HomeMy WebLinkAbout2124 REPUBLIC AVE - Building Permits ,
CITY OF COSTA MESA 4•
' BUILDING DIVISION
Fa j 77 FAIR DRIVE, COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
� FOR INSPECTIONS CALL:(714)754-5626
S bvi vi e i vt" PERMIT NUMBER: BC07-00243
PERMIT TYPE: B_COMBO STATUS: ISSUED
Sub Type: RES_RRIP DATE ISSUED: 12/11/2007
ISSUED BY: ??
JOB ADDRESS: 2124 REPUBLIC AV CM Suite/Unit:
APN: 42244221 Zoning: , ,
Vicinity: - Primary Occ: 7
Const Type: V-N ' ' SQ. FT: 3105 Valuation: $150,000.00
SCOPE OF WORK: ADD 1,161 SF,A NEW 432 SF ATTACHED GARAGE, REMODEL EXISTING AND 494 SF OF COVERED
PATIOS AT FRONT AND REAR OF SFD. 50 LIGHT FIXTS,55 OUTLETS, 47 SWITCHES, 1 REPAIR/ALT COOLING/HEAT, 1
FACTORY FIREPLACE, 1 HOOD W/MECH EXHAUST, 2 VENT FANS, 1 DISHWASHER, 1 GAS (1-4 OUTLETS), 1 GAS REPIPE, 1
SEWER
CONNECT, 2 SHOWERS, 1 KITCHEN SINK, 2 WASH BASINS, 2 WATER CLOSETS, 2 WATER HEATERS, 1 WATER REPIPE.
OWNER: WERNER,SHIRLEY J TR Address: 2124 REPUBLIC AVE Unit:
Phone: City/State/Zip: COSTA MESA,CA
APPLICANT: WERNER, SHIRLEY Address: Unit: :
Phone: 949-642-0176 City/State/zZip:
CONTRACTOR: OWNER-BUILDER . ie000000
Phone: Address: Unit: .<G
Cell: City/Stat�e:: `1 %, 1 1
, -9 ZipCode
ARCHITECT: LicensRo I ` PHONE:
ENGINEER: OIANG XIAO License No 41 I PHONE:94902 1-7740o
COMBINTATION PERMIT FEE SUMMARY YQk� c 0
Building Plan Check: $827.94 ���`��C
Building Fees: $1,273.75 J
Elec : $156.66 +1111:1/41
Mechanical
Fees: $73.00
Plumbing idFees: $$15.00
SMIP Residential: $15.00
SMIP Commercial: $0.00
TOTAL FEES: $2,518.25
**Refer to fee receipts for all fees paid for project
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
CODE r INSPECTION TYPE, ME Ix1mALSS ;ODE r INSPECTION TYPE, OA�t I AL
1616 Fixed System Final Fire Prevention _ 206 Final Mechanical a ,AJ rd
1266 Pool Spa Final 208 Final Plumbing WIN�
200 Final Re-Roof 210 Final Electrical y/V . ,/
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Signm 222 Final Site
204 Final Demolition • 250 Final Building/Occupancy
•
WORKERS4tOMPENSATION DECLARATION: Owner ID verified by driver' Yes ❑No
I hereby affirm under penalty of perjury one of the following declarations:
� Expires:— i�p
❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property t bill or deed):
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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a
number are: 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
Carrier: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap. 3.2,Grp
(Thu seam need not be completed d the permds valued at one hundred dollars(5100)or less.) 2 Arta Sec.341,Title 8.California Administrative Code).
Policy Number:
❑ As owner-builder, I will not employ anyone to do work which would
[X_I_certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above, unless
issued,I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
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 these provisions. Applicant's Signature Date
Division of Industrial Safety Permit Number:
—44;
AppGca Si
attire Dale t SOL"' /
- C - - HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes ❑No
($100,000), IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS (Section 25505 of the Califomia Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST. AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. 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
LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons. or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000) of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is in full force and effect. a registration form for acutely hazardous materials? ❑Yes 0 No
Lic.# Class# (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
Contractor's Signature Date 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
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? ❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: 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.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for'the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair.any structure, prior to its any other air pollution control district or agency? ❑Yes 0 No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Govemment Code requires that the requested
that he or she is licensed pursuant to the provisions of.the Contractors
c information be fumished on applications for non-residential building permits).
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 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031:5 by any 1000 feet from the outer boundaries of a school? 0 Yes 0 No
applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes",the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec.7044,Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes 0 No
thereon,and who does such work himself or herself or through his or her own 8. (If"yes", attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for control officer).
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 CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
cyyl I„as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions.
(4:ICENSED CONTRACTORS to construct the project(Sec.7044, Business and
Professions Code: The contractors License Law does not apply to an owner of Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction,and authorize representatives of
Business and Professions Code for this reason: 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
authoriz this ermit u it final inspection.
' l - _�,. /A// g -�`-twt?/+-' /� //-07
d, Si nature a Owners f Date-
tent - Date / ��, 1
305746(3I07) -- And/or Authorized Applicant Date
E te .
001-00180 42 -
NEWPORT-MESA UNIFIED SCHOOL DISTRICT N? 6812
CERTIFICATE OF COMPLIANCE OF DEVELOPMENT FEES
PURSUANT TO AB 1600 AND AB 181 PI
To: ( ✓) City of Costa Mesa District Receipt No. 1
( ) City of Newport Beach OUT• poato
( ) County of Orange Plan Check No.
Applicant: Shlr1 Q'141.11We
Address: aOM t c-4 I^blrlt- (AAAL, •
Telephone Number: vlt401 Le(-12 9171'
Tract/Parcel and Lot Number(s): 1 vuI-I tt
Location of Project: al;91J-4 koi4J9I l Ci V
Number of Square Feet of
Residential Space I 1 b l x $1.84 Total al)�Un 214
Commercial and
Industrial Space x $ .30 Total
CommerciaVlndustrial Project is: (Check One)
Warehouse Motel _ Preschool
R 8 D Bank • _ Auto Repair
Movie Theater _ Neighborhood Shops _ Hospital
Mini-storage Racquet/Health Large Office
Heavy Industrial _ Hotel _ Office Bldg.
Regional Shops Medical Office ___ Restaurant
Light Industrial _ Office Park _• Fast Food
This project is exempt because
This certifies that the above-named Developer/Applicant has paid school facility fees in compliance with Government Code sections
53080 and 65995. The Building Permits for this square footage in this proposed develop : t may now be issued by your jurisdiction,
Checks are to be made payable to Newport-Mesa Unified School District.
By: SIMS.
Authorized Re. nta
The above representation as to square footage is true. Applicant agrees that if it is later . : : 'nod that such representations are not
true, then this certificate shall automatically terminate and the appropriate City/County shall be notified.
//'6 7 _m�,a,), Ge� g
I O
•
m MFS9 CITY OF COSTA MESA
P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628-1200
. �:
d DEVELOPMENT SERVICES DEPARTMENT
ryC�RPORRTEO\�1b+
New State Law:
Swimming Pool Safety Act of 2006 (Assembly Bill 2977)
Effective January 1, 2007
California Health and Safety Code Section 115928 "(d) Whenever a building permit is issued
for the remodel or modification of a single family home with an existing swimming pool,
toddler pool, or spa, the permit shall require that the suction outlet of the existing swimming
pool, toddler pool, or spa be upgraded so as to be equipped with an anti-entrapment cover
meeting the current standards of the American Society for Testing and Materials (ASTM) or
the American Society of Mechanical Engineers (ASME)."
Address/Permit Number
Permit Applicant or Contractor's Affidavit (Please check appropriate box):
❑ There is an existing swimming pool, spa, or toddler pool on this property. I will
install an anti-entrapment device that conforms to this law, and I understand that the
installation of this device is required prior to final building inspection approval.
cg---)There is no swimming pool, spa, or toddler pool on this property.
SNbetar S e cti/ese
N`ame-(please.print)
eatolt
Sign ure/Date / ' teireitJ
•
•
Building Division(714)754-5273 • Code Enforcement(714)754-5623 • Planning Division(714)754-5245
FAX(714)754-4856 • TDO(714)754-5244 • vmnv.ci.costa-mesa.ca.us
February 3, 2009
City of Costa Mesa
Development Services Department
P.O. Box 1200
Costa Mesa, California 92628
Attention: Ed Petros, Chief of Inspections
Regarding: Building Permit Number BC07-00243
Werner Residence
2124 Republic Ave.
Costa Mesa, CA
Mr. Petros,
Due to the current economic conditions felt by most, not only in Costa Mesa but
nationwide, the property remodel at the above mentioned address was halted a number of
months ago. It took quite sometime to establish funding to complete our project. We are
currently in the final stages of obtaining funds to get our house finished.
We respectfully request an extension of our permit so we can get this project completed.
We expect to begin work in as little as one week. We have a project completion date of
April 30, 2009.
Thank you for you time.
Sincerely,
Kristina Dresher
2124 Republic Ave.
Costa Mesa, CA 92627
Home: 949.642.0716
Cell: 949.633.0947
`6 "' F CITY OP or MESA ,
4 '
BUILDING DIVISION
>- .-
0 i -, DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
F . .1....--iI -
k �a PERMIT E02-00170
See,memo et
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 2124 REPUBLIC AV Status: ISSUED
Suite No Applied: 03/04/2002
Vicinity: Issued: 03/04/2002
Parcel Nunmber: 42244221 i
Applicant: HALE, GLENN ISSUED BY: �'j ,
Address: 327 S TUSTIN AV - -- --
2 -Phone: 714-744-4300
ORANGE;CA - Zip: 92866
,
Owner: ' WERNER, SHIRLEY J TR
Address 2124 REPUBLIC AVE "
Phone:
I
" COSTA MESA,CA Zip: 92627 v 0S
•
•
a5 , , LL�
Contractor: BERKS ELECTRICAL an
Address: 327 S TUSTIN AV - - .y
' <Phone:
"ORANGE,CA /" ' Zip: -92866 . - -
--" - License: 634432 -
SCOPE OF PERMIT , .
ELEC PERMIT TO CHANGE-OUT ELEC SERVICE IN AN-EXISTING SFD. 1 SERVICE TO 200A
NO OTHER WORK WITH THIS PERMIT. - . - ,
• FEE SUMMARY •
Quantity " - Quantity
ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0
Temp service test S0.00 Busway/100 ft $0.00 0
Res.a/c package $0.00 Standing Section $0.00 0
New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0
New Res(3+units) , $0.00 0 ' Transformers up to 1 kvalkw $0.00 - 0 -
Pool/Spa $0.00 0 -up to 10 kva/kw $0.00 ' ' 0
• Lighting Fixts $0.00 0 up to 50 kva/kw $0.00/ 0 ,
Recept Outlets $0 00 _ Q ' up to 100 kva/kw-•. $0.00 0
Switches $0.00 , - -• d over 100 kva/kw $0.00 0 ,
0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 ' 0 •
Res Appl $0.00 - : 0 Low Volt Wiring System/Ckt $0.00 0 ,
Service to 200a $30.50 . 1 Misc.Conduit $0.00 . 0
Service to 1000a $0.00 0 Misc.Conductor $0.00 0
Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0
Motors to 1hp $0.00 0 Circus(mech ride or lights) $0.00 - 0
Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 .- 0
Motors to 50hp $0.00 0 Fireworks Stand $0.00 0
Motors to 100hp $0.00 0 Other Electrical Fee $0.00
Motors over 100hp $0.00 0
Communication drops $0.00 0 Investigation Fee $0.00
Sub panel to 200a $0.00 0 Plan Check Fee $0.00
Pole Light Pkg $0.00 0 Reinspection Fee $0.00
Sign Circuits $0.00 0
Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $54.00
Intermed Pole $0.00 0
COMMENTS/SPECIAL CONDITIONS
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
244848(W00)
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
ork for which this permit is issued.
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'compensation Insurance carrier and policy number are:
Carrier: ren SitA_UtVJ tt S, Policy Number: !v7 SP-)_C.-.- tl' 72- —0l
(This section 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 should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with thes ovisions. �\ \ ,�
Applicant Signature: S >_ , ! Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML RNES UP TO ONE HUNDRED
THOUSAND DOLLARE($1W,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 and Professions Code,and my license is in full
force and effect.Lic.# (off[( Z Class# 1 l d
Contractors Signature: . ¢ Date: 3-U—C7`/
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: 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 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.).
o I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. 0 Yes 0 No Drivers 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? ❑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? ❑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 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 en 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 ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application akermit 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 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? ❑Yes ❑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.
Signature 01 Legal Owner(s) Date
a > Au
And/OrrAut I}artzed Applicant
ODE I INSPECTION TYPE Ddg INTITIAL$ CODEC INSPECTION TYPE DAIF INTDIAL$
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
cal f
200 Final Re-Roof 1 .44
2110 Final Electrical 11�
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
License Detail : Page 1 of 1
Extract Date: 09/27/2006
* * * Business Information * * *
JENADES ELECTRICAL INC
dba BERK'S ELECTRICAL
327 SOUTH TUSTIN STREET
ORANGE, CA 92866
Business Phone Number: (714) 744-4300
Entity: Corporation
Issue Date: 12/31/1991 Expire Date: 12/31/2007
* * * License Status * * *
This license is current and active. All information below should be reviewed.
http://www2.cslb.ca.gov/CSLB_LIBRARY/License+DetaiLasp 09/27/2006
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O/%NGE COUNTY B BUILDING DDEPARTMENT APPLICATION FOR PERMIT
636
j SANTA ANA, CALIFORNIA I BUILDING 1
• •FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
BUILDING •
RECEIPT NO. PERMIT NO.
ADDRESS 2124 Republic Ave. 17 33 0 66 '7/ :Z
SCHOOL DIST. Mesa TOWN Costa Mesa RECEIVED BY DATE RECD. DATE ISSUED
NEAREST
CROSS ST. Victoria Ave. CIVA4-; -az( w-?I -S-,--/
OWNERBUILDINi n 7 i/ g .
Crow Homes Inc. ADDRESSG Td
MAIL 9363 Wilshire Blvd.
ADDRESS SCHOOL DIST.CAtsitir, frJC ,�Q-
,
OR TOWN
CITY Beverly Hills NO`CR 54361 NEAREST
CROSS ST.
ARCHITECT 0,B LIC. ZONE NO. OF TYPE GROUP
ENGINEER sin-2•icCarrach.v ni/ I PLANS
I ^Tr IyLi
ADDRESS 2110 E.Walnut-Pasadena APPROVEDP7V_1f�irJ at/
CONTRACTORBa1bOa Vista N0143231 BY /V�K//��1 DATE
ADDRESS 9363 Wilshire Beverly18CORRECTIONS
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CORRECTIONS
LEGAL I NO. 201 LOT
DESCRIPTION I BLOCK I TRACT 1872
(ATTACH METESEtH BOUNDS)
NO.SIZE OF LOT 68 x 104 I NOW ON LOT 0
EXISTING BLDG.
SETBACK LINE FROM: Y(2 I FRE RFAMILIES
YARD ROC IS
t.CENTER OF STREET L t U. SIDE YARD I 1 -3I
DESCRIPTION OF WORK 0
NEW I X I ALTERATION I I ADDITION I O
2
REPAIR I I MOVING I I DEMOLISH I D
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S ZIE DING 1034 PtROOMS 5 STORIES 1
div
EXTERIOR WALL ROOF Compo
COVERING Stucco I COVERING Shi nplp
USE OF NEW
BUILDING Residence-Att.Carport -
APPROVALS
FOUNDATION: LOCATION I INSPECTOR ' DATE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS UNDER/PINNING
FORMS. MATERIALS, /1 .4• /./ 9 )•1%,l
APPLICATION AND STATE THAT THE ABOVE IS CORRECT �(�%� rte` L / J •Y
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FRAME: FIRE STOPS. /� -7v T 1�
BRACING. BOLTS •-.f�f/�7
AND STATE LAWS REGULATING BUILDING CONSTRUCTION.
LATH. INT. 4�
SIGNATURE OF Balboa Vista Co. LATH. EXT.
PERM ITTEF
f/P^1 PLASTER, INT.L. g ..y ,
AUTHORIZED PGT. ✓La tell PLASTER. EXT. 23 7'"✓ v
*"' PERMIT FEE S /q MASONRY REINFORCED
VALUATION $ 4830.00
PLAN CHECK $
BOND BEAMa TOTpp� ��/��1 �( ) /'/
FEE S / FINAL -&-c3 Q--[I0• .4y
591 9-90-59
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