HomeMy WebLinkAbout2412 RICHMOND WAY - Building Permits �F A CITY OF COSTA MESA
BUILDING DIVISION
F sl , • DEVELOPMENT SERVICES DEPARTMENT 1 PERMIT NUMBER
PERMIT
• B02-01155
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 2412 RICHMOND WY Status: ISSUED
Suite: Applied: 07/26/2002
Vicinity: 2412-2422 RICHMOND WAY Issued: 07/26/2002
Parcel Number: TPN98078 Zoning:
Applicant: BLANKS, JERRY ISSUED BY: /�
Address: 17501 NORWOOD PARK PL V "
Phone: (714)573-0155
TUSTIN, CA Zip: 92780
Owner: MONTICELLO COMMUNITY ASSOC.
Address 150 VALLEY FORGE _
Phone:
COSTA MESA,CA Zip: 92626
Contractor: PREMIER ROOFING AND BUILDING CO INC
Address: 17501 NORWOOD PARK PL
Phone: (714)573-0155
TUSTIN,CA
Zip: 92780 License: 634404
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
REROOF BLDG WITH ADDRESSES 2412-2422 RICHMOND WAY FOR"MONTICELLO HOA":T/O FLAT ROOF ONLY, INSTALL
1 BASE,4 PLY AND ROCK WITH HOT ASPHALT.5000 SQ FT
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $13,592.00
Permit: $237.25 Claim Valuation: $13,592.00
SMIP Res: $1.36
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $238.61
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
2446-46(6/00)
DECLARATIONS 6 4' n
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.
F. 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.
orkers'comp/erisatiorjalsurance carrier and policy number are: Cy /
dztb be fr/L FGc-7t.1� mbar: /� 2 �,J/ -U/
11• : action nee t complef.d if the permit is valued et one hundred dollars($100)or less.)
❑ I certify that in the perfo nce of the work for whic his permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
- s of C rrfomia,and re t i hould become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
/amply with the =pr,�ions. / ,�/ /n�
..licam s'••- ` //=GG2 Date: NA7/69
WARNING:FAILURE TO SE sib „ORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMI PENALTI S AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,•'.•),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 her t I am licensed under,•r. 'sions Chapter 9(commencing with Section 7000)of Divisio, . . • :• iness and Pro ssions Code,and my license Is In full
f ce and effect. .It i rr / Class it C..- 3 / o
Cant o s nature: �� � �- o2G
�__- __--
CONSTRUCTION
CONSTRUCTION LENDING AGENCY: •
In 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 penally 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 coun • ' h 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 state,ant that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of DMsion 3 of the
Business and Pro•ssions 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 ap. cant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as• er of the property,or my employees with w=f- .s their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044 :usiness and Professions Code:The Con : tors 'cense Law does not apply to an owner of property who builds or improves thereon,and who does such work
him•elf or herself or through his or her own •• •loyees, •rovided that such improvements are not intended or offered for sale.If,however,the building or improvement is
so:within one year of completion,the• er-builder wi i have the burden of proving that he or she did not build or improve for purpose of sale..
■ as owner of the property,am USIVELY CONTR• TING WITH LICENSED CONTRAC •= .- e project(Sec.7044,Business and Professions
••e:The contractors LI . Law does not apply to an o • •. _ .. • • Improves thereon,and who contracts for such project with a contractor(s)
icense pursuant to •- ontractors License Laws.).
❑ am exam• . .er 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).
❑ 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 0 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? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application akermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes U 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:
CERTIFIC 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 gree to comply with :I state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above- scribed prow, •r' s -ction purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
,,r • ,
..-
Signature Of Legal Owner(s) Date
•)'C e/1 y nilf ac O'
And/Or Au • A licant bate
OODE I INSPECTIONTYPE all INTRIAL4 CODE 1 INSPECTIONTYPE PAM a4
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final Q� / 208 Final Plumbing
200 Final Re-Roof V -(/ 0Z LPX'4 210 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
0 CITY OF COSTA MESA
•
4 @ BUILDING DIVISION
> • „„r ..�d DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
1. 1 nil I PERMIT
O !'''AIS
% ro.arso'is P01-00045
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 2412 RICHMOND WY Status: ISSUED
Suite No Applied: 01/25/2001
Issued: 01/25/2001
Vicinity: WATER HEATER
Parcel Nunmber: 41916522 ,. .. , ., ISSUED BY:
Jr
Applicant: STARK, CHRIS-
Address: 7229 VARNA AVE ' '
✓�' , ', Phone: (800)444-8865/
'
NORTH HOLLYWOOD CA _ z - • Zip: ,91605 -
� 0,2•/, , i _ _
.
Owner: ;\THOMBSON,JUDITH L ` > \Z,,
Andress 2412 RICHMOND' \�A�
:/ 1//%-./, Phone: . \\ .,--
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1. ' -' COSTA'MESA,CA Zip: 92626 _\ \\-`
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//Cont actor /ALAP-ASSOCIATES GP �. - - ' C;._;,,,----
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1 ,
i , / IAddress 7229 VARNA AVE, . '
'`, i / ' - - Phone: (800)444-8865
-
.\ - %NORTH HOLLYWOOD, CA Zip: 91605 V • . ;, I 1\
, _ l�
�- _ License: 771905 - � ,
- - - / r --
, � Arch / Eng.,;: i I •
Vii- -,
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Phone 02,
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,A - V License: (,/1 l- `" r
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'',.\:,' ; SCOPE OF PERMIT '_
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�WATER HEATER CHANGEOUT. :
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r 'FEE SUMMARY., _ �;%� `'1 U/
V , AMT OTY • , - ' v ..AMT -.:QTY,-;..e...„7,,,,,_., . c5:-/-/cc: ,AMT CITY
ISSUE FEE V�� ��$23 50 \'\A,�. 'n.XLaundry Tub/Washes-'�t_ 50.00;:t "0�, .• Suritp'Pump � $0.00 0
Backflow irrigationvv $000, \0A - Landscape'Irrigation ' /22 $000 ;0 - Svnmming.Pool $0.00 0
Backflow Preventer�� (, .bap, Oi �P Trap v_,A o •, O o$O Ooi (> '0' r - Trap Primer /i $0.00 0
Bathtub z�\ $0:00/ -0` ",Pressure Regulator „ \., $000 16,/,:jr- Urmal/�� $0.00 0
Clarifier System 'V,$0 00-/�•0•//-- ProcessPiping.(per 10-ft)� :$0.09- 0Vacuum Brkr Bkflow(A-04) $0.00 0
Connect(Ice,Soda,etc) t.-;:$0.00‘,..:\•-,0'n) Receptors -* "'._-$0.00 _-0 c"cVacuum'BrkrBkflovi(5+) $0.00 0
Dental Units $0.0„0. '0 c, / / Septic Tank - - $0.00 0 - Wash Basiri�\ $0.00 0
•
Dishwasher $0.00 -�0' _2/ cSewer Cap for,Demo_ - $0.00 ;!0`\,' Wash•Basin•Set $0.00 0
Drain,Floor $0.00�-cc0,.. f <_Sewer Connect, ' ,r -it r•
- ,Wasteand Vent System $0.00 0
Drain,Rainwater $0.00 "----0--- --',-----� Sewer Private Line`` ' $0.00,..,T01/2' .%fwWatei Closet(Toilet) $0.00 0
Drain, Roof $0.00 0 . Shower • - '$0.00 0 - .r,,- ---Water Heater/vent $12.30 1
Drinking Fountain $0.00 0 '-' -Sink;.bar- - $0.00,,,,o- - - Water Piping(Inst or Rep.) $0.00 0
Expansion Tank $0.00 0 Sink,Tcommercial'- -'1,<-;.c.-/$0:60-::'0' Water Re-pipe $0.00 0
Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0
Gas(1-4 outlets) $0.00 0 Sink,kitchen $0.00 0 Water Softener $0.00 0
Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00
Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00
Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00
Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0
Interceptors(Sand Auto) $0.00 0
TOTAL CALCULATED FEES: $35.80
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
2446-46(WOO)
DECLARATIONS I ) f)
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-In -for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
for which this permit Is Issued.
e -11 have an ill maintain workers'co .: :tion insu nce,- required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued.
L-fAAyw er 'wmpensatlo r:4,‘,..:: :nd rolicy mber are: �4Z�GC0O CJ 00
`
CaFriecl � iolicy Numtier.� 0/
(This sedtion need not be completed if the one hundred dollars($100)or less.)
O I certify that in the parlor,--4v; wo this permit is issued,I shall not employ any person in any so as to become subject to the workers'
compensation laws of.. /4-1 I*a ould become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these pro
ApplicantSignature: •tea-. Date: /"2S °
WARNING:FAILURE TO SECURE WON'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED
T ousAND 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 d r pr yl ' f I ter 9(commencing with Section 7000)of Division 3 of the Business and Pjof�asions Code,and my license is in full
force and effect.f4J Class#—. C -S
Contractors.Slg re:� Dat 2S-0i
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: - Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose o1 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 Drivers License No. Expires:
Verification of Ownership by(type of document,I.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
O 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 Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature 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 0N
•
(Section 25534 of the Califomia 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? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a.permit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U 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 Califomia Health and Safety Code Section 42303 been made? 0 Yes ❑No
B (If"ye?,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 AUTHORIZA ON.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 I.•"s a : ci or• ances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection• rposes.I ...r=- not to occupy or allow occupancy of any building authorized by this permit until final inspection.
(0-e4. :..l."..")..,r s) Date
/-Z5of
d/Or pplicant CDate-' '
CODE I INSPECTION TYPE LATE' INTtTIALE CODE. INSPECTION TYPE DATE 'MAL*
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 206 Final Plumbing 2 1-o)
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 _ _
ABBESS OF BUILDING: 2412 ..An A T flt'gA -*¢¢ h.IG1'VKOY)p1s ° CITY OF COSTA MESA — BUILDING PERMIT
OWNERS NAME IFI01OWN: ..TMCVM� r PERM NO: B 073460
ADDRESS: 2412 AvQ,i i ii1oP 9 ud•
•
COSTA MESA,CA PERMIT NO: B 073460 PLAN CHECK NO: N GOVT: N SUPP: N
AML.MMUNG ADDRESS , CONSTRUCTION TYPE: VN PERMIT TYPE: STR_ PURPOSE: OTH
ARCHITECT OR ENGINEER: UC NO.: JOB DESCRIPTION : T/OFF, SHEATH & REROOF W/COMP SHINGLES SQ FT: 2, 999
ARCH.OR ENG.'S ADDRESS: UNT:
CLAIM VALUE: 2, 999 . 00 CALC-VALUE: 2, 999 .00 GROUP OCC: R-3 /
CONTRACTORS NAME STOUT ROOFING INC ( 310 ) 923-6775
CONTRACTORSMuuNG P 0 BOX 4309 COMMENTS: SMOKE DETECTORS ARE REQoUIRED PER 91 UBC
ADDRESS: DOWNEY CA UC,ND.: 402536 ********************************T�**AExRE+ExxRE�E�ERERERERERE�E�E*RE+tx*RERE+N+E+r*RExREREx**xREREREx*****
90241 uMT: ZONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby ellirm under penalty ury that I am licensed under provisions of Chapter 9 _ SETBACKS
(commencing with Section 7000)of Division 3 of the Business and Profen and my T se is in full force. •effect.
GMT LIG,��059q,7 Cuss C 39 UC.N 25 E ' . 10/ 95, MAIN BUILDING ACCESSORY BUILDING
Data: ? L b ir Contractor: 4° as ANT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN
LEFT: FT IN RGHT: FT IN
aWNER BUILDER DEC RATION:I hereby affirm under penalty of perjury that I am exempt from the Contractors Ur. a Law for the
dowing reason(Section 7031.5 Business and Professions Code:Any city or county which requires a permit to cons .alter.improve. PARKING REQ: PROV: PARCEL: Z N E: REF NO:
y,. molsh,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 Dirvision 3 of the PLANNING NOTES>' q I q I(0 522.
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.My violation of Section
7031.5 by any applicant for a permit subjects the applicant to anvil penally of not more than live hundred dollars[45001). *************1E*.*******************************************************'*********
❑ I,as owner of the properyormyemployees with wages asthersdeoompensation,will dothe work.and the swcturesndintended D E V E�L O P M E N T SERVICES R E U I R E M E N' T S
or offered for sale(Section 7044.Business end Professions Code:The Contractors License Law does rot apply to an Owner cif properly y Q
who builds or doesimproves thereon,and who such wort himself or her-sailor through his or her own employees,provided that such ( '.v,
improvements are ref intended or offered for sale,If,however,the building or improvement is sold within one year of completion,the ZONING APPROVED BY DATE:
ownerbuilder will have the burden of proving he or she did not build or improve for the purpose of sale).
o propI.as owner of the contracting project(Section 7044.Business and /,.(
erly.em eo Contractors Lien awilicensed c n owner le opertyd the
contracts to Ouch:Toe withac License Law does not apply to owner of sproperty who builds or improves thereon and who BUILDING APPROVED BY : DATE:
contracts for such projects with a contractor(s)licensed pursuant to the Contractors License Law). :l
o I am exempt under Section: B.&P.C..for this reason: APPLICATION ISSUED BY: F / DATE: )�'0
Dale: Owner: C Y
************************************ ' * - �F************************ **
LEGALIZATION:N F E E S MMARY STRUCTURAL SEGMENT:Y
I do hereby candy that I am aware of end understand the requirements of California Health and Safety Code Sections 25505,25533,and
25534,end that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for
apennt for construction or modification from the A'e u�Os IAty ananagement District Residential fromhese BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
provisions. dmnsruciion applications are exempt t
PERMIT 54 .00 . 50
Dale: Applicant: SMIP/NON-RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty d perjury one of the following declarations: PLAN
ISSUE FEE
❑ I have Code,f twill hepeantainceofthateofconsentt thispsureror orkerscompensation,asprovided for bySeasn373dthe Labor BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID
Code,forme performance of the work for which this pemmb is issued. .DUE
�Iorkforand widmaintain worker;ed.Mywcompensation insrance,asnrequired bcecaron3703of the Labor Code.for the performance ofthe
TOTALS--- > 54 . 50 0 .00 0 . 00 54 . 50 54 . 50 . 00
work for which this permit is issued.My workers'compensation insurance carrier and policy number are:
Carrier: STATE EXPIRES REVENUE DIVISION TOTALS--> COLLECTED : 54 . 50 OVER/SHORT: .00
Policy Number: A4494I10004F.R7 10/19/95 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
(This section need not be completed r the permit is for one hundred dollars(5500(or less.) 54 .0 0 . 5 0
o 1 cenfy that in the performance of the work for which this pencil is i I shell nd employ any person' any manner so as to
become subject to workers' sun laws of oat Callanvn nee that ' I should bxo de lyes tot workers' **************************************************************************1E****
Mori /y 3700 of the Labor Code.I sA h corn. • h those prom' ..
. ,
X Dale ) 417 \ Applicant: / r INDIVIDUAL F E E BREAKDOWN
Warning:Failure to secure workers'compensation coverage is unlawful,and shall Subject an employer to cd • I penalties end , TYPE _ QTY. __ D „E S C R I P T I O N UNIT COST TOTAL COST
civil fines up to one hundred thousand dollen(St04000),In addition to the cwt of compensation,damages as provided for In
Section 9706oIthe Labor Code,interest,and arcomey'elees. SFR , 2999 REROOF BY VALUE RESIDENTIAL NOZONE _ 1 .00 2, 999 .00
CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury that there is constructiona lending agency for the END OF FEES
performance of the work for which this permit is issued(Section 3097.Civ.C). ' ,
LENDER'S NAME:
LENDER'S ADDRESS:
I certify that I have read this application and state that the above information is correct.I agree to campy with all city and county ordinances _
and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above.mentioned property
for inspection purposes.
D ENE BURFOR
j .
y Dale: 01 60237154-00.187155 TOT 54.50
igmlure of DATE: 07/2228/95 TILE: 09:23
1St51 d6 WP) White-Building A Safety;Green-File;Canary-Appicant:Pink-Revenue:Goldenrod-Assessor
CONSTRUCTION AND PLANNING
PC 9 SPA
APPROVALS Permit# ' Date Inspector APPROVALS Permit Permit Date Inspector
. r
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. ^J • 53. Steel Reinforcement ,
W'
_tQ tiectrical Condu_ii Ut,ity-Undlgrnd. _ 54. Forms •
r`; . -
-4.1Electrical Conduiit-Un rgrnd- - 55. Electrical Bonding
.,;r71`' 3ceel Reinforcert4r4 56: Rough Plumbing & Pressure Test
-.. 1-• 7
frfiQElectrical UFERL,chd. • - 57. APPROVAL TO COVE _
�
_: R'Footings sv" - - 58. Electrical Cond Yt��'Jndrgrnd. •
l• •.,_' L. r'
%J' -Foundation ;� . a 59. Gas Pipe;El Un4rgrrid.,Test o'
3•=Water Pipe-Undrgt�d. ` 60.. Backwash-Lines, Ftrap, D-Undrgrnd.
1, •
-;10. 'Structural Floor System ' 61. APPROVAL TO [�ECK - .
1Y. 'Aroperty Sewer Line & Housetonriedtion _ 62. Backwash & Rece�uor-Final, •
•12. wer Cap c' - 63. Heater & Vent-Final
--1,3,-Roof Drains - 64. Plumbing System - Final
.j7j Rough
Plumbing 65. Electrical-Final •� '� •
.0 -
• ' 15- Rough Electrical-Cor¢iuit e v• , _ _ 66. Solar System-Filial -: LA
16. Rough Electric Whir --, 67. Fencing & AcceasApprovat-
i
17. Rough Wiring Sign 68. APPROVED FCLTFPLASTERING. ,
18. Rough Electricatii Bar Ceiling' 69. POOL/SPA SYTt_mS FINAL
19. Rough Heating & Air Conditioning T FIRE DEPT. REQUIREMENT '
a r' r`- ' -r t .-'- •1 Cr H :
m , - s N
20. �pugSFgt. orFirp'face S O # y
Gm. ", r H a* � APPOV r `� PecT(nit r ''
- t' , r4. ' 9
e- - ' .t �
2- z...,..< .•,
21. Ductf,in$truzurgr,; •• •. _ i n r n 70. tlndergoir Hiro
22. Quct aVe3til ng"]; ^q K .J 4 T 5,r,' 71. Produg, ,ping r.i as d.Oil
23. Gas ape-lTouglj• & Te,st mn m ' < p* : .72. Undergrd7rrd Flasa F- a.
_ - y Sr ... • ' a z i.
24. Roof raining•' E I -"" Jr IN '' t > ;� `R .7 Undergrrtl3.StoI 9tasink'';D Gas ❑Oil
25. RoofShe`a2hing tri* Z. irj'`gry (:(r. 7q�Overhead'HydrQ)_C x
26. -F•BaRCeiling (Struet6rall & IA}tvc6at * ^ p'•. 7-z ry Chemical ,_' x `" `''
27. �.,rarna an Fla in * = �` °7 * rt LI t•"•- Li.a.
* .. •.
�. 3h i* � ^ �' -^ %+ wx 76. Dry Stanrytz�te F-,tz * _ G
J28. Lathing i�ic g '}r :n `3-*: ^ E " •' 7e FIXED TEM INAC - , m
29. Insulation- ti. ;a s r j'xi .. 78E FIRE PREV. FINAL x > r •>-
_
30. Drywall NQJjilir4•g c:,1 ' _ H r_7NALTflDEPt, RECTA REMENT
rr r* i * l . t.
:,31. Plaster 8rgwn,•froat tr. S t i---',7 . 791.1)FINAL IASPP.ECT&ON ._ C
r32. Electrical oWej M rd 1 x 1:1 * r • 8i FOOD CERTIF `S
TE I ED_ G
•
x_-_Ina Elec'ric 21",„ Y * t+7 F* , :=i -1 2. r. m
.33.
I CI t* No-test '-,tr. * t- _ Pi r.:
"34. Fina t-leas4ng Pei Altn'B
iGotionirrT S n r _ ' `•t G S -. S no
H 0 la 'l F4' iJ r-! 1 rC *
I 35. &Inaf-Gas ipet•jest,k' G -+ 4 . .
• -
m36. Hoodior Canopy TFC * 1 C'- r 1 t T1 C? :tr
-, .7' --• * . I.- .. * I rn TJ *. T -t.,
X37. F;�rtafFac qrY Fireplape F-_, Iraer "• * ''
-+38. Finalc9luttbing 0_ U • Com. f .* . S a �. a O
'39. Waterr^$arty ce-.Fnai ! s, * ; I * e.e. *
L * S
s.;140. Gas Service-Final . :1 rrCr• ' .* Cr; I* C= '-till * ~
y41. Solar Dor7}gsttFinaly S -
I G .4y v _
L �� •t . ^ t
42. 8ackflow ,reventer t
I P 4 • r G
43. Backflow Irrigation )- x t^ * u
^, •
J
4. Landscapa7lrrfpation'6ystem -Cr,CJ r R1 G C C* n; �: �;,� to o
1e'- r t e e* 8 r ru p c ,. S .
$ S and A�l;en69tion . r * E F H. F* t-t H -4 q4; * .
i * r r t*PF o' c" C, • F G *
4' t t _ LL ' -
. d6. HandicapRegulation.s a * - * • " �o S
47. PN{s STRUUTURf& BUILDING /`7 cc 64c/(/ rue` *
J 1, w a •_ ^.
48. ELNA-1,.PLANNING * ; r + * {um a; * t- 'AC x * I r* 0 cu S
49. Electric Release to Bison x ! G
6$. Cres 9 Iea5e to Southern California-Cas Co ; 1 . a y • cm x. O •
51. CERTIFICATE OF OCCUPANCY * ' CJ ,^.±o x * r. :J
No. Date
27467
P�i°
COSTA MESA BUILDING-SAFETY DEPARTMENT ERAu
SEPEs 67 0 167-r. ***,',6 7.50
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 --r
For Applicant to Fill in Completely APPLICATION FOR PERMIT
TYPE OR PRINT • BUILDING
/. For Office Use Only
BUILDING
ADDRESS -R %, pr(i(AA.UCIUe S
RECEIPT NO. „Pe Nl r,elq.
COSTA MESA. CALIFORNIA !-�/d/%�N 7
f/`yi // [��y. /� p[CD OY 7 RP `21t12n /��89 HD
OWNER Chea Vd II I��`��.K��(/////��//1e1�/edi e n RECI-cern/} ,/ nYVY (//,VJ_ (///J/A �j
4,7
MAIL _(.i / "I/ �-NAA=C.L(- -4 ADORRBY/2(174/.9 .C�Gr/nt'fr7 ' �/
ADDR ,re L.( FIRE
/�/1
CITY FIII
y/W� NO. OpC�dV-I ZONE TYPE -.... GROUP Yy'
ARCHITECT (/(�)����yp�/�� T Lq BYPROVED DATE
OR ENGINEER vv`-'V'uii • NO. (Z3�I4
ADDRESS 4o,-'a ll. f . -M✓IQc c , (' .u�L/�=O ND.Or ^Z�'ONING of Nnr s/HHH��� '�Jr l��y
0 3 PLANE y BUILDING t./p q j4e
CONTRACTOR Q Of/,�1.� �p J
LEGAL la., 23 1 ?��t�-y--516-0
ADDRESS I.}CLake
DESCRIPTION �"l.
CITY Ocucti.."---' A.P.NO.
930 - 03 - Z3/
NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
STATE TEL 80•TO SIDE&REAR p.L
LIC.NO. NO. .
SIZE �/ '7
OT t J� ((7 INO.or SLDGBC ALLOWEDEAVES
NOW ON (U.B.C.REQUIREMENT)
MOT OLLOT
YARDS APPROVED YARDS APPROVED
USE OF
EXISTINGFLD0 MAIN BUILDING ACCESSORY BUILDING
(FROM C/L STREET)
SCENTER er9ACE��p1E PpoN R6AR.ARD FRONT 0 FT. FT.
OPO r
SIDS YARp`LEr1 —motif
R•SIDE 0 PT, MT.
DESCRIPTION OF WORK L SIDE `67 FT. FT.
NEW _ALTERATION_ ADDITION REAR 0 PT. FT.
DISTANCE BET. BET.MAIN&
REPAIR MOVING DEMOLISH MAIN BLDGS. ACCESS.BLDGS.
BUILDINq.() �7 NO.OF �j VAR.# DATE
SIZE /A(Q X (n ROOMS 4- STOORIEs I G.U.P.# APPROVEDf�Eal
COVERINGRIOR W ROOF OF 11._ . COVERING !'C SYFROV[D /f` DATE —/��a /
USE OF BUILD e D WOR TO B[ ERFOR D Or'p6 p,
ri.i
�at 9 Yeo eO.FTX �- ��o '°'y�/y/��
THE AMOUNT SHOWN UNDER VALUATION IS FOR THE C
I N ATHATYILE ■TNAT.I ORRECT D THIS APPLICATION ^
AND STATE THAT ABOVE IS AND T AND AGREE TO COM- PURPo/E OF ESTABLISHING A PERMIT VEE oHLY. v�1
111
PLY WITH ALL CI 0 INANCES AND STATE LAWS REGULATING VALUATION A�
BUILDING CON CTI ,,// ✓V
SIGNATURE OF PERMIT FEE SYS
PERMITTEE �T / 5D
AUTHORIZED AO
5/3 azlie PLAN CHECK S 4��' 19
TOT/tl.PEE t; ere?
UWIVER WIN V1b'1'A BU.LL11i1Gi UU. DA'lri 9_0_b7
JOB ADDRESS 2412 Richmond Way BUILDING PERMIT NO. 27467
GENERAL CONTRACTOR. Same as above DESCRIPTION OF WORK Res. w/Att. Garage
AT' No. 930-03-231 LOT 231 TRACT. 5160 FIRE ZONE VALUE $13240.00
1 ECTIONS I Signa a Date GROUP DJ TYPE V ZONE R-3
Sou —La.
17-/I-C7 SUBCONTRACTOR I PERMITS ISSUED
Gas _ Date j Number I Signature
Water iCc '^ /fir / ' •lumbing/
Rough Plumbing &a. It( -0 "MI 7.0. � WfAr (r /
Prop. Swr. Line 0 House Con. It: t fig--67
Sprinkling System
Miscellaneous
Rough Heating and Air Conditioning 4fr /'+2"en
Temporary Service or Pole
Underground ❑ Power 0
Rough Wirin• / /(/� �a 9. 69 Heating and Vent.
Trenches
0.
Trenches L� Steel Reinf. �" � 'u, @ G.'7 `7..-4.44../y�ywp p /e-/S-67 5-3/YC
Floor System P+ g/61 r/ /
Bond Beam 0 Steel Reinforce 0
Sheathing o c- / // 6 7
Frame and Flashipg / e /„{ ?
Lathing— In V! Out [ ' 7O, fS3
Plaster, Brown Coat mai i f yt/�
tural, Final ectric
1._..Jng, Vent., Refrig. and A.C., Final S /2--7-(.-D 'moi_ a #�. /0-Ay-47 �)77o.\
Plumbing, Final and Gas Test a S/;--->Z- 2
Electric, Final / 67
Building, Final__-`- �a- / ,f/G
fri)411;0 . 77,( 4,