleted d Ihe peimi! is valued a�f o/ne nunOretl cbllars (S10pJ a less )
Policy Number. G(9 C�j �� 7� 7 �
❑ I certi(y that in lhe performance of the work for which this permil is
issued, I shall not employ any person in any manner so as to bewme subject
to the workers' compensation laws of Califomia, and agree that if I should
become subject to the workers' compensalion provisions of Section 3700 of
lhe Labor Code, I shall forthwith comply with lhese provisions.
<< �-7-OC�
Appifanl's Signature Oate
ARNING: FAILURE TO SECURE WORKERS' COMPENSATION CAVERP,GE
IS UNLAWFUL 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 affirm that I am licensed untler 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 ef(ect. /�
Lia # � .� `rS ` Y �% � Gess tt /�
GQ7�� O S!
n <tor'sSlgrolure Da��
CONSTRUCTION LENDING AGENCY:
❑ I hereby affum that there is a constructbn lending agency for the
peAortnance of iha v.ork for v.fiich this pertnit is issued. (Sec. 3097, Civil Cotle).
Lender's Name:
Lender's Address:
Date
OWNER-BUILDER DECLARATIONS:
I hereby aKrtn lhal under penalty of perjury ihat I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the follovnng reason (Sec. 7031.5,
Business and Professions Code: Any ciry or county which requires a permit to
constmct, alter, improve, demolish, or repair any slrucNre, prior ro its
issuance, also requires the appliwnt for such permil to fle a signed stalemenl
that he or she is licensed pureuant to the provisions of lhe Conlractors
License Law (Chapter 9(wmmencing with Section 70W) of Division 3 of the
Business and Professions Code) or Ihat he or she is exempt therefrom antl
the basis tor the alleged exemption. Any violation of Section 7031.5 by any
applicant for a permit subjects the applicant to a civil penalry of not more than
five huntlretl tlollars ($500).):
❑ I, as owner o( the property, or my employees with �vages as their sole
wmpensation, WILL DO THE WORK, and Ihe structure is not intended or
oKeretl for sale (Sec. 7044, Business antl Professions Code: The Contractors
License Law dces not apply to an ovmer of property who builds or improves
lhereon, and who dces such wark himself or herself or through his or her ovm
"employees, pmvideC that such improvemen[s are not intended or ofleretl for
sale. If, hovrever, the building or improvement is sold within one year of
completion, the ovmer-builder will have the burden of proving that he or s�e
did not build or improve for purpose of sale.).
❑ I, as owner of the properry, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to conslruct the project (Sec. 7044. Business and
Pmfessbns Cotle: 7he con[ractas License Law dces not apply to an owner ot
property who builds or improves Ihereon, and who contracts for such project with
a cantractor(s) license pursuant to lhe Contreclors License Laws.).
❑ I am exempt under sec.
Business and Professions Coae for this reason:
Owner ID verifietl by dnvi i � Yes ❑ No
Driver's License No. � Expires: �
Verification of Ownership by (type of document, i.e. • property tax bill or deetl):
DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION:
❑ I hereby certify ihat no excavation frve (5) w more fcet in depih into v.hich a
person is requiretl to tlescentl, will be made in connection with work author¢ed
by this pertnit, and lliat no building sWCWre, scalfdding, talsework, or demolition
or dismantling thereof, vnll be more than thitly-six (36) feet high. (Chap. 32, Grp
2, Art 2, Sec. 341, Ttle 8, Califomia Administrative Code).
❑ As owner-builder, I will not employ anyone to tlo work which would
require a permit from the Division of Industrial Safery, as notetl above, unless
such person has a permit to tlo such work from lhe division.
Appliwnl's SignaWre Oale
Division of Intlus[rial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will �he appliranl or present or future building occupant need to file antl
certify a Business Plan for emergency �esponse [o release or threatened
release ol a hazartlous material? ❑ Yes ❑ No
(Section 25505 of the Califomia Health and Safery Cotle requires, with some
exceptions, that a Business Plan be filed with the CosW Mesa Fire
Department by every business which has al any one time dunng a reported
year a quanliry o( hazardous materials equal to or grealer Ihan a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of wmpressed gas
at standard tempereture and pressure).
2. Does or will the applicant or present or future building occupant need to fle
a registration form for acutely hazardous malerials? ❑ Yes ❑ No
(Section 25533 ot the Califomia Health and Safey Cotle. vnth some
exceptions, requires regist2tian vrith the Cosla Mesa Fire Department by
each business which at any one time has on hantl a quanti[y of acutely
hazardous materials equal to or greater ihan a weight o( 500 pounds, or a
volume of 55 gallons, or 200 cubic feel of compressed gas at standard
temperature antl pressure).
3. Does or will the appliwnt or present or future builtling oaupant neetl to
prepare an RMPP (Risk Management anG Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the Califomia Heall� anE Safery Code proviCes that the
Cosla Mesa Fire DepaAment may require the preparation, certification and
Ning with lhe 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 0( lhe Califomia
Health and Safery Code been (ully complietl wilh7 ❑ Yes ❑ No
5. Dces or will the applicant or present or future building occupant require for
Ihe work which is the su6ject of this application a permit for such consWction
or modifcalion from Ihe South Coast Air Quality Management Distnct or from
any other air polNtion conlrol tlisMct or agenry? ❑ Yes ❑ No
(Seclan 658502 of Ihe Califomia Govemment Code requires lhat the requestetl
informa�bn be (umished on applications for rWn-residential building permils).
6. Will any part of ihe facility to be Conslructed under this permit Ge within
1000 feet from Ihe outer boundaries of a 5cho017 ❑ Yes ❑ No
Qf'yes", Ihe faciliry must mee[ [he requiremenl of Sections 25534 and 42303
of the California Health and Safery Cotle).
7. If a permit trom the Soulh Coast Air Quality Management District or other
air pollution control district or agency is required for the vrork which is the
subject ot Ihis appliwtlon, have all of the disclosures prescribetl by Califomia
Health and Sa(ery Code Section 42303 Deen matle? ❑ Yes ❑ No
8. (If �yes', altach certificale of wmpliance�from the appropriate air pollution
conirol oKcer). � .
CERTIFICATE OF COMPLIANCE: I ceAify that under penalty of perjury the
information given above is covecL I agree to wmply with all state laws and
city ordinances regarUinq Hazardous Materials and Emissions. .
Signalure Da�e ,
CERTIFICATE OF COMPIIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury ihat I have reatl this application and sta[e ihat
Ihe information given is correcL I agree to comply with all state laws and ciry
ortlinances relating to buil0ing construction, antl authorize representatives o(
the Cily of Cos[a Mesa to enter upon Ihe aboveEescnbed pmperry for
inspection purposes. I agree not to occupy or allow occupancy of any building
aulhorized by this permit until final inspection.
Signalure ol Lepal Onwne/r�sf_� Da�e A
Si9nalure Date . L Z"�f�a�`�Yi p�7`��[
]OS)�d6 (10])
AnOlp Aut�onie0 Applicanl Ddl¢
(714) 754-5273 • Feu (714) 754-4856 • www.cl.cosla•mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Jobnddress: 292 PALMERST
Suile:
Vicinity: APT BLDG A
Parce� Number: TPN003183
Zoning:
Applicant: BURKE, MIKE ,
Address: 1653 SUPERIOR AVE, -� � . � _ �
� �:'� ' Phone: (949)642-7222
COSTA MESA; CA- ��- "_-' Zip: 92627
i�
/. ��'.
� �_, .
Owner: PALM.COURTHOA- ' �
Address �292 PALMER � � - - -
ISSUED BY:
Status: ISSUED
Applied: 11/24I2003
Issued: 11/24/2003
. -�
i
/ � j;' � �; �, , � _ Phone: 949-642-7222 , �� , � . � � �.
', COSTA MESA; CA �- � �� . Zip: � ' ` , , ' .
� , , ,� ' . , , .
.' i . : j,',..-.- ,�,�, �, ..
Contractor. �LEE ROOFINGOF COSTA MESA ` � � "
� �; .
i Address: 1653 SUPERIOR AVE - ��`
, � , . " . Phone: (949) 642-7222 . � .
� - � : COSTA MESA, CA � ' � :
Zip: � 92627 ,. '.License: 349686 , � �
Arch : - � Eng:
Address: � - � � � �' � ' : � Address: �
'� . � � Phone: � � - � Phone:
, Zip: � � � , ' License: � � License:
� -
� SCOPE OF PERMIT
REROOF APT BLDG A: TIO EXISTING SHAKE ROOF, 1/2' O58 SHTG, 1'LAYER 30# FELT, AFPLY'30-YEAR GAF TIMBERLINE SHINGLES.' 37
S�UARES
' � � � . FEE SUMMARY �- � - .
` Plan Check: $0.00 ' -
Permit: $23725 �
� SMIP Res:' $1.34 � -
SMIP Com:. , . $0.00
•, �_ Other.� �. ,$0.00
�Irispection:- �$0.00 � '
� .�
�. -
\ Total: �$238.59 � „ : � - �
�� :� ,: � , :c.
Calc Valuation. Si3,3ea.00
Claim Valuation: s�s,ssa.00
� � � PLANNING & ZONING
SETBACKS�, � �
MAIN STRUCTURE Front 0- 0, �� � - Rear- 0. 0
V ��
� �
ACCESSORY Front,' 0= 0 � � Rear _ 0. 0
� ,
PARKING Existin : �0� _ �- 'Reauired: �0. �
Left 0- 0
Left 0- 0
Pr000sed:� 0
Righl � � 0-0 . �
Right 0- 0 � , �
i.'
INOTICE: The work authodzed by this permit shali compry wflh all applicable handicap access requirements under Califomia statutes and related
, regulations. (Ord. No. 92•28, § 1, 12•21-92)
EXPIRATION: This permlt shall automatically expire and become void it work is not commenced wlthin 1 BO days, or if work Is suspended or abandoned
br a pedod ot 180 days. '
INSPECTIONS: In order lor the work aulhorized under this permit to be consitleretl legal, such work must comply with all epplicable eodes, end ell
requlred Inepeetiona end flnel epprovel musl be obtained. Failure to obtaln inspections and tinal epproval will result in the expiratlon of this permit.
FOR INSPECTIONS CALL: (714) 754-5626
zae-ae �a�oo�
[D`ECLi4RAt%ONS�
WORKERS' COMPENSATION DECLARA710N:
I hereby attirm under penalry of perjury one ot Ihe following declarations:
❑ 1 heve entl will maintain e certiTcate ol consent to selt-Insure tor warkers' campensetlon, es pravidetl tor by section 3700 oi the Lebor Code, for tha peAarmance o1 the
work for w�ich Nis pertnit is issuetl.
,�� 1 have and will maintain workers' compensetlpn insurence, es required by section 3700 of Ihe Lebor Code, for the peAortnance of Ihe work tor whitli Ihis permit is IssueO.
My workere' com nsatlon surance carner en pdicy number ere:
Carrier. Policy Number. ..�D �/ � � ZGO�j
(Th/s sec0on need nof be completetl/l e permir is ve�uea e� one nu�ree eoners �Sioo) o� �ess.)
❑ I cerUfy that in Ihe peAormance ot the wo which this permil is issued, I shall not employ any persan In eny mflnner so es ta become sub�ect lo t�e workers'
compensation laws oi Calllamia, end e et il I should become sub�ect to the workers' compenselion provlslons of Sactlon 37 �Ne Lebor Cade, I shell toMwlih
wmply with these ro ' 'o .
ApDllcent SignetureC Dete: �'1 _�� —t� ��
WARNINO: FAILURE TO SECURE W (ERS' EN$AT�pN ppVEqpOE IS UMAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINALPENALTIES AND GVIL FlNES UP TOONE HUNDRED
THOUSANDDOLLARE�5100,000 ADDRIONTOTHE�$Tpp�f,�pEry$p7�pN,pqMpGESlSPROVIDEDFORINSECTION3'l090FTHElABOR�DE,INTEFE5T,ANDATTORNEYSFEES.
LICENSED CONTAACTORS DECLARATION:
I hereDy eNirm that I am Iicensed under prm�sions of Chapter 9(commendnp wilh Sectlon 7000) ol DMslon 3 ot the Business entl Professions Code, entl my Iicense Is in full
larce end ettect LJc. a � Class N'
Comrectofs Slgnature: '�(,{ ���(( Dete: /� O `G
CONSTRUCTION LENDING AGENCY:
❑ 1 hereby affirtn that t�ere is e construction lending agency for Ihe peAortnance of iha work lor which this permll Is Issuad. (Sec. 3087, Civll Cotle).
lentler'S Name: Lentlefs Atltlress:
SignaWre:
Dete:
OWNER-BUILDER DECLARAT10N5:
I hereby eftirm �het untler penelry of perjury Ihet I am EXEMPT FROM THE CONTRACTORS LICENSE LAW lor 1he lallowing reeson (Sec. 7031.5, Business end Prafessions
Code: Any ciry or counry which requires a pertnit lo conslruM, elter, improve, tlemolish, or repair eny struqure, prior to its Issuance, also requlres tha applicant lor such pertnit
to fila e signed stetement that he w she is Iicensed pursuant to the 0���5 of Ne Contradors Licensa Lew (Chepter 9(commendng with Section 7000) of Dh�islon 3 ot Ihe
Business and ProFessions Cotle) or Net he or shg is exempt Neretrom and tha besls for the elleged exemptlon. My Nolatlon of SecUon 7031.5 by eny appllcant for e pettNt
su�jects the applicant ro e civil panalry o1 nm more than five hundred dollars (5500).):
❑ I, as owner of the proparry, or my employeeS wlth wages es Uelr sole wmpensetlon, WILL DO TME WORK, and Ihe structura Is not intendetl or aHered tor sale (Sec.
7044, Busineu and Professions Code: The Contractors License Lew does no� apPh to en owner ot pmperry who bullds or Impmves t�ereon, erW who does such worlc
himself or herself or through his or her own gmployaes, provided ihet such Imprwements are not Intended or aHered tor sele. If, however, the building or improvement is
sdd wiihin one year of wmpletion. Ne ownqr-builder vrill have the burden of proving Ihat �e or s�e tlitl not Duiltl or improve tor purpose ot sele.). �
❑ I, as owner of Ihe D�operty. am E%CLUSIVELY CONTRACTING WIiH LICENSED CONTFiACTORS to construct t�e project (Sec. 7044, Business end Pmfessbns
Cotle: The contrecrors Llcensa Lew does not appty ro an owner ot property w�o builAs ar impmves thereon, end who contrects lor suc� Droled with a contrector(s)
license pursuant to the CoNractors Licensa �ws.).
❑ I am exempt under sec.
SignaNre:
Owner ID verified by drivers Iicense. ❑ Ves ❑ No
Business end Pmtessions Cade lor this reason:
Vedtication of Ownership by (rype of daument, i.e. - properry tae DIII or deed):
OIVISION OF INDUSTRIAL SAFETY VERMR C@RTIFICA710N:
Drivel5license No.
Date:
Expires:
❑ I hereby certily that no excevetlon iNe (5) or more leet in tlepth Into which e person is requireO to descend, will be matle in wnnection wlth work euihoAzed by this
pertni6 end that no building strudure, scalloltling, lalsework, or demolition or dismantling thereot, will be more then thirry-six (36) laet high. (Chep. 32, Grp 2, Art 2, Sec.
341, Title 8, Celitomia AdministretNe Cotle).
❑ As owner-builtler, I wlll not employ enyone to do work wNch woultl require e permit trom the Dlvislon ol Intluslrial Seley, es noted ehove, unless auch pereon �aq e
pertnit lo do suc� work irom the dMsion.
SignaWre: Date:
Divisian of Indusirial Sefety Permit Number:
CERTIFlCATE OF COMPLIANCE AND AUTHORqAT10N OF EMRY: I certlty unOer penelry o1 per�ury Ihal I have read this epplication end stete thet the Intortnetion given is
correct. I egree lo compty wllh ell stete laws entl dry ortlinences relatinp to bulltling conswctlon, anO euthadze representetives of the Cly ol Costa Mesa to enter upon t�e
ebove-Aeurlbed property for inspection puryoses, I egree not lo occupy or ellow occupancy of eny building eu�horized by thls permit until linel Inspection.
caoe r.
1616
1286
200
201
202
203
Fiaetl System Flnel Fire Preveniion
Pool Spe Finel
Finel Re-Rool
Finel BIocWRetaininp Well
Flnal Fectory Fire Place
Final Slgn
200 Finel Demditlon
QAIE lii�IdL9
( Z'�' "� —`¢i"�
/�/Z5�/ `�ate
Date
CODE� INSPELTIONTYFE
208 Flnal Mechenlcal
200 Final Plumbing
210 Finel ElectAcal
212 Finol Fire Preventlon
220 Final Planning Approval
222
250
Final Site
Finel Building/Occupency
pAg It�Li
City ofCoste Mese •
Buildinp Safety Depertment
P.O. Box 7200
' Costa Mesa, Celifomie
� `'r � �I .- ' �,:•. , � ." .
CERTIFICATE OF OCCUPANCY
i
The Building located at 799. P�lmar� Ctraat .k-1 R A_9 � ' ' ,
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group .� � Occupancy. , � � .
IUse of Building Cnniin'r �� � '
Legal Description AP;IH9F-1F9-l10 ' � '
. - � (Sae reverse side for Metes end�Bounds)
r
BuildingPermitNo �n���inna�n ElectricalPermitNo.���o����i�� PlumbingPermitNo,�n�C��r.r_ i40Sr�
t;. . , . _ . .' . - - � _ '' � !- , �. --
�� Number of apartments '� -�_ N.T and/oi�guest rooms- =�= � - �- " - �-
ISSUED TO:
Building Official-�-�
�..-�i...L�.-,eQ*.. � � `"'k--�
�.bY 1�L�`z �.. � /'�' `�',7.1:_.
n z N TNUFCTMGRITC "' V1C�OP C. P�aWtO�-D1t^2Ct0Y 61111CIlnq I�1V75T�. �
� ' � . Daten„�„�,,.„ oi ��nn �
This'Certificate of Occupancy SHALL BE posted in a�conspicuous place on the premises and SHALL NOT BE removed except by the
Building Official of the City of Costa Mesa under Sec. 306 (e) U.B.C. !
Form BU 34 Rev. 11/70 , . . . '
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COSTA MESA BUILDINGSAFETY DEPARTMENT APPLICATION FOR�S'fli�l$C�'�fJ$A`�.PERMITI30.52 TL
P.O.BOX1200 COSTAMESA,CALIFORNIA92626 -�- ' - �
E B PERMIT �^
For Applic ' in 1— U Ink Only
.%
BUIIDING A.P. NO. � �_�� `� - O O '
ADDRESS . ^
BVILDING�-p --- -n � � y��
OWNERORD `, �V�1.�y��� ADDRESS �/a. ..-G�4�. ��1 ._ .
TENANT d'�V Gl�•� - /� ---'
MAILING 1 '1.2�J C _ .^\_ � �%�_S�y. SPACE NO. '� ` � r� -
A�DRE55 / ! 1� �J ��ZJ ^-� L —'" '
TR.NO. LOT - � BLK.
��T� %�1n�t�ir� ' q2� No`.�931-o5oi �so � �
NEW ADD AITER REPAIR MOVING DEMOLISH
conisraucrionr7AC.1�IG %Or.i�Al_. 5�%L--
I FNf]FR i
BPANCH
ADDRESS
ARCHITECT �1 TEL: ] ',Z
ORENGINEER N �ZINI NQ �S�"J�S�
ADDRESS ���� t\/-"^'P�WA/ NVC C.�
�-�
CONTRACTOR 11�C �W �
ADORESS ���� �,�UGV1S� w• SI�.J�
CITV/�YVI�.NEIh( �CA QZpt/�o NOL 771 y,�/�
LIC. NO. ���� J� �ICVNQL�i�W�I
SIZE '�.S-7S NO.OFBLDGS.'
OF LOT � � NOW ON LOT
USE OF ^y�
EXI5TING BLOG. ��-`O
Separate permits are required for
electric, plumbing and heating work:
USE OF BUILDING AND WORK TO BE PEFiFORMED
I heraby acknowled0a that I have read thls application anG state
that the above Information iz correct and apree to comply wlih
ell laws re8ulating building conscructlon, antl I sha11 not employ
eny perwn In violation of the workman's compensation laws of
the Siata ot Californla. . . �
I hereby certlfy thai I am p�ope�ly licansetl as a contractor under
the State of California eusiness'�antl Professioiis Cotle, Division 3,
Chapter 9, and that h licenses�are in full torce entl etfect, or I
am exempt from i rovisioni ot he S a of C ornie Businass
antl Professions C tl Division ap �Li��
Signatufa of � 'A
Permittae lruJ�� '
or
Authorized Agent Date
OWNER N IY K-> rl�lr'I
VAL
USE
20NE K Z TVPE GR
APPROVED
gV DATE
APPROVEDSETBACKS
R. SIDE N D FT. d
L. SIDE 9� FT. v
REAR S FT. d
PLANNING ACTION
APPROVED
�,_, `"_-i '
C� SGw.,�o�
zr_ _�9-/
3 /�o/�o
�f:
�a
�
�
AOLD FOR SPECIAL ►ttllu�t�C»"�''+' - � �
i . . J d �
I)� �
SQ. FT. � �1 �' �mv
�
THE AMOUNT SHOWN UNDER VALUATION IS FOR m
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV: �
VALUATION PERMIT FEE S a
��� PLAN CHECK y � s "�
$�38Z , , '
TAX $ f
� U
TOTALPAID $/�A � S�
�aao 3ieiiea 195.aa ?�
. . _,..,-> --
• COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR STRUCTURALPERMIT
P.O. BOX 72� COSTA MESA, CALIFORNIA 92626
RECEIVE BV PERMIT ^��
For Applicant to Fill in Completely — Use Ink Only �1
BUILDING (/ ,. p ...,_ _ . _ '� n L�_ /�: A.P. NO.
MAILING �
ADDRE55 /��3�0���'���f��
� A 'c TE
CITV�'�L�yK r/Tq�0�6 NG
ODNSTRU N
LENDER f �'� .�
BRANCH �iLZJ�T
/ `7
ADDRESS (l� O � ' d _ Ja
ARCNITECT � TE
OREN INEE ,�ti
BVILDING � / /
ADDRE55
UNIT OR
SPACE NO.
TR.NO. LOT BLK.
�/ NEW ADD ALTER REPAIR MOVING DEMOLISH
OwNER
VALUE
USE �Q S
n� ZONE J TVGE GROUP
APPROVED �
gy DATE —
CITV ` NO� '�CZS�
E STATE CITY APPROVEDSETBACKS
� LIC. NO�y'S '� LIC. NO. �y�
{J,� SIZE NO.OFBLOGS (FROMC/LSTREET)
M OF LOT - NOW ON LOT ONT FT.
a USE OF
� EXISTING BLDG. .%')1 O
y
FSeparate permi[s are required for L SIOE Fr.
� electric, plum6ing and hea[ing work: REAR Fr.
F USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION
a
o .
• DATE
a� � APPROVED
� APPROVED
y, -�
'' ��
x
w
0 1 haraby acknowletlBo that 1 have reod this eppllcation antl state �
y� Nnt tha ebove Information is correct end a0ree to comply with
0+ ell laws regulotinp building consttuetlon, entl I shall not amploy �
z any parmn in violation of Me workman's eompentation laws of E
W ffia Steta of Ceiifornla. y�
3 I hareby cenify t�at I em properly Ilcenaed ea o contrector under SQ. FT.� 7 �W`+
tho Siete of Colifornia Busineu and Profauiona Cotla, Dlvlsion 3, TNE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chaptar 9, and Nat suc� licanses are In full force antl eftaet, or I THE PURPO6E OF ESTABLISHING A PERMIT FEE ONLV: �
am exempt irom tha provisionsai ihaSiata af California Busineu VALVATION PERMIT FEE 5 •!� q
entl Pr �
PLAN CHECK S r� �
SI �
Pe I $ TAX S � LL
P
Aut� Ize�Apent I�jfl _ � TOTALPAID S� -� u
� '