HomeMy WebLinkAbout3121 ROOSEVELT WAY - Building Permits PROJECT ADDRESS: 3 ?1 ROOSEVELT WY UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO; B 058600
OWNER'S NAME: NGI EN• THANH 1'• 1
- . Amu: 3121 ROOSEVELT WAY PERMIT NO: B 058600 PLAN CHECK NO; 03100-92 S GOVT: N SUPP: N
COSTA MESA,CA 92626 CONSTRUCTION TYPE: V-N PERMIT TYPE: STR PURPOSE: ALT
241-9629
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : T/OFF RESHT 23SQFT W/MISSION TILE SQ FT: 108
ADDRESS: UNIT:
CLAIM VALUE: 8, 100. 00 CALC-VALUE: 108 . 00 GROUP OCC: R-3 /
PERMITTEE: DAN NGUYEN CONSTRUCTION ( 714 ) 567-3287
ADDRESS: 14351 EUCLID COMMENTS: ICBO#2656 SMOKE DETECTOR REQUIRED
GARDEN GROVE CA 92627 ************************************* ***********sr*********+ESE**sesE*****+ESE*s6*****
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS
71100)of Division 3 of the Business and Professions Code.and my license is in full force and feet. SETBACKS
CITY LIC.: O 6765 STATELIC.:616869 Lass: H f •
:rte: 'I5 —q 1/ Signature' ma MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: thereby affirm that Ihave acert i to (consent to sell-insure or a i' eof workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
Compensation Insurance.or a cendied copy thereof(Section 3800.Lab.C).
POLICY NO.: EXP.DATE:
COMPANY: PARKING REQ• PROV: PARCEL: 14169321 ZNE: REF NO:
0 Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. PLANNING NOtES>
f> •
Date: Applicant. D E V E:-L OPMENT SERVICES REQUIREMENZT S
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($WO0)or less),
I certify That in the performance of the work for which this permit is issued,I shall not employ any rson in any anner so as to become —
subject to the Workers'Compensation Laws of California. I ZONING APPROVED BY : �'/ DATE: -0 '
g -13 — iv Signature: 'V 2� BUILDING APPROVED BY • 51+11L 1, DATE: f l`/3-�L
NOTICE:If.atter makingthis declaration,you should become subjectoh�'e Ilrkers'Compensation provi Labor v \ /`
Code.you must forthwith G comply with such provisionsmthat or this permit Il be eemedng revoked. APPLICATION CAT ION ISSUED BY: [ DATE: ''�—� 1�
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for +++EEE
which this permit is issued(Section 3097,Civ.Cl. ************************)* * ****** *:******'***********'**********aE***********
LENDER: *************(************************** *************************** *********
ADDRESS: LEGALIZATION:N F E E S U M MAR Y STRUCTURAL SEGMENT;Y
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 15.00 • 50
repair any structure.prior 10 its issuance,also requires the applicant for such permit to lite a signed statement that he/she is licensed
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business
PLAN 9 , 75 • SMIP/NON-RES •
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(S500). ISSUE FEE
I, as owner of the progeny or my employees with wages as their sole compensation, will do the work, and the BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS S ----> 15. 50 0. 00 9, 75 25. 25 25 . 25 . 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through
his or her own employees.provided that such improvements are not intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED• 25. 25 OVER/SHORT• 00
improvement is sold within one year of completion.the owner will have the burden of proving he/she did not build or improve
for the purpose ol sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
I,as owner of the properly,am exclusively contracting with licensed contractors to construct the project(Section 7044.Business 15 ,00 •`, . 50 9 , 75
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of properly who builds or improves thereon
and who contracts for such projects with a Contractors)license pursuant to the Contractors'State License Law).lam aware ********************************** ********************************************
that proof of their Worker's Compensation insurance should be provided to me. I N D I V I D U A -L, F E E BREAKDOWN
o I am exempt under Section: B.8 P.C.
for this reason: TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
Date: Owner: SFR 108 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 108 . 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END' OF FEES
25534 and that I or any future building occupant will/will not(circle one)need to comply with said slate codes and the requirements for a
permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from
these provisions,
Date: Applicant:
I hereby certify that I have read this application and slate that the above information is correct I agree to comply with all city and county ,
ordinances and Slate laws relating to building construction and hereby authorize representatives o is city to enter upon the above-mentioned
property for inspection purpossseess..
Date: ~13 "1 ✓ Signature: / ...I..V •
t1
Diver's License or Social Security
Pink—Revenue:Goldenrod—Assessor
r�"ONSTRUCTION AND PLANNING POOL °A
Date 'Inspector
APPROVALS Permit# - APPROVALS Permit #
Date Inspector
1. Temporary Electrical Servtie or Pole 52. Pool & Equipment Location
L
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
'.;:.“tectrdcal Condhit GTiility-Undrgrnd. 54. Forms
-4T _ _ .
-- A. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
_It - r - t
E SirS2eel treinforceania'ntt 56. Rough Plumbing & Pressure Test
• S - '
v 6,.Ehctrical UFEE Gmd. 57. APPROVAL TO COVER-GUNITE
7.'FQotings 58. Electrical Conduit-Undrgrnd. •
F}•8. Foundation _ •" 59. Gas Pipe, 0 Undrgrnd., Test a
>t9,'Water Pipe-Undtgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floos System 61. APPROVAL TO DECK
11. Property SeweCLine.& House Connection 62. Backwash & Receptor-Final
12. S(wer Cap y 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final .
16. Rough Electric-Wiring 67. Fencing & Access Approval
17. Rough Wiring,S$ign 68. APPROVED FOR PLASTERING
18. Rough Electricil-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20.1.Rotigh E�ctoty Fireplace I S?i Z'. -+ 3 '3 c - rAPPROVA.LS ?,Permit # ` -
' ' •o .7" a z
r21 -Dubs,i,Strwct :: � >• ..70. Undeg.oan Hydro x
-n
22.C' Ventittiny .);,-.5: k t r ty > 571. Produq[.Ptping Clays Roil
•23.;Gas PipejRoih &;fest r- : C c.c • x -72. Underground Flush -.
24.iRocdFraming it': - - •G r -.737 Undergrnf7.Storage`TJnk.?Gas 0011
25. Roo} Sl athing(7-:: i ''l t2-
�tt4 ' Q_
- Overhead Hydro
26..T-Bar Ceiling (Stcucturall &<j�onocoat s 7 ;+7* - 75'Dry Chemical '
27'=Frame and Flashing; > td:: w76. Dry Stangipe _ ' ' r i
oz .- , J
• •
28`•Lathin -& Sidin y< - I.. J „ • M .. - .-
9 gl 2..:. x t '= ' i .•ts ° 77: FIXED SYSgTEM,5INAL" -
'29. Insulation '. : C " " > a. ' .^
.. �; 78. FIRE PREV. FINAL r
30. DrywalltNaiting 7� r' ' HEALTH:DEPT; REQUIREMENT
..31. Plaster Brown Coat' ' rte. ;; !' ; ,791.' FINAL INS! CTIQN 4
•t
-32.-Electrical Power-Meter-Final a I - . -.80. FOOD CERTIFICATE ISSUED
>33.`Finpl Electric `-_ r S is =' ; ; L.Ngtes: ' �'/111 0.<1,-
/[{//�-/tom`
:7 1, r r .1 'C
--7. .
V -nrr :•;..n.-....
, - ///I ''"
:.,34.-Final Heating&*ic Conditionidiq IL t- e Cl.
35.-final Gas Pipe-Test-•-t" • _ ' ' -
t.36.•Hoad or.Canopyt� 2 •-y + r 1 t . - �T
_37..Final Factory Fireklacer i " -' r` I. ' `• `,
Y r (. _• .1. -i
-38.,Fina) Plgmbing j 5 -
'39.Water Service-Final -- I - --
;40. "Gas Service-Final .. i E
x'41.•5olar DOmestic'Finel. •• s II I •i' _
,� a ° a 1 I• ••• r
•42. Backflow Preventey ti- - > - . - -
43. Backflow Irrigation 'S S- i•-i: 'r _o ' - '•
r ,
44. Landscape luigatign System: ,t, „q R ._ c. * .. i
.45:J
� Sound Attenuation - T > - t; -. - 'i <
X46.,Handicap R�gulatigns _ = •• -• ` t' { - -
47.:FINALSTRUCTURE & BUtLDING •Z-/�7/Cj ( ,t/ t _ -
48:. FIr4ALPLANNINOi ' `r''r I 1. r n
rt ..
49.-Elaictric Release to!Edison t o I I . I< . i - -
r750. Ga1Retease to Sou)hern Caliioznia Gas Co . , j (, ' s _^ J i t
51. CERTIFICATE OF OCCUPANCY _
No. Date
21351 FEE RECEIVED
COSTA MESA BUILDING SAFETY DEPARTMENT JAN 1 7 1964
P.O.BOX 317 COSTA MESA.CALIFORNIA FINANCE DEPT.
' (;I FY OF COSTA MESA •
' For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
BUILDING L /// For Office Use Only
ADDRESS 31a 1�(lfs e,1 C' \ \ `l 1,
A COSTARECEIPT NO. 2prmii.
\ MESA, CALIFORNIARECEIrlY D E RE WED 'DATE ISSUED
/>.
OWNER '\1C1/4.- n�y[�(1ei IXcoN�e_,. BUILDING
'
ADDRESS S _]l t. CY _ ADDRESS •
FIRE
ZONE TYPE MAWS
_ _ II I
..n ► Iker/nIli ZONING
n •n
lltill
LEGAL 0-2)
T
• DESCRIPTION • / Q
CITY 1OV\ c W\ �J c a C. 1 A.P.NO. ft
NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
LIC.TNO. A I So H NO. S� -C-7, a 30"TO SIDE a REAR P.L.
�( EAVES
OFSIZE
LOT a )c 1 h I NOW ON LOTS K ALLOWED (U.B.C.REQUIREMENT)
YARDS APPROVED YARDS APPROVED
USE OF MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG. '
(FROM C/LST ET)
SETBACK LINE FROM ' S CENTER OF STREET REAR YARD
FRONT `/ .
S�
SIDE YARD LEFT RIGHT
FT.
R.SIDE J Fr. FT.
DESCRIPTION OF WORK L.SIDS CC .
` Fr.
ALTERATION _ ADDITION REAR 3t2JET. F7.
DISTANCE BET. BET.MAIN&
REPAIR MOVING //pp DEMOLISH MAIN BLOCS. ACCESS.SLOGS.
BUILDING '�3 y RNO.OF OOMS In
SIZE LL STORIES I CA .J U.P. APPROVED
EXTERIOR WA COVE APPRO 11,,'' A DATE 1y/
COVERING 'S�( ( Q COVERING ��\ IPS BY �� V`�'y l ��/ /
USE OF BUILDING MID WO TO BE ERFORM D I.•
. , 666���
C r� t RC%YV \J io . W \)\.n
I' ,/y , /n s N
ki ' 4}mrS0.FT. - 7�� o
I HEREBY ACKN• _- T -- • READ THIS APPLICATION THE A OUNT SHOWN ER VALUATION IS FOR THE �•,
AND STATE T THE AB- - CORR- T AND AGREE TO COM. PURPOSE OF ESTABL RING A PERMIT FEE ONLY. O
PLY WITH A CITY OR•� D : ATE LAWS REGULATING VALUATION m
BUILDING C• STRUCT1•• ��.�/ �J
PERMITTEE OF .. ./ (/J�// PERMIT FEE $ N,/q(i�`U m
/ j#" PLAN CHECK $ ��/'D a
$ L / 0
LL
AUTHORIZED AGENT - /7i 1
I .\ TOTAL FEE $
---,,
OWNER McCARTHY, John DATE 11-3-71
'Ct JOB ADDRESS 3121 Roosevelt Way BUILDING PERMIT NO. Ri/734
GENERAL CONTRACTOR William Dietz DESCRIPTION of WORK Patio Cover
Na. 141-1.)93-21 LOT TRACT FIRE ZONE VALUE $ 360.00
I, ECTIONS Signature Date ,GROUP J TYPE V ZONE R-1
SOIL PERMITS ISSUED
GAS SUBCONTRACTOR
Date I Number I Signature
WATER Plumbing
ROUGH PLUMBING
PROP. SWR. LINE❑ HOUSE CON. ❑
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND [J POWER ❑
ROUGH WIRING Heating and Vent.
TRENCHES Ej FORMS ❑ STEEL REINF. ❑
FLOOR SYSTEM
BOND BEAM 0 STEEL REINFORCE n
SHEATHING
FRAME AND FLASHING
LATHING - IN n OUT n
PLASTER, BROWN COAT
ICTURAL, FINAL Electric
..TING, VENT., REFRIG. AND A.C., FINAL
PLUMBING, FINAL AND GAS TEST H
ELECTRIC, FINAL 4 jj JJ
_ 3378.4 Ii.�U
1971
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR-BUILDING PERMIT'
For Applicant to Fill in Completely
wsr�f r 1 /R.,�(j�.��yF mot RECEIVED/}B/(/ D!ATEORECEI)VED DATE SUED
BUILDING 912.7 4clir .a r. G11�t� � .tf I // '^J^ / /f as ,�
ADDRESS /} .�.-° uG �i / !J
OWNERUr f-4J ma C g.,r1 A.P.NO..//5 _/C 7 2 PERMIT NO.
ADDRESSIL14"441C---
Z
BUILDING a 1 7 J dam• __ /!, y
�W }J ADDRESS A' fJ'G��J`^t�/'r U`P 1sj'
a 0 CITY C C*C NO.
X14'-32 ' TRACT J4 r- LOT BLOCK
Z Q CONSTRUCTION
O cn LENDER
0- co
J D BRANCH �/
. OWNER 4/ / . K,-/r /
11, ADDRESS /iVALUE? i.
ARCHITECT TEL. USE 7+,'/�'� i74Ov'
J Q OR ENGINEER NO.
Ei m FIRE 'IT/ —
Z Q ZONE TYPE—..— GROUP A
w CC ADDRESS
a 1-Irl
APPROVED 1 Ir
W Z CONTRACTOR 00 ♦`•-- 13,RTt. BY 41r, DATE //•`3_r
J p •
03 2. yy/n�L� ys Q ii �,
J ADDRESS Q r L�a ` 1
W W - r p ZQy� NO.OF USE OF NE 'w
Z= T• y ', TE1bY.6,39 '//_/ PLANS , BUILDING "„pme—,,
CITY NO. /\ �- /-�±
w 0 STATE ^ �I CITY YARDS APPROVED YARDS APPROVED
7 O LIC. NOl! i G4-� I�� LIC.NO. MAIN BU DING ACCESSORY BUILDING
SIZE pp�� art ^ NO.OF BLAS. �/
OF LOT t/ { . I NOW ON LOT •ONi_ -- - ;. FT.
USE OF $ /�,T'? r+ w n �r
EXISTING BLDG. \�J f'r- l�fl'-K.. R SIDE 'J OFT. FT.
I— SIZE OF 2.40 /3 NO.OF /
Z NEW BLDG. ROOMS �j STORIES L.SIDE /e FT. FT.
U EXTERIOR WALL ROOF guu1,....'1-- ug /J
COVERING COVERING (��ta-1c` REAR ,Z3 FT. FT.
USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN&
_ %t /� MAIN'BLDGS. ACCESS. BLDGS.
.7:r.
12, I h.2..e 7 PA,--r--i O Ct t41. i VAR.# DATE
OI— �{, Y'� C.U.P.#
APPROVED
N ABYROVED/// S, e DATE //3-7�
z LLL4���z���� . .
o /
V I hereby acknowledge that I have read this application and state
O that the above information is correct and agree to comply with
CC all laws regulating building construction, and I shall not employ
F any person in violation of the workman's compensation laws of '
fn m the State of California. (9
zI hereby certify that I am properly licensed as a contractor under SO. FT. O
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
LC
am exempt from the provisions of the State 5oaL1iness
and Professions Code, Division 3,Chapter 9. VALUATION .(+�•' ro
..y PERMIT FEE $ 5 , N
Signature of t Z ^ C+�fi D
Permittee 'yv 11� \/ $i/a PLAN CHECK $ `�_ E
L1{ C/ / 0
v.
Authorized Agent TOTAL FEE $ ,57 h---