HomeMy WebLinkAbout2419 RICHMOND WAY - Building PermitsFir
CITY OF COSTA MESA - - ' ' •
,jitL BUILDING DIVISION
. -
`Ii 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
PERMIT NUMBER: M08-00150
PERMIT TYPE MECH STATUS: ISSUED
APN: 41916562 DATE ISSUED: • 12/04/2008
ISSUED BY: BJK '
JOB ADDRESS: 2419 RICHMOND CM, Suite/Unit -
Vicinity: .
SO. FT: 0 •
SCOPE OF WORK: FAU CHANGE-OUT IN AN EXISTING SFD. 1 FAU < 100K BTU
•
OWNER: ABATANGELO JOSEPH TR:' Address = 2419 RICHMOND WAY- Unit: •
PHONE: - - -".City/State/Zip: : COSTA MESA••CA ..
APPLICANT: HUAPAYA;YOLANDA r1_ Address: ,' 1531 COLLINSAV Unit - . i
PHONE: 714-997-2969 :1. - City/State/zZip: ._:ORANGE,CA ':;i 1
-1 7'i. J ,, 1 - r s _ �Yi1 .
CONTRACTOR: ADD'AIRE INC:,; - License No. 906705 I 1 '
Address: 1531 COLLINS AVUnittPHONE:-• 714.997.2969•',.- ' • - - ,
City/State: ORANGE1CA 'ZipCode 92687" - - • . . - ' CELL:
MECHANICAL PERMIT FEE'SUMMARY
MECH ITEM FEE: - .... - -
PLAN CHECK FEE: $0.00
INVESTIGATION FEE: 0.00 -
REINSPECTION FEE: -$000
TOTAL FEES: $38.30 t
:.4.. 1
4
•
. .
•
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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 S. INSPECnONTYPE 11E INTTALS CODES INSPECTION TYPE1 IN11T11LL
1'n1616 Fixed System Final Fire Prevention 206 Final Mechanical 1(.�7
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 .
NN
WORKERS'COMPENSATION DECLARATION: - Owner ID verified by drivel.. .ense. 0 Yes ❑No
I hereby affirm under penalty of perjury one of the following leclarations: - Driver's License No. Expires: .
❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed):
compensation, as provided for by section 3700 of the Labor Code, for the
p rformance of the work for which this permit is issued.
I have and will maintain workers'compensation insurance, as required by
' tion 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 ❑ I hereby certify that no excavation five(5)or more feet in depth into which a
person is
number of / /' required to descend,will be made in connection with work authorized
1Y J �/�/-� \� )(du f/ by this permit,and that no building structure,scaffolding,falsework,a demolition
Carrier: ..XY ►✓.XX""IIYII ►►►JJJ 1/ �e or dismantling thereof,will be more than thirty-six(36)feet high.(Chap. 3.2,Grp
(This section need not lgratne peel awes a1 pie nuwree mwrs 200)ortess.) 2 Art 2,Sec.341,Title B,California Administrative Code).
PolicyNumber. '/'/fl 2 i^C.�t'11'2
❑ As owner-builder, I will not employ anyone to do work which would
❑ 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 subje t to the workers' compensation provisions of Section 3700 of
Applicant's Signature Date
t e burr•..,A I shall f.-hwith comply with these,prov.ions
S. I.S. _A// — f(11� t- Division of Industrial Safety Permit Number:
'pplirant's gnat � ,e��V ill))) HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WW G: FAILURE TO SEC ORKERS'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 0 No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California 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
ATTORNEYS 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 i9'p ivQofce -•. e ect � a registration form for acutely hazardous materials? 0 Yes 0 No
Lic # . A 1 V IIYn Class# / (Section 25533 of the California Health and Safety Code, with some
•MA.Y c 1 1O exceptions, requires registration with the Costa Mesa Fire Department by
/t.J ✓� ` 4' ll D each business which at any one time has on hand a quantity of acutely
contr.1 pr's Si D e 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
C•• RUCTION LEND! ENCY: 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 fa which this permit is issued.(Sec.3097.Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? 0 Yes 0 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? ❑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? 0 Yes 0 No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the Califomia Government Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be furnished 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? ❑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? 0 Yes 0 No
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 8. (If yes-, attach certificate of compliance from the appropriate air pollution
sale. If, however, the building or improvement is sold within one year of control officer).
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
properly, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions.
0 I, as owner of the . •
LICENSED 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
0 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
authorized by this permit until final inspection. .
1� natur Le er(s) `) 410(i
Signature Date Lr -
3057.46 13/07)
And/or Authonzed pscant Dat
iss OF BUILDING, 2419 RICHMOND WY YMT: • _
MCITY OF COSTA MESA — BUILDING PERMIT
aMER'SISNAME IFImayN: JONES DARCY A PERM NO: B 073613
ADDRESS: %JONES, CHUCK
5512 RIVER AVE PERMIT NO: B 073613 PLAN CHECK NO: N GOVT: N SUPP: N
NEWPORT BEACH,CA 92663
APPL.MMUNG ADDRESS: CONSTRUCTION TYPE: VN PERMIT TYPE: STR .PURPOSE: OTH
ARCHITECT ORENGNEER: LIG.NO.: JOB DESCRIPTION : T/OFF, SHEATH & REROOF W/ COMP SHINGLES SQ FT: 2, 999
ARCH.OR ENG.'S ADDRESS: LIME
CLAIM VALUE: 2, 999 , 00 CALC-VALUE: 2, 999 . 00 GROUP OCC: R-3 /
CONTRACTOR'S NAME: STOUT ROOFING INC ( 310 ) 923-6775
CCNTRACTORIMMUNG P 0 BOX 4309 COMMENTS : SMOKE DETECTORS REQUIRED PER 91 UBC
ADDRESS: DOWNEY CA uC.NO.: 402536 SE+E ** +ESE SESEx*+FSE+E+ *********+ESE******+ERr****+E****+ +E*****+ESE ****iE*SE*SE***SE******* +E*
90241 MT: ZONING R EQU IR EMENTS
UCENSED CONTRACTORS DECLARATION:I hereby affirm under penal), dory that I am licensed under provisions of Chapter 9 S E TB ACK S
(commencing with Section 7000)of Division 3 of the Business and Pro/ns' and my iconse is in full effect.
cfrr Llc.No2 0593 7 Lic.Cuss: 39 sec 025 6 E 10/ 5 MAIN BUILDING ACCESSORY BUILDING ----
9yFRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
")77L
Date: '' ? Contractor: lis, 44 LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under penalty of perjury that I em exempt from the Contractors Lice a Lew for the
following reason(Section 7031.5 Business and Professions Code:Any city ix county which requires a permit to contra .alter.improve, PARKING REQ: PROV: PARCEL: 41916562 Z NE: REF NO:
demolish.or rept*any structure.prior to its issuance.also requires the apppicant for such permit 10 file a signed statement that he or she
licensed pursuant to the provisions of the Contractors License Law[Chapter 9(commencing with Section 7000)of Division 3 04 the PLANNING NOTES>2 i
rsiness and Professions Code)or that he or she is exempt iherehum and the baso for the alleged exemption.Any violation of Section >'
031.5 by anyapplicant for permit subjects the applicant to a civil penalty of not more than live hundred dollars(55001 *******************************************************************************
❑ I,as owner of the property or my employees well wages as their sole compensation,Mild°the work.and the structure is not intended D E V E '-L OPMEN T SERVICES REQUIREMENTS
or offered for sale(Section 7044,Business and Professions Code:The Contractors License law does notappy to an Omer of properly ,
who builds or improves thereon,end who does such work himself or herself or through his or her own employees.provided that such i +'`
improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year a completion,the ZONING APPROVED -TY DATE:
owner- at
boer will have the burden of proving he or she did not build or improve for the purpose of sale).
❑ I.as owner of the property,ant exclusively contracting with licensed contractors to oonstrud the project(Section 7044,Business and �+
Professions Code:The Conlracton License Law does not apply to an owner of property who builds or improves thereon end who BUILDING APPROVED B Y DATE
contracts for such projects with a contract«(°)licensed pursuant to the Contractors License Law).
❑ Iamexempt under Sectioh: B.AP.C.,f«mismason: APPLICATION ISSUED BY: * — DATE: '} 5—
*********************************************** ************* * ** ***
Date: OwnerLEGALIZATION:N F E E SUMMARY STRUCTURA SEGMENT:Y
I do hereby candy that I am aware of and understand the requirements of Caliomi°Health and Safety Code Sections 25505,25533.and
2e5531,eM that l«any Mitre building omthent witwill/ not(circle one)need to comply with said state codes and the requirementsromlf« BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
permit I«annstruction«modification from the Ai will
I Manegemenl Dpstea. to bat construction applications are exempt from these
provisions. PERMIT 54 . 00 . 50
Date: Applicant: SMIP/NON-RES
PLAN
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the following declarations: ISSUE FEE
❑ I have and will maintain a cedificale of 031,SeMt to sellensure foe workers'compensation.as provided for by Section 37C0 al ihe Labor BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
Code,for the performance of the work for which this permit is issued.
QI have and will maintai worker compensation insurance,as required by Section 3700 of the Labor Code,for the performance of the TOTALS 5 4 . 5 0 0 . 0 0 0 ,0 0 5 4 . 5 0 5 4 . 5 0 0 0
work for which this permit u issued.My workers'compensation insurance under end policy number are:
Carder: STATE EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 54 . 50 OVER/SHORT : .00
' Policy Number: 04494U000468 / 10/19/95 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
cis section need not be completed I the penni is for one hundred dollars($1001 or less) • 54 .00 . 50
0 I certify that in the performance of the work for which this permit is ,I shall not employ any person i manner so to
become subject to the workers'compensation laws of Celfomi• that I should become •'-.. to the . . • *******************************************************************************
compunsati vpsi«u of ion 00 oft Code,I eh- h those• •vjsio
«/�7yRre�ts of d '' bar /y./ i ,� ,/ . I N D I V I D U A L F E E BREAKDOWN
Date: !i `� Applicant:
Warning:Failure to secure workers'compensation coverage Is unlawful,and shell subject en employer to cdm/nal wattles end TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
civil tines up to one hundred thousand dollars($1040001 In add/tion to the cost of compensation, ag
dames sit '•tided for/n
secdon37asptmeLaborCode,Intereatandatromey''.faaa. SFR 2999 REROOF BY VALUE RESIDENTIAL NOZONE 1 , 00 2, 999 , 00
CONSTRUCTION LENDING AGENCY:I hereby affirm under pe of perjury that there n e construction lending agency for the END OF FEES
performance cif the work for which this permit is issued(Section' 97,CN.C).
LENDER'S NAME:
LENDER'S ADDRESS: -
LI candy that I have mad this application and state that the above information is correct.I agree to comply with all city and county ordinances
and state laws reWngtobuildigconstrrwionand hereby authorize representatives of this cytoenter upon the above-mentionedpropero 01 0015?ba"f.OCIe"7637 TOT 54°50
f«inspection purposes. DA NE BURFORD
DATE: 08/04/95 TIME: 09:05
kite-4r Data L�
•
— 9
$i to a er/AganVApplia°nVConlred«
(5151 45.WP) White-Building A Safety:Green-File: Goldenrod-Assessor Pink-Revenue:Goldenrod-Assess
• - 111111111111.e.i, "' - . . POOL PA
..,` 1 CONSTRUCTION AND PLANNING
' APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole - 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. ' 53. Steel Reinforcement ,._ U
- 3: Electrical Conduit Utility-Undrgrnd 54. Forms - 1
"`, El e'ctrical Condmt-Uirdrgrnd. 55. Electrical Bonding 71
5`.Steel Reinforcement" 56. Rough Plumbing & Pressutse-Test `
:x-;:Electrical UFEI�;,Grnd. _ 57: APPROVAL TO COVER-GUNITE
- ).7:,fag tings �O - 58. Electrical Conduit,Undrgrnd. •
_
J'
`7<8. ,Foundation zis a 59. Gas Pipe, 0 Uitdfigrnd.,Test
9. Water Pipe-Undrgr-nLi.-.1 _ 60. Backwash.Lines, e,Trap. Undrgrnd.
10. Structural Floor System , _ i 61. APPROVAL TO DECK.-;_ '
11. Property Sewer Line..& House Connection 62. Backwash & Receptor-Fin31 .
12. Sewer Cap -. 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final ,
w
14. Rough Plumbing- - " 65. Electrical-Final
•
15. Rough Electricat:Cocduit ,Y.. .- 66. Solar System-Final ;L , J
16. Rough Electric Plirici 67. Fencing & Access-Approval
17. Rough Wiring Sign _.- 68. APPROVED FOR;PLAST• ERING .
18. Rough Electrical-T Bar Ceiling ' - 69. POOL/SPA SYSTEMS FINAL . •
19. Rough Heating & Air Conditioning > FLRE.DEPT EQUI EMENT ill
20. rfiough F tory Fireplace ;m y c > S = .r c APPI3OV_ALSLL PeQmit# i = [+'
21. Duct in-Strutt.ure* •• •• �� _ r_ ',max r' 70.�Jnder`�'r iRd I-kydro
22. Ducts, Ventiliiiin Nt's & .75 r rt =x 71. Prodten Piping O-Gas 'Oil
23. tas Pipe.flough &^Test 1 -^:- i: v- - }: 72. Undergroitid Flbsnn r C
24.'floof•Fr icing' p:,: �;�,,, �' ,..,r -. 73; Undergrnd.StcjeJanit0Gas 0Oil
25. Roof Sheathing ;!. _ gy' •,G�ti (�---4,.t 74?-OOverhead HYdr _ 'K
26 T-Bei Ceiling (Strucihural) & Monocoat ,: j. q =:i 75::_-Dry Chemical :„.„-D6-: t ' -
27. •6rarpeand Flashing- =z.x _ * - i
'
CITY OF COSTA MESA
,`v, i. BUILDING DIVISION
• "``^' ' DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
f
' trigi PERMIT
M00-00126
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
MECHANICAL PERMIT
Job Address: 2419 RICHMOND WY Status: ISSUED
Suite No Applied: 03/28/2000
Issued: 03/28/2000
Vicinity: UPSTAIRS BEDROOM .
Parcel Number: 41916562
ISSUED BY: ,...-----
Applicant:
Applicant: ABATANGELO, JOSEPH
Address: 2419 RICHMOND WAY
Phone: (714)549-4128
COSTA MESA,CA - Zip: 92626 • '
Owner: - -ABATANGELO;JOSEPH -
Address: 2419 RICHMOND WAY -
Phone: (714)549-4 8
COSTA MESA,CA Zip: 92626 31`d®
Contractor: OWNER-BUILDER
Address: .0 1
Phone' . .6-.
t+; fN
Zip: r• , ;f t' yi:
License: 0 `S '47-;64, • ='' "' -
Arch/Eng: -
Address: ,
Phone:
Zip:
License:
SCOPE OF PERMIT
MECHANICAL PERMIT FOR PREVIOUSLY INSTALLED AIR CONDITIONING UNIT.
FEE SUMMARY . ' .
Quantity - Quantity
ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0
Inst FAU<100 k BTU $0.00 0 Repair/Alt Refrigeration Unit $0.00. 0
Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0
Repair/Alt Cooling/Heat $0.00 ' 0 Evaporative Cooler $0.00 0
Inst/Rep. Recess Wall Htr , $0.00 0 Commercial Incinerator . $0.00 0
Refrig Sys<100 k BTU , $0.00 0 Domestic Incinerator $0.00 0
Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems
Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0
Factory Fireplace _ $0.00 0 3 To 15 hp/500 k-BTU $0.00 0
Hood w/Mech Exhaust $0.00 0 15 To 30-hp/1,000 k BTU $0.00 0
VAV Box • $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0
Vent Fan/Single Duct $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0
Appliance $0.00 0 Boilers
Fire Dampers $0.00 0 Up to 3 hp $0.00 0
Smoke Dampers $0.00 0 3 To 15 hp $0.00 0
Inst or Relocate Appl Vent •.10 0 15 to 30 hp $0.00 0
Air Handlers< 10000dm ,10,,•5 ,,h 30 to 50 hp $0.00 0
Air Handlers> 10000cfm .0.30 ,I I; Over 50 hp $0.00 0
Floor Furnace O:•0, y • ,• ,'r-,. Other Mechanical Fee
Floor or Suspend Heaterice••• '0 > • Investigation Fee $0.00
/D - V :;
V J
C ,• (. , V c r 1
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
7111111111111
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.
❑ 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'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed if the permit is valued et one hundred dollars($100)or less.)
❑ 1 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 these provisions.
Applicant Signature: Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND COLLARE(5100,000),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.# Class#
Contractor's Signature: Date:
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(5500).):
❑ I,as owner ofkthe 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 properly who builds or improves thereon,and who does such work
himself or tierself•oi 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 owne;,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 exe pt under�`
er s�ec. .- •' Business and Professions Code for this reason:
•
Signature: T'`—r / i; - I' • -• Date: .5'12 Cc-SOD v
Owner ID ve•ied'by driver's license; ❑Yes 0 No • Driver's License No. _ ' Expires: t -12-6
Verificatio 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? ❑Yes ❑No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature 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? 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 a2ermit 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 LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No
(If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or.egency 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? ❑'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 aboveis correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: 4 '. Dater
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of,perjury that l'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 pro for inspection pey I agree not to occupy or allow occupancy of any building authorized by!his permit until final inspection.
3-076-0DD 0
ignature Of Legal Owner(s) - Date
And/Or Authorized Applicant , - . ' Date
;ODE# INSPECTION TYPE RAIL ItiTIDB-L3 CODE I INSPECTION TYPE RA¢ INTRIALS
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
2446-46
OWNER SAN VISTA BUILDING COMPANY DATE 6-1-64
JOB ADDRESS 2419 Richmond Way BUILDING PERMIT NO. 22271
GENERAL CONTRACTOR same VALUE $ 13,895.00
AP No. LOT 221 TRACT 5160 FIRE ZONE DESCRIPTION OF WORK res W/att gar
INSPECTIONS Signature DA TJ GROUP I&J TYPE V ZONE R3
Soil /� .*Z1 SUBCONTRACTOR
ISSUED
Gases/ ( / DATE NUMBER
Water
Rough em. Refrig. 0 Air Cond. 0 '� -
Rough Heating /L-� /g ,E2 ��„z V�{/ .35
Rough Plumbing /T �. 7 h 44 .�0-(�,l//L/c i -/-6, 'V j/
Miscellaneous _ / v ,(y0`,
Prop. Swr. Line 0 House Con. eSt. Swr. 0 4 SSC rallr .-e-t DEC 9 1963 4 0`7€.1
Sprinkling System , '
Construction Pole ) -2I(o6
Underground 0 Power 0
Rough Wiring__ • /- y. I -7---k7q- 4----- SEP 1 7 1964 - -
Trenches are Forms rn Steel Reinf. El 4 /7/jJ
Floor System
Bond Beam 0 Steel Reinforce 0
Sheathing -�/ e Q y fL
Frame and Flashing_ /p// tQf�
Lathing—In ❑i�Out [Z]� a /p�� fz mann:.__v.pl• d
Plaster, brown coat c ��f�/J SL / s`, sce�- C°'
Refrig. 0 Air Con. 0 Final U oda
Heating, Final / a�tld�
Plumbing Fixtures, Final i y
Final Gas Tcst�
Electric Fixtures, Final A " 7 _ „/
Building, Final (* .__
OCCUPANCY
Form BU4- 5M-3-63—S-B P tarn n FOR SPECIAL RUQUIREfvihN73
• - 22271 r V
COSTA MESA BUILDING-SAFETY DEPARTMENT FEE REGEl ` ED
P.O.BOX 917 COSTA MESA;CALIFORNIA • SAY 1 9 1084
For Applicant.to Fill In Completely APPLICAT >t 1 (1F�E,'-1t PERK
TYPE OR PRINT for •: )LI{ISe()STA MESA
gamBUILDING p�
ADDRESS oLiri/� / Cu/ RECEIPT.NO. PPRNj'NO.
COSTA MESA. CALIFORNIA ' C�j/j !7
D
' 1 �['�(�� RICE BY DATE RECCEIV!EDD DATE ISSUE
OWNERS 0,lk ( Q�` CQ //�f/
AD / .IIIN In r.$
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DRESS 1 \ 6 gb J /� ADDRESS
CITY ' . i /I. ' NO.4/ R /)p ZONE ' TYPE
pi, 27-. FIRE pt`
(L
APPROVED
ARCHITECT 7�J TEL BY DATE
OR FNGINEERv KJ.Afl}�,A.LGq_i NO. O/O
(( 0 -1-- • ZONING /J
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) PO.LAOIC ) I USE
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CONTRACTOR (aCtia.L V1 T (J—$�!X 1 . LEGAL\` .�N "^\/ `��(WyT'�11OIaK. �o`/ G
iA
ADDRESS• 1 I c LS- S-l1 DESCRIPTION Z tl�/_ �'- /�
/ I /i/ A.P.N O. 1 LI I ./ / / '
CITY T L ! I
NOTE: NO EAVE OVERHANG SHALL BE LESS THAN ,
STATE /9 9 e a- NO- yI-I�.] ?It? 50"TO SIDE 8 REAR P.L.
EAVES
LIC.NO. d/� /7// J 0
OF LOT 9.UM Or 0 I NO.OF EILD0 .NOW ON LOTS Q ALLOWED (U.B.C.REQUIREMENT)ri
YARDS APPROVED YARDS APPROVED'
USEOF iNi ,� __ _ MAIN BUILDING ACCESSORY BUILDING r
EXISTING BLDG.. V V�Y`v "?
(FROM I5 FT.
1, �y
SETBACK LINE FROM D FRONT{ FT, C FT. _ l
CENTER OF STREET / 9 REAR YARD // //
SIDE YARD LEFT 0 I RIGHT R.SIDE FT. FT.
' DESCRIPTION OF WORK L.SIDE FT: FT,
LOI
N X ALTERATION _ ADDITION REAR C FT. FT.
DISTANCE BET. BET.MAIN Et
R. R MOVING' DEMOLISH MAIN BLOCS. ACCESS.BLOCS.
BUILDING is/ (/ `� NO OF rti�v '� i t'j VAR.# DATE
SIZE pLUT i7 3 ROOMS ,S (STORIES j..
C.U.P.#�I • APPROVED
EXTERIOR WAy,;�---- ROOF I APP' A�^ 'C
COVERING �.IJA-C,(.� I COVERINGgl
BY {�', • I I/L- DATE /
USE O/,F/�1�,{ILDINGAND WORK TO BEP RFORM q}-�
-+f'/, -� n♦ - ILLI / 4
, `` �a7 '
D
C
a.Fr. 120 r q
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN DER VALUATION IS FOR THE F
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTAB HIND A PERMIT FEE ONLY. O
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION /�'y' ai
BUILDING co STRurnon. PERMIT FEE $ /TL Y a/ N
SIGNATURE 0
PERMITTEE /.J 87,5d i„/) �/], L O X
$ I (/!/ PLAN CHECK $ G'1'•�J o
AUTHORIZED G T - // / E
0 - - TOTAL FEE '5 �D