HomeMy WebLinkAbout125 BAY ST - Building Permits a- ,
-
ell MF 9 CITY OF COSTA MESA
4 BUILDING DIVISION
or� r.�,
F 1 rr� �7Thisl 9,— I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
/ PERMIT
�• B00-01606
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ctLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 125 E BAY ST Status: ISSUED
Suite: Applied: 10/06/2000
Vicinity: GARAGE ONLY Issued: 10/06/2000
•
Parcel Number: 42618109 Zoning:
Applicant: PANGBURN, DEBI ISSUED BY:
Address: -
Phone: 714-526-0351
Zip:
Owner: LINDSTEDT, DANIEL S -
Address %POLENTZ,JON M - - - - _ - - - �
- ORANGE,CA Phone: - _ - , , `\
1537 E CHAPMAN AVE I Zip: 92866 -
Contractor: FAIRWEATHER ROOFING INC ' '
Address: 2600 SHERWOOD AVE "
- . - Phone:- (714)997-9449 .
FULLERTON,CA - -
Zip: 92831 License: 770565 - .
Arch : _ _
Eng:
Address: - - Address:
Phone: - - Phone: '
Zip: - • License: License:
__ - SCOPE OF PERMIT-- - -
REROOF GARAGE ONLY:T/O EXISTING ROCK &COMP ROOF;REPAIR'SHTG AS NEEDED, INSTALL 2 LAYERS OF 15#
FELT&NEW DRIP EDGE,APPLY 20-YEAR FIBERGLASS/ASPHALT SHINGLES CLASS A.PITCH 3:12. 9 SQUARES.
• I'' .. -FEE SUMMARY ,
. Plan Check: $0.00 - - --- - - __ -' Calc Valuation: ' $1, 93.00'
Permit: $50.95 ,_ .
, „ , Claim Valuation: s $1,393.00
SMIP Res: '. $0.50 , '
SMIP Com: $0.00 - -
Other: , • $0.00 -
Inspection: .v '$0.00 ,
e! / -
Total: $51.45 , -
`v / /j ,PLANNING'S ZONING ' , / 4 /,'
SETBACKS
MAIN STRUCTURE-Front 0-0 � - \ Rear - 0-0 I - Left I 0-0 Right, I-0-0'
ACCESSORY Front 0-0 • Rear 0-0 Left „ 0-.0 Right 0=0' ,-
PARKING ExiE 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
reaulred.inspectlons 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
WORKERS'COMPENSATION DECLARATION:
_I,h xeby affirm under penalty of perjury one of the following declarations:
LY 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.
9 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.
M workers'co enation Insuranceancarrier and poli ymbarr acre: T \1 L
Carrier. g0� 1 �e� 1_� S `k 1✓e C0 Policy Number: W a_o LSO IO(V)
(This sec need not be completed if the permit is valued at one hundred dollars 100 or less.)
O I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with thes visi s. f j�
Applicant Signature: JL-, Date: 10_6-0 V
WARNING:FAILURE TO SECURE WORKERS'COMPENSATI COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CNIL FINES UP TO ONE HUNDRED
THOUSAND OOLLARE($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 under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business an rgessions Code,and my license is in full
force end effect.Lic.# ?')cab J Class/t C." I
Contractors Signature:E4,/¢X✓ U Date: 10 ' b"d U
CONSTRUCTION LENDING AGENCY:
O 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).
Lenders Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I em 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).):
O 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.).
o 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 drivers 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).
O 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? ❑Yes 9 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? .❑Yes 9 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 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 Califomia Health and Safety Code been fully complied with? 9 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 apermit 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 Govemment Code requires that the requested information be fumished 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 9 No
B (If'yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
• regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signature Of Legal Owner(s) Date
And/ Authorized Applicant Date
CODE# INSPECTION TYPE DATE INTITIALS CODE! INSPECTION TYPE DAM IIfII1ALE
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final 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 01(0 Q(/ Q W
OWNER KONVISOR Semon DATE 2-28-62
JOB ADDRESS 125re ay St., A, B, C, & D BUILDING PERMIT NO. 16461
GENERAL CONTRACTOR Shoreline Construction VALUE $ 29,870.00
AP No.118-020-31 LOT TRACT FIRE ZONE DESCRIPTION OF WORK(4-plex w/Det.
INSPECTIONS Signature DATE GROUP H & J TYPE V ZONE R-2 Gar.
Soil 4°
Gas ISSUED
k/t� ifr/., /
DATE
Rti1[TSNUMBEP
SUBCONTRACTOR
Water /.,(,c/ :54:o 2-
Rough Corn. Refrig. 0 Air Cond. 0 /,a7��
"Rough Heating -/ 4
Rough Plumbing • Afar: / / //. - .,65- >;-'2-Cil
Miscellaneous / _ 1 i ,
Prop.Swr.Line (House Con. a St.Swr. 0 ei3X YllycL- eP e/at2..� 3r�9 L t_ f y0 f L9
Sprinkling System 61/164
Construction Pole
Undergrettnd ❑ Power ❑ /' '$r.' '/ p L awic.
Rough Wiring 7,0%14,2.C1. 2 (1JYer0 at , oA+.t". -6?-. /z(J,_V- loxto
Trenches 0 Forms 0 Steel Reinf. 0 �k=���/ 7 - 7— .Z
Floor System •
Bond Beam 0 Steel Reinforce�0
Sheathing 1-- ,/S -C. Y
Frame and Flashing , / 111 1,
Gil(
Lathing - In ❑ Out [ `�� (yf� - C. `
Plaster, brown coat yy/o- j 7 - Co y
Refrig. 0 Air Cond. 0 Final
Heating, Final /P-'/fG /. „f
Plumbing Fixtures, Final '�'//C/// l �
Final Gas Test /S /„/�.0•/- /J ,_
Electric Fixtures, Final /LG�"„J �i r'+ , i
Building, Final . C. 1 ct \ I\\-.‹
OCCUPANCY
FORM RIM.SM — r.RT 161161
_ '" R.
af4Ti``Ar CITY OF COSTA MESA -
y'a". �' 4, BUILDING DIVISION
v.. ' DEVELOPMENT SERVICES DEPARTMENT
PERMIT P IT NUMBER
B98-01415
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 125 E BAY ST Status: ISSUED
Suite: Applied: 08/10/1998
Vicinity: Issued: 08/10/1998
Parcel Nunmber: 42618109 Zoning:
Applicant: DAVIS, MARSHALL
Address:
;v.-Phone:--. " -... v ;
�7�: - :Zip
Owner: LINDSTEDTfDANIEL S
, _ �
Address %POLENTZ,JON M ` : ' . ' ' ' � `r
ORANGE CA\ \ ,„- - -Phone _� -�' ` \ -�
1637E CHAPMAN AVE-:-.1-1� Zip: 92866N -: 7 ('N '
Contractor., GOLDENWESTROOFING vi,��,,1 `7
r/Y/ -, / / /// vtom- -'
Address: 1171 PASEO-TASCOCI �I � ,� VC''�
/���.
/!(/ ��� Phon 909371-8130 \\=\ \ \-;•\
/,,i% / ,_//, CORONA,CA Zip:. 91720
A4th �� Li 432088 I __
Arch/Eng: /; � t I A t
��i \.
+/ Address %���'' /, '< •'
�- � ,�_ • � i�r'i _Phone_ � .
/. _
i
/<- ‘'.. -- License: ,,H - .
i \. ' v` r \, �' SCOPE OF PERMIT N
C / H TEAR OFF EXIST:COMP..SHINGLES&ROCK ROOF,INSTALL 2 LAYERS 15LB FELT&REROOS WITH
'‘.: ;'20 YEAR COMP.;SHINGLES,;_ ` \, 4
' - -4, FEESUMMARY 'l N
,'. ,
Plan Check $0.00 i - ' Calc Valuation: $2,636.00
:l.;' 'Permit: % $74.75 Claim Valuation: '- '$2,636.00
fSMIPRes ,`$0.50 � - /
SMTP Com:-, '\$0.00 _ _
\\Other:A\, $0.00
Inspection:' $0'00 ' j' '
.,� �` �,, i r'
\Total ',$75.25 t, _ n
\'H ' \�k \.,_ ` , ). ' .I ii "->.i _ '
\ .-�\ //` \NN\ v PLANNING-8 ZONING //
U -�� '
SETBACKS \ /; / A
MAIN STRUCTURE Front.--, 0=6: //,' ,: ,/,Rear 0-0 Left 0-0 Right -0-0-
� 'N v�
� '//. 7 .
ACCESSORY Front 0-0 A `-/ Rear 0-0 -' 'Left 0-0, • , Right'-C 0-0
PARKING Existing: 0 `Required: 0 ' ` ' Proposed: -0_,,:, -"'
NOTES:
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 end final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5628
DECLARATIONS W-. ;c.
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have end 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.
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'compensansurance carrier and policy number are:
C mer: S l �I✓J Policy Number: f/ -7 7 7 4" 7Lc
(This section'Ky�n need not be completed if the permit is valued et 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 of California,and agree that If I shou• become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
s.
•
pplicant Signature: • �/i Fate: —' -/
WARNING: + - 0 SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJE EMPLOYER TO CRI• PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
•+Y• D DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN - •8.•OF THE •:FR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CO. : •- . • ARATION:
I hereby• Irm that I am licensed under p •visions of Chapter 9(commencing with Section 7000)of Division 3 of t : •. ne and Professions Code,and my license is in full
force:.. . . . c:s 4 ),.I,_S • —3
ontractor's Signature: Date: Ml. a
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 Ucense 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 live(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,fatsework,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? 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 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 apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes Li 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 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 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 occ • • allow occupancy of any building authorized by this permit until final inspection.
And/Or Authod :d App' :nt
mai iasfEcnolurl(/ gait MALS cnnF( IyrprciioN TYPE DA¢ WEALS
1616 Fixed System Final Fire Prevention �(�////.Q(/// ,� 206 Final Mechanical
1266 Pool Spa Final F / 208 Final Plumbing
200 Final Re-Roof 2110 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
• Applicant to fill in all spaces except those withir 'lvy border lines and sign all appropriate declarations.
, CITY OF COSTA MESA I PERMIT NO. TflAC - LOT NO. BLDG. NO. 1 - ' ^' -
•CONSTRUCTION PERMIT. 5-- fQ G ,9S- • / t' t 2962 1/24/8u 30.53 ` TL
Project Address /, 2,' Lar A Y / 5 rT! ' ' "- ' ' ' • TYPE OF CONSTRUCTION • ; 'U NEW LJ ADD IJ ALTERATION ❑ REPAIR . �• - '
' Applicant's Mailin Addressy/TT7/♦♦///)<IYRL'nectC//C RV/'Vc • ❑. CONVERSION ❑ DEMOL 4O OTHER I - A?p,# - ' IcZone •-
��/ ti kA S 'Phone £79'-tT 0 -DESCRIPTION OF WORK /—�� -- '
Owner's Name• `/ �1 y , -. •
S Main Building: ' Accessory Building: ' Z
Address �I�a 97 R•M/i1 t1AY ' .Sr.Q! r - _ r--i - r-;� - T.
E - _ 0
• '`�' 27 J TYPE OF PERMIT ,❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL T Front t _ - ' _ N
Arch/Eng. / _ License No. '.❑ TENANT ❑ ELF.GTRICAL H_ PLUMBING ❑ MECHANICAL B •
+
\ /s'`/ /1 • : : Rear • - •
- N ,
Address /f 1 '❑ 'OTHER+ .., C/••-aQ� - ' - • 'A .. . . -
A1 Contractor's Namee�k-•A�YS/Rc'o F7•✓Fj re, Phone SSP-�f149 PROJECT DESCRIPTION. SQ. FT. .00° OCCUPA-N�C,Y., - • C Right G
�t Qddress'ImailingM!"'/terrN«<S7 ' CfR- ,"1j//A-J 727 Y ' - CON STRUCTION TYPE VALUATION$ `��•�_- $ Left _ E
•
ZONE GRADING CU.YDS. ACRES Ping. Ref.# I Park.Fees $ - - Q
•
City License No. - - p /J - - ! U
LICENSED CONTRACTOR DECLARATION Remarks: pp t rote /S" QOOF w/7�/� �/CAf�r'/Z �Q.�J',.S' Parking Req./Provided ! - ._ I•
FfG/YDVf n ac - .
hereby affirm that I am licensed untler provisions of Charter 9 (commencing ��/I n Use of Building: R
with section 7000) of Division 3 of the Business and Prof¢ssions Code,and G•G1dr-Q' S!-•lN��� g E
/� My Iicense_is to full force and effect. ^
•"': /6 I Planning Notes: I M
License Class + �[ • �/f �{¢ansa No. �(' (, PLUMBING . FEES C E
' pate it--).5- 8f Signature gay'�Gl/J 6-2r'-t+.,-,— s - i • I N
YORKERS'COMPENSATION DECLW HTION' Bar Sink Showers
T
I hereby affirm that I have a certificate of consent to self-insure or a certificate Backflow Preventer Service Sink' + " S •
-of"Workers'"Comeensation Insurance, ora certified-copy thereof LSection - - - _ - ' -'-- ' - .. - - - •
3800, Lab. C o ��� T -I Backflow Irrigation Sewer Cap I ' i ELECTRICAL : I FEES
Policy No. �93-83elta-f Company ���t g Fo4i '" ' ' +
BCertified copy is hereby furnished. Bathtubs Sewer Connection Automatic Washer . :Transformer D 15-50 KW I -
Certified copy is filed with theicity Building Division. D 50+KW I
Clarifiers Solar Collectors ) I Construction Pole Sub. '
Date ' Applicant r
"EXEMPTION'F ROM WORKERS'COMPENSATION-DECLARATION - ' - " - Dishwasher 1 ' Solar Piping. I " �` - - - --
(This section need not be completed if the permitlls for one hundred($100) or ' 91 Cooking Unit Meter ❑up to 100amps
less). DrinkingFountains
Icertify that in the performance of the work fso,as this permit iect t ed I Solar Tank ' Dishwasher Meter Dover 100 amps. •
shall not employ any person In any manner soi as to become subject to'ttie , , -
DateWorkers; Compensation Laws of California.! i I I 1 • Flgor Oreins' I Swimming Pool w/Spa' Dryers EIGas ❑Electric ' ' •SubPanel I '
Date Signature
NOTICE:If,'af ter making this the you should become subject to the Floor Sinks Urinal '- _ Fan _- _ _ 1- ' _ Motors❑0.1 HP Ell'A-'8
Workers' Compensation provisions of the Labor Code, you must forthwith _ - - - -"-
comply with such•provisions or' this permit' shall be deemed revoked. Gas Service 'outlets 'Water Closet' I ' '
CONSTRUCTION- LENDING AGENCY- ` -- ti - •^ - F.A.U. r ( Inc.Solar ❑9-15 HP 016-15+ ,
I hereby affirm that there is a construction lending agency for the performance ' Interceptors; ' Water Heater I Fixtures Microwave
of the work for which this permit is issued :(Section'-3097 Civ, •C:) ; ,
Lender's Name_ - . i - , • 7" 1 . .
_ . _ K_ Itchen Sink Water Service Device Boxes !
Lender's Addressl - - -
1 'Pole Light • '
OWNER BUILDER DECLARATION - .Lavatories • I < • Outlets • Range • I I
I hereby affirm that I am;exernpt from the Contractor's License'Law for the + P—Trap ' • % '
following reason (Section.7031.5 Business and Professional Coder-Any city or '-- I : - - _- r �- Switches ' - Sign , j •
,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 'Roof Drains' - - - . - , _ , _ Garbage Disposal , • . Standing Sections - 1
`o file a signed statement that he/she is licensed,pursuant to the provisions of . "' - , - -
be Contractor's License Law(Chapter 9(commencing with Section 7000) of Generator ❑O-5 KW ❑5.15 KW Trash Com actor ' -
Division. 3 of the Business and Professions Code) or that he/she is exempt I- - p
:therefrom and the basis for the alleged exemption. Any violation of Section _ • • - - - -
70311.5 by, any applicant for a. permit.subjects-the applicant to -a civil I I - - 1 - • I -
enalty of not more than five hunred dollars($500). Reinspection Fee-.;I ,$25 - Issue Fee $ 3
D I, as owner of the property or my employees with wages as their sole MECHANICAL " Reinspection Fee $25'. Issue Fee $ 3
compensation, will do the work, and the structure is not intended or offered ! • FEES -
for sale' (Section 4044, Business and professional Code: The Contractor's - - - - "- ---- - PUBLIC SERVICES REQUIREMENTS: I I
License-Law does not apply to an owner of a property who builds or Improves Boiler Hood on Type I 0 '
thereon, and who,does such work-himself/herself or through his orvher own Zoning Approved By - • . Date
employees, provided that such-improvements are not intended or offered for Canopy ' Type II ❑ ! ,
sale. If, however, the building or improvement Is sold within one year of com- Duct- Under Ground • '. I - Application Approved By _. Date
pletion,ithe owner will have the burden of proving he/she did not build or.im- I - - /,
grove,for thelpurpose of sale). I i , Duct-Structural I • Refrigeration System 1 : •' I •Application Issued By Date /��/.rfS`�
U I, as owner of the property, a'm exclusively contracting with licensed con- ❑4100,000 BTU ❑100,000 BTU
tractors to construct the project (Section 7044,Business and Professions Code: Duct-Ventilating , SUMMARY OF FEES
--The Contractor's •License Law•does not apply to-an owner of property-who . Ir/BUILDING PERMIT $ t/! SMIP i S 0
builds or improves thereon, and who contracts for such projects with a con- Exhaust System IDMultiple❑, System Repair/Alteration ' $
tractor(s) license pursuant to the Contractors License Law). PLAN CHECK , $ PERMIT ' t
Di,am,exem & is pt under Section B. P.C.for threason Firepl/Fact.-Bit. ICBG# ' - •
PLUMBING $ ISSUANCE $
PLAN CHECK $ ENERGY P.C. $
Date ' owner' I Heating System&Ducting '
I hereby certify that I have rear this application and state that the above , Do-i00000 BTU-❑100,000 BT ELECTRICAL $ - GRADING ' $
-information is correct. I agree to comply with all city and.county ordinances-' - "- - -" t ,
and state laws relating to building construction,and hereby authorize repre- : • PLAN CHECK $ MICROFILM $ + ,
sentatives of this ity to nter upon t above-mentioned property -for , or-
inspection pure (1 5-....„' I _ MECHANICAL $ • TOTAL FEE . $ I 3 Cl
SignatDriverure � • Date ,
Reinspection Fee •$25 Issue Fee I $ 3 PLAN CHECK $
Driversr License o 5# I I
I
CMF 0865-46-rev.'7/83- White-Building;Canary--Applicant;Pink-Accounting;Goldenrod -Assessor ' ' • - - - - -' - - -- - ' . - - -- - -- -• - - - -_ . - - -
--. . .
•
CONSTRUCTION AND PLANNING " - Pl- --&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 Utility-Undrgrnd. 54..Forms •
4. Electrical Conduit-Undrgrnd. • 55. Electrical Bonding
5. Steel Reinforcement r 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, ❑ Undrgrnd.,Test
9. Water Pipe-Undrgrnd. - • 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 • 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 Kactory Fireplace • APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas ❑Oil
t 3. Gas Pipe-Rough&Test 72. Underground Flush
4. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
15: 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 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
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' - J
47. FINAL STRUCTURE& BUILDING 44_85
48. Special Requirements Completed • „��/YYY///"'
49. Electric'Releaseto Edison - - •
50. Gas Release to Southern California Gas Co -
51. CERTIFICATE OF OCCUPANCY -
.
No. • - Date - -
x
.1646 ' FEE RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT !
P. O. BOX 917 COSTA MESA, CALIFORNIA f; FFIIN��ANCE DEPT.6 ,A"--
For
�
For Applicant to Fill In Completely APP2SCATIONOFOR PERMIT
TYPE OR PRINT G BUILDING
BUILDING /�J�' f e� Lp 4O Gy
ADDRESS [COSTA MESA. CALIFORNIA 1'l/!� For Office Use Only
OWNER 6E/"\/) 1.<1,1,-..).\) s0 Y ` I RECEIPT NO. I/ PeNMIT.No/
MAIL ` ` RECEIVED,BY DA �TRECEI D fiDDDATTEEY/ISSUED
ADDRESS ��/�lO N�V�CZ-T ,1
en,hf ,yC �/1i. 10(J
CITY ` /'\ NO:/1\ r6 'DRESS /0?s CCC / 4
Cr // °DRESS /
ARCHITECT RAJ 1162€u1J e. NIS Ai-6-.503,r COSTA MESA. CALIFORNIA `
OR ENGINES ,q ` ` �T�''.J�{
ADDRESS L.Ftill N��V Q6�( ✓I 41 n FIRE .-.7y
�` :-I FIRE (�� PE GROUP
CONTRACTOR ,_ .440 YL,F(�/NF' CO MST BYPROVED /I j7 DATE G� .1-
ADDRESS 2280 IJewporL.T .C�-( ZONING �A, _
/� zoNR NO.OF USE OF NEW /Q� ,,
CITY G/ �( I PLANS BUILDING
LIGE 141z8.9131 TEL. (� / cd3 LEGAL /��) J/�f,. ^/
LIC.NO. NO. /(\(�(�- ll-1�,� DESCRIPTION L' �' �a'�V !/
SIZE I NO, OF BLOTS. / I&— O ,-c,-,-c,- / C�`i�.
OF LOT • NOW ON LOT A.P.NO. �'
EJ(HTING_BLDG. APPROVED ALLOWED
USE OF YARDS EVES
5q.caX /0
SETBACK LINE PROM it,
‘ SO I (CENTER LINE ST.)
CENTER OF STREET I V REAR YARD •..7r_ FRONT FY. t.17-47) IN.
I
SIDE YARD LEFT S I RIGHT I O R.SIDE /D FT. IN.
DESCRIPTION OF WORK L.SIDE SFT. N.
NEW I - LTERATION I (( 1(ADDITION I REAR -=R-0 FT. ) IN.
REPAIR I II MOVING I II DEMOLISH I APPROVED DATE
SZE DING'29`f2 n' ROOMSF I.O STORIES 2--... ) (�L��� _ (—a0-f 624.
EXTERIOR WALL I ROOF
UJj 1
COVERIN 1 ,S — / T - - 8 . GI .
USE OF BUILDING AND WORK TO BE PER.ORMED
a a E WI O( r• i1 0
�I
�a�a • a - __ '"„"�' Is .j i.,— i _
,
P0-4. o-9'9,,,71'/Y i-ga' 7 . 9s . ..,,r6,
I HEREBY ACKNOWLEDGE THAT I HA THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION..IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONSTRUCTIO VALUATION
SIGNATURE OF ''/�i PERMIT FEE $:� 60
PERMITTEE _ rLy y�— S. 'D n
�% $� N CHECK $ IT;
AUTHORIZED AGENT77e, �/ .7 Ce) F
- TOTAL FEE S /f�( 0