HomeMy WebLinkAbout117 BAY ST - Building Permits • ket_HiIY.ti8E 117
20453 - 2-3-64 4 p .ex/det gar $29,876..
6748 - 1-19-70 Htg. NC (furnace) • !
56437 - 2-2-70 Plb&. NC (W.}i. ) cancelled
- 859027 et -�—
- E59028 �I/24 V (859027)
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4149 CITY OF COSTA MESA /
BUILDING DIVISION
r E! MIT NUMBER
z DEVELOPMENT SERVICES DEPARTMENT
PERMIT + 00-00848
M1r�rORnit9\9��
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 117 E BAY ST Status: ISSUED
Suite: Applied: 06/12/2000
Vicinity: WHOLE ROOF Issued: 06/12/2000
•
Parcel Number: 42618107 Zoning:
Applicant: ZERGMAN, ROBERT ISSUED BY:
Address: 17092 VAN DYKE LN
Phone: (714)542-5397
HUNTINGTON BEACH,CA Zip: 92647
Owner WICKLAND, JACK M
Address 1237 W EISNER PL -
Phone:
ANAHEIM,CA Zip: 92801
Contractor: ROB'S ROOFING
•
Address: 17092 VAN DYKE LN
Phone: (714)542-5397
HUNTINGTON BEACH,CA
Zip: 92647 . License: 532516
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
REROOF EXISTING 2-STORY APARTMENT BUILDING(25 50).TEAR OFF EXISTING COMPOSITION SHINGLES, INSTALL
2-LAYERS OF 15#FELT UNDERLAYMENT,AND REROOF WITH 25 YEAR COMPOSITION SHINGLES.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $3,500.00
Permit: $97.25 Claim Valuation: $3,500.00
SMIP Res: $0.50
SMIP Corn: $0.00
Other $0.00
Inspection: $0.00
Total: $97.75
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 . Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTES:
•
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord.No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced Within.180,days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
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
work for which this permit Is issued.
_eVI 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'comemsation Insurance cam.andpoy yrumber are: O F-1 [� r
Carrier: l ^t�� `�JW 4� • I Policy Number: I -1 ` b O
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws a or ,and agree t ' I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these rovis' ns.
•
ry1�ajf�
Applicant Signature: /`-' \ 'Date: ( 2_-0-c)
WARNING:FAILURE TO SECURE WORKERS'COMPENSATI VERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL 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 DECLARATION:
I hereby affirm that I am licensed nd r raviolis yyf Chapter 9(commencing with Section 7000)of Division 3 of the Buusin s aj d Professions Code,and my license is in full
force and effect.Lic.# b Class It C.,_9 I
Contractor's Signature: Date: G--(7-(l'
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 end 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 then five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). •
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044, Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 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:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 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? in Yes 0 No
(Section 25533 of the Califomia 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 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.... .....PP-.is _lyre_.0 , . Secio ofha...He... Safety
nfll .. d-with? __-__ ............... .-._... __. ...
4 If an RMPP is presently required,has Section 25534 the California Health and Safety Code been fully complied with0 Yes ❑No
5._ Does o_- ----.—o--"'enutu.rebuildngoequire for the
__
5 Does he will the applicantsAiror present or emen building occupant at y Other for work which isi the subject age of this application aUPeNnit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes LJ 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? ❑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 COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
IP I
-. . . e Of Legal Owner(s) 4_ / Ra e_ov
An.Xr Au ooze. •pp lcant j Date
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CODE* INSPECTION TYPE DATE INDML$ COPES INSPECTION TYPE, RALE INTITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 6 -0 -co a 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
2446-46
City of Costa Mesa
Building Safety Department CERTIFICATE OF OCCUPANCY N°
1792 C
P. 0. Box 317
Costa Mesa, California
The Building located at 1X7 £AAt Bag Street, a,b,erO •
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group R A .7 Occupancy.
•
Use of Building 21111A ilex Restdeese an4 Cttached_6asnn
.'Legal Description A. P. ff.0ri0..91'
'(See reverse side for Motes and Bounds)
_Building Permit No. 2053 - Electrical Permit No. 211Plumbing Permit No. 19323
Floor Load Signs have been installed as Room Capacity Signs have been instaled as
.,;required under Sec. 2308 U. B. C. required,under Sec. 3301 (1) U. B. C. - -
'°17050. CERTIFICATE OF OCCUPANCY. (a)' No apartment house, hotel, or lodging house shall be used or occupied
•+until the owner or operator has been issued a valid certificate of occupancy by the enforcement agency.
(b) A new certificate of occupancy shall be obtained whenever there is a change in:
1) Occupancy classification of a building or portion thereof .•
.. . . .
2) The number of apartments or guest rooms
3) Ownership
If Group H Occupancy, number of apartments and/or guest rooms as required under Sec. 17050.1 (d), California
Administrative Code, Title 8, Chapter 9, Article 8. •
Number of apartments FC13! (I) and/or guest rooms
• ISSUED TO: Building Offic• I ,
• Date - - - •
•
This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed
• s, encept by the Building Official of the City of Costa Mesa under Sec. 306 (e) U.B.C. Form B134-1M-11-63- S-B P
PROJECT ADDRESS: 117 E BAY ST UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NU; E UDtVLa
OWNER'S NAME: WHELAN DEVELOPMENT
ADDRESS: 666 BAKER ST PERMIT NO: E 059028 PLAN CHECK NO: N GOVT; N SUPP; N
COSTA MESA,CA 92626
CONSTRUCTION TYPE: 5-N PERMIT TYPE; ELE PURPOSE; REP
( 714 ) 540-7191
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : REPAIR DAMAGED LIGHT FIXTURES SQ FT:
ADDRESS: UNIT:
CLAIM VALUE: CALC-VALUE: GROUP OCC; R-1 /
PERMITTEE: JAMES RAY THOMPSON ( 714 ) 636-2557
ADDRESs: 13592 FERNWOOD COMMENTS; RE; B59027 PRIMARY BLDG, PERMIT,
GARDEN GROVE CA 92643 ***aE****�6 �E*4�6�ETE�E*******�E*****st*********SE*********** *F6************************
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS
7000)of Division 3 I the Business and Professions Code.and my license is in full force and effect. SETBACK S
CITY LIC.: 4 46 STATE LIC.: 348 • • � CLASS: B
Date. /`�� Signature: -/' •' "' MAIN BUILDING ACCESSORY BUILDING
FRNT; FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
WORKERS'CO PENSATION DECLARATION: I hereby affirm that I have a certificate of consent tosell-insu:or a certificate of Workers' LEFT; FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN
Compensation utappe, ce II d.cm g ctmn 3800,Lab.
POLICY NO.: 'l7-7 LUl , Li a EXP.DATE: A.1 /01 I93
1 CDMPANY: STATE FUND,�!! PARKING REQ: PROV; PARCEL; 42618107 ZNE: REF NO:
o Certdie cc is hereby furnished. L'l Certified copy is filed ith the city Building ''vision. PLANNING N TES>
G •
>
�- Date'. G u � Applicant: 1��. 'a _ - _ **************iE******************i(•'*'IE.***********************4k**if*******iE********
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed it the permit is for one h ed($1G0)or less). DEVELOPMENT S E.y R V I C E S R E Q U I R E M E N T S
I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any so as to become r YD
subject to the Workers'Compensation Laws of California. ZONING APPROVED BY - -� DATE;
Date: Signature:
NOTICE:II,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY DATE:
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. C ti
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction tending agency for the performance of the work for APPLICATION ISSUED BY; '*tEDATE• - /7
*.
which this permit is issued(Section 3097.Civ.Cl. * *****.*-**.*-**.*.***.**.**.*.** ** .>k*.* * *. *.*.'N' *.*************.*.***.*.** ' . . - - **
LENDER: *********************************A6i***** *************************************
ADDRESS: LEGALIZATION;N F E E SUMMARY 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 1 , 50
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 5O* SMIP/NON-RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)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 of not more than five hundred dollars(3500). ISSUE FEE 15. 00
I. as owner of the property or my employees with wages as their sole compensation. will do the work, and the BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 1 . 50 15, 0 U 0 , 00 16, 5 0 16 . 50 . 00
does not apply to an owner of a properly 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• 16, 50 OVER/SHORT: 00
improvement of sale).
is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve
fororthe purpose oBLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 16. 50
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of properly who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).l am aware **********'******************'***'**'***'*******************************************
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
o I am exempt under Section: B.&P.C.
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: Owner: ELE 2 FIXTURES, LIGHTING 1 ST 20 EA. . 75 1 , 50
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 tat taws relating to building construction and hereby authorize representa' '5 of this _, to enter upon the above-mentioned -
properly lot i spe ion purposes. I.--
Date: Signature: `- 44 II 1 31)77+, ' ,1 -
Driver's 'cense or Social Security p: + r4Tr; ;1 .p„ Tit ',•-..01641,46 While-Buildinq:Green-Code Enforcement:Canary-Aoolicant:Pink-Revenue:Goldenrod-Assessor
- CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit# - Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole i. - 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, 0 Undrgrnd., Test .
9. Water Pipe-Und1•grnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.•
10. Structural Floor System 61: APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains _ 64. Plumbing System - Final _ -
14. Rough Plumbing _ ` 65. Electrical-Final ,
15. Rough Electrical-Conduit , - 56. 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 0 Oil
25. Roof Sheathing • 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding - - 77. FIXED SYSTEM FINAL
29. Insulation I i 78. FIRE PREV. FINAL
30. Drywall Nailing . , I ' HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 1 I . 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric q'Qg1QZ- Notes:
34. Final Heating& Air Conditioning .rr�� I I . _ . .
35. Final Gas Pipe-Test •
_
36. Hood or Canopy
37. Final Factory Fireplace - ,
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final I '
41. Solar Domestic-Final • -
42. Backflow Preventer I 1 ! .
43. Backflow Irrigation -
44. Landscape Irrigation System. - -
45. Sound Attenuation .
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING - -
49. Electric Release to Edison : ��
50. Gas Release to Southern California Gas Co I j }
51. CERTIFICATE OF OCCUPANCY .
No. Date
PROJECT ADDRESS: 117 E BAY ST UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 059027
OWNER'S NAME: WHELAN DEVELOPMENT
ADDRESS: 666 BAKER ST PERMIT NO: B 059027 PLAN CHECK NO: N GOVT; N SUPP; N
COSTA MESA,CA 92626
CONSTRUCTION TYPE: 5-N PERMIT TYPE: STR PURPOSE: REP
ARCH/ENGINEER: ( 714 ) 540-7191 REG.NO.: JOB DESCRIPTION : REPAIR DAMAGE TO EXTERIOR STAIRWAY SQ FT: 688
ADDRESS: UNIT:
CLAIM VALUE: 688 . 00 CALC-VALUE: 688. 00 GROUP OCC; R-1 /
'L PERMITTEE: JAMES RAY THOMPSON ( 714 ) 636-2557
' ADDRESS: 13592 FERNWOOD COMMENTS; REPAIR WORK SUBJECT TO FIELD APPROVAL,
GARDEN GROVE CA 92643 ****************;��r****dr*x** iE*****EE*�E�E�H�E�tEE�L�t�E�HTEEE****EE***;,rEr****Frdrd6k *************
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS
7000)of DhAsi n 3 i the Business and Professions Code.and li is in full for . and effect. SETBACKS
arta 746 STATE LIC.:348943 cuss: B ,
Dale: Signature: —Z MAIN BUILDING ACCESSORY BUILDING
WORKERS COMPENSATION DECLARATION: theature:tirmthatlhaveacenifkaleolwnsemtosell-insurepra • JiutealWorkers' FRNT; FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
WORKS Compensation :'ENSA. � `a x e I$¢ttion3800.Lxb. LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN
r POLICY NO,: ZLJ UN 1p1�V���7 EXP.DATE: 1/1 /OS /93
COMPANY: STATE FUND�A PARKING REQ: PROV• PARCEL: 42618107 ZNE: R2 REF NO;
0 certified opy is hereby furnished. A Certified copy is filed with the city Buildinwision, PLANNING NOTES> REPAIR LOWER PORTION OF STAIRWELL,
Date: Applicant: T� *******************************************************************************
DEVELOPMENT SERVICES REQUIREMENAPS
EXEMPT! FR M WORKERS'COMPENSATION DECLARATION: (This section need not be completed it the permit is for a ndred(5100)or less).
I cenily that in the performance of the work for which this permit is issued,I shall not employ any person in any niter so as to become C�
subject to the Workers Compensation Laws of California. ZONING APPROVED BY . (— IE • r DATE; ', ( 2-
Date: Signature: BUILDING APPROVED BY : ct4i e �7/`�/re-14
T��A•r�� ip 'NOTICE:If.aver making this declaration,you shouldvisio became spermit to the Workers'Compensation provisions of the Labor * 1 Q/ P DATE;.• tryCode.you must tonhwilh comply with such provisions or this permit shalt be deemed revoked. 1CONSTRUCTION LENDING AGENCY: I hereby attirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY• DATE! JO AO 2.
which this permit is issued(Section 3097,Civ.C). **********************3e 441k * **ic * *** *********************` - **
LENDER: **************************************** ************************'***'*^0********
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL jSEGMENT: Y
OWNER BUILDER DECLARATION: I hereby affirm that l 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 19 . 00 s N, S 0
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed SMIP/NON-RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN
'''r
and Processions 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 penally of not more than live hundred dollars(5510). ISSUE FEE
I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law
TOTALS----> 19. 50 0. 00 0 , 00 19 . 50 19 . 50 ,0 0
does not apply to an owner of a properly 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 altered for sale.It,however the building or REVENUE DIVISION TOTALS > COLLECTED• 19 . 50 OVER/SHORT: 00
for theepurmk soldfle)hin one year of completion,the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
1for the purpose of sale).
. 5
I,as owner of the property,am exclusively contracting with licensed contractors to construct the protect(Section 7044,Business
❑ and Professions Code: The ch projects with
License Law does not apply to an ownerofproperty who builds Law).
thereon **!E****************************************************************************
and who contracts for such with a e dor(s)license pursuant to the ner of oe'State License Law).I am aware
that proof of their Worker's Compensation insurance should be provided to me, INDIVIDUAL FEE B R E A K D O. W N
❑ I am exempt under Section: 8.8 P.C,
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: Owner SFR 688 ALTER BY VALUE RESIDENTIAL NOZONE 1 . 00 688 . 00
I do hereby cenily 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 far construction or modification from the Air Quality 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 representative-.1 this ci i to enter upon the above•mentioned
property for ,sp ction purposes. /
(� ♦y 1
Dale'. 7r'r� Signature: .._.V. C - y✓ : ill 5:1_7 - _ 1.1 .
�� Driver's License or Social Security a: L•�T[; jr .' ._ �' •
,'
'_1`41-46 White—Building:Green—Code Enforcement:Canary—Applicant;Pink—Revenue:Goldenrod ssessor
CONSTRUCTION AND.PLANNING POOL & SPA
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location - -
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utillty-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, 0 Undrgrnd., Test
•
9. Water Pipe-Undrgrnd. ' 60. Backwash Lines,P-Trap, D 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 D Od
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing - 73. Undergrnd.Storage Tank 0 Gas 0 Oil
- • 25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat - - 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation j i 78. FIRE PREV. FINAL
30. Drywall Nailing -- - .I HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat "� ": 79. FINAL INSPECTIQN
32. Electrical Power Meter-Final I �s 80. FOOD CERTIFICATE ISSUED
33. Final Electric I 1 •1 _ Notes: .
34. Final Heating & Air Conditioning I � '' -
I
35. Final Gas Pipe-Test - �.
36. Hood or Canopy •
37. Final Factory Fireplace -1
38. Final Plumbing -
39. Water Service-Final
'
40. Gas Service-Final
41. Solar Domestic-Final • • _
42. Backflow Preventer ' `)
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE& BUILDING
48. FINAL PLANNING ` • �;
49. Electric Release to Edison - -
50. Gas Release to Southern California Gas Co I 1 I
51. CERTIFICATE OF OCCUPANCY
No. Date
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• DIRECTOR Of FLAPH411r3 • : on . :nag .
id- I 1,- .rtii. 7 1.1+-4''•••rite a • Cr) I
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REVIEW AND APPROVAL . ...
ON-SITE _-
OWNER KONVISOR, SIMON DATE AUG 2 7 1963
JOB ADDRESS 117 E. Bay Street, A-D BUILDING PERMIT NO.20453 .
)) GENERAL CONTRACTOR Harbor Crest "fB1drs. VALUE $ 29,876:00
AP No. 118-020=91 LOT TRACT FIRE ZONE 3 DESCRIPTION OF WORKI+-pleX &det.Gar
`9l INSPECTIONS__ 9 of Signature/ DATE GROUP H & J TYPE V ZONE R2
-/L-j<; PERMITS ISSUED
Gas ,� / SUBCONTRACTOR DATE NUMBER
Water/L/� a-!/./.I - f-/Jf
Rough Corn. Refrig. 0 AleCond."0 _ ,
Rough Heating O/ /9-Ta-/1 `� C'.vd�. . ,.�. /c/2-9/&3 a-C v-
Rough Plumbing ',!. D/ 4'-11-L; 2-/,-. 6-.4.7,7,--,- A.-a- a. 7-, -c 3 3 9 3a 3 —(r)
Miscellaneous
Prop. Swr. Line 0 House Con.gist. Swr. 0 t ///�j,3 7-2- z -c-. 7-/p -63 - o o _ alt
Sprinkling System t
Construction Pole
Underground 00 Power 0 71,rbil°11
Rough Wiring 1.2".... 0'J red" - /O-,u-c3 AZns>
Trenches 10 Forms ❑ Steel Reinf. 0 ^— -q—/A--
..y_A�/
Floor System ,_y Fy fl F 3 /J
Bond Beam 0 Steel Reinforce 0 -'
Sheathing f r -73.:--4 3 I .1.7�"-
Frame and Flashing :i„=e-----_� _---_ tir_ 1;2.. `-�,�, e- — — 6,3 / 1 `”
Lathing—In.® &I- -Out as i//�_ 65 /r'/1.4'
Plaster, brown coat / /2r-.4 —GA ()/j-r I c, / .'
Refrig. 0 Air Con. 0 Final D (/ ✓ // %Y' __
Heating, Final /1-1") -67 µ- ILr" l ,
Plumbing Fixtures, Final �_ti �� ��
Final Gas Test e. // f`r/' l '
Electric Fixtures, Final 4O /-q (� ) _ _ _
Building, Final VW") /46 —k 1 . 1 - `%:.-,,,OCCUPANCY /7% - ft/ ✓y.,/ 3 -3 6iy '1
Form BU4-6M-3-63-5-B P wnk.n tnw RPRrT At. PPMIrnncnrrc , onkc�
11111"X pr.,-
2045" -
14
.:COSTA MESA BUILDING-SAFETY DEPARTMENT
'P.O.BOX 317 COSTA MESA,CALIFORNIA EE RECEIVED
1 For Applicant to Fill In Completely For 2 2APtegATION FOR PERMIT
TYPE OR PRINT • IFJPI
BUILDING
RESS ./17 G 84 s
- r a_4 CITY
ADDoSN`�Si'
,J ! RECEIPT NO. P MIT Np _7
COSTA MESA• CALIFORNIA 9 , D�/ j
// P RICEI SY DATS.RiC,IY$D4 e IEEDED
OWNER S7/HO// ire N viSOIC K� Jlf o[a,eL i3" a
MAIL BUILDING
ADDRESS
ADDRESS .S/}II E
FIRE pi 1 -77
//lJ
j},/ TEL. ZONE TYPE GROUP
CITY e. . /4/ . NO. % d
APPROVED
ARCHITECT IIagger �.ly•/�tn BY 4 A._ DATE 12 Yr
EN
OR ENGINEER /7 L1(zc M
.� J J� A NING --'-
ADDRESS H i i A %• 4
'n ��'{{}}!!�� 7 pNO.OP U8 OP N W
CONTRACTOR T�^e/U{� .0.4SO4/psr 6d ��� ��� •v�(/Yu1,�Ne{�(���/��//• '/L�JI NJ
`I
ADDRESS 2/38 H#4' QA DZSCRIFTION�, 1 lieu I / 1' eel
,
G` os 771- Ala' • ._ 2- 0
CITY A.P.NO. " • srti i%. - e% "/
y G p �/� • NOTE: NO RAVE OVERMAN v La LESS TH N�
LIC..NO.ATE � 7tiC2/ 4i NO. Jfi 733L 90'TO SIDE a REAR P.L.
EAVES
SIZE 66 O NO.OPBLDOS. ALLOWED (U.B.C.REQUIREMENT)
OF Lor /. X / now ON LOT 410jt/�
USE OFnr7 p YARDS APPROVED YARDS APPROVED
EXISTING BLDG. yblu r '.Tarr` r MAIN BUILDING ACCESSORY BUILDING
(FROM C/}.S'RETIT/ I �/ FT.(� /I
SETBACK LINE FROM I FRONT /7��/ FT.
CENTER OF STREET 4O REAR YARD -1 ` II /I
SIDE YARDI LEFT /0 , I RIGHT sFT !81�.9 R.SIDE /
. FT. •
DESCRIPTION OF WORK L.SIDE/0 FT. C ` /// Fr. v
NEW ✓ ALTERATION _'.ADDITION REAR FT. Ali �/ FT.
it
DISTANCE BET. BET. MAIN Q p.
REPAIR MOVING DEMOLISH MAIN BLLOGS. ACCESS.BLOW. Z
BUILDING V ✓ NO OP p
VAR.#7`5-� DATE 02_'y_�' -1'— 2
SIZE 3/ i(yy 7 ROOMS /6 STORIES .2- C.U.P.# APPROVED Lw•
3
EXTERIOR WALLL,,Tr�q ROOF �u APPRO �j'�
COVERING av-v CO I COVERINGkDT )•rOP BY CE
DATE �I e '-�/ a
USE OF BUILDING AND WORK
KTO.BBEE PERFORME¢ •
Ill
fern ' irG il. otLCd:z / a
�U�V! 5 $-1-4:v1" ° 'Or�Euc ' If 1
99°7-130.Fr. i 760 w
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE 1. (,L
AND STATE THAT THE ABOVE IS COR.-+ T!'ND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. G LI)
PLY WITH ALL CITY RDINANCES S REGULATING
BUILDING CONSTR ION. /� VALUATION 9� SO m (�
SIGNATURE 0 �,,,((((�,�// 1 I PQI,v�� 79 FX
/ PERMIT FEE $ 4/5-/A I j U.
O
PERMITTEE • S O• g(/ X y o a
3 4 ',
AUTHORIZED AGEN 'J G
5 TOTAL FEE $./ t"-7 Z