HomeMy WebLinkAbout1947 POMONA AVE - Building Permits - .a F t
CITY OF COSTA MESA ,
BUILDING DIVISION
•44100 DEVELOPMENT SERVICES DEPARTMENT PER T NUMBER
PERMIT
03-02014
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 1947 POMONA AV Status: ISSUED
Suite: A Applied: 11/20/2003
Vicinity: ROOF Issued: 11/20/2003
Parcel Number: 42226128 Zoning: R3 R3 /r////
Applicant: KYLE LEWIS - - - _ ISSUED BY: �0L�
Address: 4071 E LA PALMA „---N%''
SUITE K Phone: 714-632-3800 -
ANAHEIM,CA ,(2-- • Zip: 92807 - i ��
Owner. HAEFELE; ROBERT C TR
N
Address i 1186 N-GROVE ST - - N
A , - - Phone: ''� - , N - ,VN
i ANAHEIM;CA Zip: 92806 -
Contractor: N-LEWIS-& SONS'CONSTRUCTION 'y�\ ..��
'Address: 4071 E LA/PALMA "N��- , -N
SUITE K--% Phone:' 714-632-3800 -` �
ANAHEIM,CA
Zip: - 92807 . License: 416525
Arch : < • Eng: - -
Address: - - - .. Address:
Phone: ,- , v Phone:
i
'Zip: - . = License: `.� License:
- ` ,. SCOPE OF PERMIT-
TEAR OFF EXISTING ROOF. INSTALL,30#FELT,30 YEAR COMPOSITION SHINGLES AND REPLACE SHEATHING AS-NEEDED.27 SQUARES
FOR BLDG.A - - . . .. ..
", ;^ -, FEE SUMMARY.,'. '_
Plan Check: , $0.00 - - - ,. - - ' Calc Valuation: $4,000.00
• Permit: $97.25 '` Claim Valuation: $4,000.00
'.-SMIP Res: $0.50 -/ , '
SMIP Com: ', $0.00
Other: ' '. -$0.00 ,
Ins'pection: , x$0.00 w.,: - ;
,e _
VNotal: ' $97:75 . .. - . _
N v; N'-
`� ' PLANNING &ZONING .
SETBACKS‘, \-. .,\,, _ . N
MAIN STRUCTURE'Front 0-0 ; , A Rear- 0 0 - Left 0-0 -
N-
ACCESSORY Front 0-0, Rear 0-0 Left 0-0 Right 0-0 " :"
, •
PARKING Existing: 0 - Required: ,0 Proposed: 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 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
2446-46(6/00)
DECLARATIONS c i i;•
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
0 I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
1 I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued.
My workers'/� n�pt' n Insurance carder and policy number are:
Carder: _ Lrdr( (r - Policy Number:l Ill-C-5 6164 /6 30/
(This section need not be completed if h rmil Is valued et one hundred dollars($100)or less.
❑ I certify that in the performanc of e 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 Califor a, nd 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 provi ' o
Applicant Signature: ,_Date: '//-Z6"-a ✓
WARNING:FAILURE TO SEC WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(5100,000),IN ADDITION TO THE MAT OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 370B OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DE 'RATION:
I hereby affirm that I am'leers der proyisions of Chapter 9(commencing with Section 7000)of Division 3 offi a Busirgpss rofesslons Code,and my license is in full
force and effect.Lic.N1 •
$'L S C
Contractor's Signature: �/ Date: 711" -015
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(commenting 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 properly,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 ere 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 Cale for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires:
verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet In depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title B,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: •
1 WIII the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, P
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 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
(Section 25534 of the California Health and Safely Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 if an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application a,aernit for such construction or modification
from the South Coast Air(Duality Management District or from any other air pollution control district or agency? 0 Yes 0 No
(Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(if'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (if'yes',attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF CO, PUMICE 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 toad.. ply 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 dor arty for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
✓��/
Signature Of Legal Owner(s) 15Y Z_o /Date
' • And/Or Authorized Applicant Date
;ODE I INSPECTION TYPE SAME UITITIALE CODE II INSPECTION TYPE ZEE IIiIlDELS
1616 Fixed System Final Fire Prevention -0/'-/�(Qf/�.� 206 Final Mechanical
1266 Pool Spa Final Y t 2081Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
. ' 11
CITY OF COSTA MESA •
-
ta4 w9 BUILDING DIVISION
li li DEVELOPMENT SERVICES DEPARTMENT PER IT NUMBER
If 14y PERMIT
J �" do B03-02015
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 1947 POMONA AV • Status: ISSUED
Suite: B Applied: 11/20/2003
Vicinity: ROOF Issued: 11/20/2003
Parcel Number: 42226128 Zoning: R3 R3 Y
Applicant KYLE LEWIS -- ISSUED BY: SD/�
Address: 4071 E LA PALMA -' " -%y' —1 - _
•
SUITE K r-- �y i_- - Phone: 714-632-3800 ' -_ -
ANAHEIM,.CAi�_'-- Zip: 92807
Owner: HAEFELE; ROBERT,C TR'- - ' l • / V',- \-��
Address .186 N GROVE ST - - - .1// ; V „ Phone:
j/ //ANAHEIM;CA/ - Zip: 92806 .�
Contractor: LEWIS &'SONS CONSTRUCTION
7
/Address: 4071 E LA:PALMA .; '
' / ' ' ' SUITE K-/ Phone: 714-632-3800 '
'. ANAHEIM,CA
Zip: 92807' License: 416525 .
Arch' : - - - '' Eng: ,
Address: ' . ' - - . Address:-
,Phone:" - Phone:
•
Zip: .� -" License: ' License:
/ .- ,r', SCOPE OF.PERMIT- ,
TEAR OFF EXISTING ROOF.INSTALL 30#FELT,30 YEAR COMPOSITION_SHINGLES AND REPLACE SHEATHING AS NEEDED.27 SQUARES
FOR BLDG.B
' _ FEE SUMMARY • '
,, Plan Check: $0.00 . — -- , ' ` Calc Valuation: $4,000.00
Permit: $97.25 �' Claim Valuation: $4,000.00
SMTP Res: . . $0.50 ,
' , SMTP Corn: $0.00 '
Other: . $0.00 •
\Inspection: A$0:00 •
p7`
Total: ' ' $97:75�'. - '.
�7 ,
PLANNING &ZONING ,
SETBACKS
MAIN STRUCTURE' Front 0-0 ' ' Rear - 0-0' Left 6-0 Right - .0-'0 ' '
` ' -
ACCESSORY Fro`nt 0-0 `,/ Rear , 0-,0 - -, Left 0-0 ' Right - 070 1 /
N
PARKING Existing: '0.,' Required: -0- Proposed:. 0 '
-i
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
2446-48(800)
•
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
..,c, work for which this permit Is issued.
E��I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued.
/ My workers' pensatlon Insurance carrier and policy number are:
Carder: //��( Policy Number: 'A2,522I441 1030/
(This secfic dee not be tromp edit the permit Is valued at one hundred dollars($100)or loss.)
❑ I canny that in the perfo 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 C la,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' oW s. 11-7.
�0 3
Applicantv //Signature: Date:
WARNING:FAILURE T E URE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMIN PENALTIES AND CML FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($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 DECLA N:
I hereby affirm that I am licen,pejoi ,e� visions of Chapter 9(commencing with Section 7000)of Division 3 of the Buslne, s rofessions Code,and my license is in full
force and effect.Lic.p11 /t A 5- Class# L'
Contractor's Signature: Date: �1 6-0-5
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 properly,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 properly who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every •
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure). _ —
_
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 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 end 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
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 if an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification
from the South Coast Alr Quality Management District or from any other air pollution control district or agency? Yes No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If yes',the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). _
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If yes',attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF •0• -UANCE 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 t/ . 'ply 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-describe/-r.:erty for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signature Of Legal Owner(s) //—Z/7-20.-63 3 Date
Vr And/Or Authorized Applicant Date
CODE I INSPECTION TYPE QAIE ILLS CODE I INSPECTION TYPE PAIL ?MAL@
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 446 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition • 250 Final Building/Occupancy
PROJECT ADDRESS: 1947 POMONA AV UNIT: g CITY OF COSTA MESA — BUILDING PERMIT PEM NO: P V7b1b4
OWNER'S NAME: RUDY MAR IMAN
ADDRESS: 1955 POMONA AV PERMIT NO: P 056164 PLAN CHECK NO: N buy! : N 5UPI): N
COSTA MESA `
CA 92627 CONSTRUCTION TYPE: 5—N PERMIT TYPE: PLU PURPOSE: OTH
( 714 ) 642-5858
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : BATH TUB CHANGE—OUT SQ FT:
ADDRESS: UNIT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /
PERMITTEE: MEIER PLUMBING ( 714 ) 557-3312
ADDRESS: 2521 S . DIAMOND COMMENTS: REPLACEMENT ONLY
SANTA ANA CA 92704 ##******#*%+E *#**%#Tc##************** ****#%*# •N :##N#.N.%.x.N..**** a*## x****>E#*#ae**#*
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS
�s DOD)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACKS
✓ ITYLIC.: 0, 5236 STATE LIC.:297435 cuss: C-36 •
Date: a/ � I �Z signatu — MAIN BUILDING ACCESSORY BUILDING
A A FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
WORKERS'C cal
TION DECLARATION: I hereby affirm that have a certificate of consent to self-insure or a certificate of Workers' LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
Compensation Insurance.or a certified copy thereof(Section 3800,Lab.C).
POLICY EXP.DATE:
COMPANY: 1:] PARKING REQ• PROV: PARCEL : 00000000 ZNE: REF NO:
r] Certified copy is hereby furnished. Certified copy is filed with the city Building Division. PLANNING NOTES>
**•####*##*###*************************** •*###**#xN*##**##**#*####***#**#**#####
Date: Applicant* DEVELOPMENT S E R V I C E S'- REQUIREMENTS
EXEMPTION FROM WORKERS'COMPENSATWN DECLARATION: (Nus section need not be completed it the permit is for one hundred 15100)or less). -
I certify that in the performance of the work for which this permi�i issued.I shall not employ any perso in any manner so as to become
subject to the W ikons'Coogipensation Laws of Califomi• - I / ///9 ,x ZONING APPROVED BY DATE:
r--
Date: 1 / ' 4- Signature:! S/e .� /�
NOTICE:A alter mkking this declaration,you should become subject to the Workers'L`ampensation provisions of the Labor BUILDING APPROVED BY DATE:
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y• s�_ , rte/ ' ,;,,L . •
DATE: vl �
which this permit is issued(Section 3097.Civ.C). *******K''****IE**51*%*##ft' ' xn' -I' ,s lr,civ - r. '*********#3FSF� - x#*
LENDER: **********#*****#********************* ***1, ***********************************
ADDRESS: LEGALIZATION;N F E E S U M A R Y STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code'. Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 2 00
repair any structure,prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 5% SMIP/NON—RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 70W)of Division 3 of the Business PLAN
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty 01 not more than live hundred dollars(S5W). ISSUE FEE 3.00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
I, as owner of the property or my employees with wages as their sole compensation, wit do the work, and the —
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS—— — 2 . 00 3 . O 0 0 . 00 e , 0 0J . 00 . 00
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 sale,If, however the building or REVENUE DIVISION TOTALS--> COLLECTED: 5 . 00 OVER/SHORT: 00
improvement is sold within one year of completion.the owner will have the burden of proving he/she did not build or improve
for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
5. 00
I,as owner of the Th,am exclusively aicese with licensed appot atoconstruct the project 7044,Business
❑ and Professions Code: TheContractors'
Cootev'State License Law dries not apply to on ownerof propertywho builds or improves
Pras threon
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I
am aware #'*#'****'********#******#**#*##***************##*##**#**###*#*****###******##*##*
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
❑ I am exempt under Section: B.&P.C.
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: Owner. PLU 1 BATHTUB 2 . 00 2 . 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533.and END OF FEES
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from
these provisions.
Date: Applicant:
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county
ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter pot the above-mentioned
property for inspection purposes. .. _
�J ��) Cl OG10s?1'a—C;1C3a13 'f:;'`
�' Dale: oL/ 9Z Signawr:�Y"���.._ _ /_ '_ �_ or DATE: 02/10/52 TIi�E: 141225 0�
Driver's Lice{Anse or Social Security
1641-46 White—Building;Green—Code Enlorcemenn Canary—Applicant;Pink—Revenue:Goldenrod—Assessor
- POOL SPA
CONSTRUCTION AND PLANNING -
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole •
52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. I .. - 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 COVE R-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 0 Gas 0 Oil
23. Gas Pipe-Rough& Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas OOil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing C.• HEALTH DEPT, REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final `• 80. FOOD CERTIFICATE ISSUED
33. Final Electric • Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test '
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing 1-741/42-- Ger>
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING •
48. FINAL PLANNING
49. Electric Release to Edison -
. r
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
OWNER FRY, LEON A. • DATE 10-6-58 _
JOB ADDRESS 1947 Pomona Ave. BUILDING PERMIT NO. 7729
hGENERAL CONTRACTOR Romar Builders VALUE $ 9,295.00
11;1,-. 42-47�Vo?- 7 LOT 31 TRACT FIRE ZONE DESCRIPTION OF WORK Duplex
1 UP I & J TYPE V ZONE R4 PLAN NO.
INSPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED
DATE NUMBER
Trenches Form' Steel /fr1/40/1 j'
Floor System
Steel Reinforce Chimney Re-Rod ., A am
Bond Beam .S-4..."1 /4 "•- ,0,-.:4-4? .sM'i 6 ..--..Zi-i",.. .r.,-.Frame
1
Frame.and Flashing �-a 1 it/g irk /r
Lathing, In a--Al'/-Out (idf 7j- %///'f/S-X
Plaster, brown/coat Ler-}14- "-/f/de
Underground soil/Pf- ' WIG Pipe Testi„w jf•1 4-W 1
"Top Out /0--/.5-ins /`,�
Furnace
Gas Vents
Rough Plumbing 1_C U'9,frfw A /�r rt- /G-15-5.- /4- /c ' <p — /y�
Cesspool Septic Tank 'p
Prop. Swr. Line House Cony- St. Swf 9/,4,-J,-I. en, I -(I h[r - it AYH"
fr �D'
Sprinkling System
Ic..;., ng Final t{/FKS 12-2)- 6t /y
l xn";+'ming Fixtures, Final / S I1-`.-?--AR" a Pry
Final Gas Test /.5 /MC f1.-]-.Z-S7Pr \ 1
-Construction Pole p. ,L�
i MIei.ti.... d -Power id,x 'A C?/ JA-X /0 2, -S-8 / /f 1/
Rough Wiring 4p4 l a.3-- YY (7— t/AX /a'/S Sjq 9,20 oL --
-11
_ �4
Fixtures, Final J1 '- /2-)2.VY "i \ N. I I
-+_OCCUPANCY MTS /2-2x--Kt
Form 210-5M-1-57 7790
7729 S=EE RECEIVED
/o-(c -C`6 Uc---
COSTA MESA BUILDING DEPARTMENT �'en'
P.O.BOX 317 fINANCE DEPT.
COSTA MESA. CALIFORNIA OF COSTA
MO
FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT
ADDRESS /0577 m,✓,y ' CLC.- _ BUILDING
COSTA MESA, CALIFORNIA FOR OFFICE USE ONLY
// RECEIPT NO. PERMIT NO.
OWNER flog /�Z /rely/ 97o2—
MAIL 9/� �J
RECEIVED BY / DATE RECEIVED pot_
ISSUE{,{,,
ADDRESS J I/`/GCt.LSO/Al V" /0 �G- S!! po t_ 4 is V
,� J TEL. BUILDING
C I T' Cry�,AO/E�'�, gz,)J, NO. ADDRESS
ARCHITECT / LIC.
OR r NEER . ' COSTA MESA. CALIFORNIA
FIRE
ADDR 43 — / c kiesi ZONE
CONTRA est-e-�/�7 r CITV NO.,73D,1'-`pp ZON P AN$ TYPE !/ GROUP /�
ADDRESS / 44-Ty oriAter% Q -903 S8 BY DATE DATE Cl/
LEGAL LOT ///
DESCRIPTION NO. �`/�
BLOCK TRACT 6/a CORRECTIONS
A.P.NO. //s -3y r2 4SIZE ? .OF BLDGS. a APPOV E D
OFLOT �J A� w ON Loi/j�p�
USE OF
EXISTING BLDG. CITY 0 OSTA MESA
SETBACK LINE FROM , AFC
7��y'y/ , PLAN G D'ePT.
CENTER OF STREET zQ Wj. REAR YARD/45 /A n�- FPT RFG
`�J SIJOJCL TO BLOC Da
TT.
YARD RIGHT . LEFT J' E �J nn `_,7��f
DESCRIPTION OF WORK' By(719' DATE l��`' U
/ WW LAN IC�j77
NEW ALTERATION ADDITION
REPAIR MOVING NO.OF �4 DEMOLISH
5 ZELDING-gyp/ ✓33 •
ROOMS .0 STORIES
EXTERIOR WALL ROOF
COVERING COVERING
USE OF NEW _ '' I,ao.. V ce-//y
BUILDING O�� P
1` 47 //
4'
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND p? iD
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL
CITY OR D STATE LAWS REGULATING BUILDING CONSTRUC
TION. VALUATION
SIGNATURE F r MIT FE PERSay
PERMITTEE �Nt� V• ni'+"-r' �~G -,
�y� t�
L/� PLAN CHECK S /a _
AUTHORIZED A T ci i TOTAL FEE S:Jb `wF
C