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HomeMy WebLinkAbout3125 ROOSEVELT WAY - Building Permits PROST ADDRESS: 3125 ROOSEVELT WY UNIT: ' CI'TY" OF COSTA MESA —, BUILDING PERMIT' PERM NO: B 045305 • • OWNER'S NAME: se THELMA HOLLAND ADDRESS: SAME AS ABOVE PERMIT NO: B 045305 PLAN CHECK NO: _ GOVT•: M SUPP : 1J CONSTRUCTION TYPE': PERMIT TYPE: STH PURPOSE: NEW 714 /839-9041 ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION T/O SHAKES/PLYWOOD/FIBERGLASS SHINGLES SQ FT: 2 , 000 • ADDRESS: UNIT: • CLAIM VALUE: 2, 000 . 00 CALC—VALUE: 2,000 . 00 GROUP OCC: R-3 - I' ' PERMITTEE: THELMA HOLLAND • ( 714 ) 839-9041 ' ADDRESS: 3125 ROOSEVELT WAY COMMENTS : - , COSTA MESA CA 92626 ********tE9****y6**********36***-*3E***********3r******34343ESE****fl'***x"**3 ****k)E**-x:** sk . . LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section • 7 ONING R E Q U I R E M E N T S 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. • S E T B A C K S CITY UC.: STATE UC.: CLASS: Date: signature: • — MAIN BUILDING — ACCESSORY BUILDING • WORKERS'COMPENSATION DECLARATION: Ihereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: , FT IN REAR: FT IN • Compensation Insurance,or a certified copy thereof(Section 380 .Lab.C). ' - LEFT: FT IN RGHT: FT .1N LEFT: FT IN RGHT : : FT IN- POUCY NO.: EXP.DATE: . COMPANY: • PARKING REQ: PROV: PARCEL : 00000000 ZNE: REF NO: . Certified copy is hereby furnished. 0 Certified copy is tiled with the city Building Division. PLANNING NOTES> .. • > ' • _ . _ Date: - Applicant: ********************************************************************i4********** EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred(3100)or less). '• D E V E L O P M E N T, S E R V I C E S R E Q U I R E M E 'N T, S ' 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 Wo rs' penssaation Laws of California. • �.x' ZONING APPROVED BY. DATE: _ • _ Date: 1 'Co/I/ Signature: O✓�,// �,(A.f -- _ _ NOTICE:1 after rAel ind this declaration,you should becom subjeh to the Workers'Compensation provisions of the Labor . BUILDING APPROVED BY . : ' __ DATE: _ Code,U you must foDING G with such provisionsmaa this permit shall bedeemed revoked.cyf � 1� CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency far the performance of the work for APPLICATION ISSUED BY. : • DATE which this permit is issued(Section 3097,Civ.C). **********************************96**t** * **** **********f'ak9e * ** LENDER: ******************ik*************************************************iE********** ADDRESS: LEGALIZATION:N F E E S U 'M M A R Y STRUCTURAL SEGMENT:,Y OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contactors'State License Law for the following reason ' BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE ' SMIP/RES GRADING (Section 7031.5 Business and Professional Code: My city of county which requires a permit to construct,alter,improve.demolish,or . 45 . 00 i . 50 repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed $MIP./NON—RES, pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business ,,PLAN • • 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($500). ISSUE FEE - I • • I, as owner of the propeM will do the work, and the BUILDING—DIV—> PERMIT: ISSUE PLAN—CHECK TOTAL 'PAID DUE structure is not intended or uttered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law jTOTAL 5:---->• 45-. 50 0 0 0 0 : 00 4 5. 5 0 45'''.,:50• . 0 0 / 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--> . 0.. 00 im COLLECTED: 45 : 50 OV F.R/SHORT• . 00 • forptheement is purpose ofld sae)�in one year of completion,the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC' MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK . •I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business - ' • 4 S . O O , 5 U .,• ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon • and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware ***"*************************************************************,*,************** that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN • ❑ I am exempt under Section: B.&P.C. , for this reason: TYPE QTY D E S C R I P T I• C) N UNIT• COST !'- TOTAL COST t Date: /2 �l Owner: C„Gv SFR ' 2000 REROOF' BY L7ALUE RESIDENIAL • NOZONE: 1 . 00 2 , 000 . 00 I do hereby certify tha am away 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 wilvwill not(circle one)need to comply with said state codes and the requirements for a • permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from these provisions. - ' Date: Applicant: _ 1 • I hereby certify that I have read this application and state that the above information is correct.I agree to comply 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-mentionetl - - • , 'r property for insPectio urpq s,.p �� Date: 7 P Signature: 77a7--/i7 I F . • Driver's License or Soci Security I 01 00049230-00049231 TOT 45.50 • DATE: 12/07/89 'TItlE 1841-46 White-Buildinq:Green—Code Enforcement:'Canary—Applicant;Pink—Revenue;Goldenrod—Assessor - - 15 :32 CONSTRUCTION AND PLANNING POOL SPA ° APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole c' 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. • _ %"� 53. Steel Reinforcement - - ' 3. Electrical Conduit Utility-Undrgrnd. ' 54. Forms _ 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding �• 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings - 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd.,Test r -> 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System . 61. APPROVAL TO DECK - �, 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final _ , A , 12. Sewer Cap • 63. Heater & Vent-Final rj, • 13. Roof Drains 64. Plumbing System - Final .7 , 14. Rough Plumbing . ' 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final ,' 16. Rough Electric Wiring 67. Fencing & Access Approval r" $ 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning • - _ FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 21, Ducts, in Structure - - ' ' 70. Underground Hydro 22, Ducts, Ventilating - 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test - 72, Underground Flush 24. Roof Framing - 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74• . Overhead Hydro • 26:T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing ' ' • 76. Dry Standpipe - 28. Lathing & Siding 77. FIXED SYSTEM FINAL •29. Insulation 78. FIRE PREV. FINAL 30. Drywall NailingHEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat- - - - '79.-FINAL INSPECTION 32. Electrical Power Meter-Final • .80. FOOD CERTIFICATE ISSUED 33. Final Electric - ' • r Notes: 34. Final Heating & Air Conditioning - ' 35: Final Gas Pipe-Test - - • . • 36. Hood or Canopy _ ' , - . t - 37. Final Factory Fireplace .. ... 38. Final Plumbing • •• - 39. Water Service-Final 40. Gas Service-Final . , 41. Solar Domestic-Final - - - 42: Backflow Preventer - • • ...� 43. Backflow Irrigation ', 't 44. Landscape Irrigation System - - • - _ - - - 45. Sound Attenuation - • - T'--31 F -- e, / es/ - 46. Handic4ap Regulations C ' 6 -&/ 47. FINAL STRUCTURE & BUILDING 7_31-.9/ 4c.4,',f - - 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas.Release to Southern California Gas Co - • 51. CERTIFICATE OF OCCUPANCY No. Date LIMITED STATEMENT OF RESPONSIBILITY Bldg. Permit # TO WHOM IT MAY CONCERN: This Permit # 4o,ic ve /r w,9-17 Street Address AP Number I, lie% /9 1-16 G G-/24f J , as Owner in Title of the above referenced property, do hereby authorize: 4 / , Coyr71/9 Sal e, 95o Name Telephone No. of e r,e lr Ybht7 Street Address • C654 /22 ra 91_2, Gel City State Zip y, to obtain permits in my behalf, as owner/builder, for ?"-Al 1117,157 y6 //g)1/i at the above referenced property. Should any person become an employee engaged in the improvement of the property, I shall immediately provide Worker's Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa Mesa, as required by State of California laws. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other per- son, company or corporation. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or personal injury to myself or any other parties. irei(,r/S, 4�""""`/ fPI Printed Name / to fika /ad Signature 077946.rev.6/87 UWNCH HOLLAND, T. UAIt 4-1-76 JOB ADDRESS 3125 ROr/5nel t Way BUILDING PERMIT NO. 43500 c4GENERALCONTRACTOR D W Mr Ferran DESCRIPTION of WORK Friel Patin Cover AP No. 1 Ll_hgq_9p LOT TRACT FIRE ZONE VALUE b 1 Ann on I {„i:71cTIONS Signature Date TYPE LV GROUP ,1 ZONE R-1 SUBCONTRACTOR PERMITS ISSUED GAS Date I Number I Signature WATER Plumbing J ROUGH PLUMBING PROP. SWR. LINE LI HOUSE CON. fl SPRINKLING SYSTEM \) MISCELLANEOUS \ROUGH HEATING AND AIR CONDITIONING • TEMPORARY SERVICE OR POLE UNDERGROUND fl POWER ❑ ROUGH WIRING Heating and Vent. TRENCHES 0 FORMS 0 STEEL REINF. 0 . FLOOR SYSTEM BOND BEAM [1 STEEL REINFORCE n SHEATHING FRAME AND FLASHING LATHING - IN in OUT ID PLASTER. BROWN COAT STRUCTURAL. FINAL Electric H' IG, VENT., REFRIG. AND A.C., FINAL PL._...SING, FINAL AND GAS TEST n ELECTRIC, FINAL BUILDING, FINAL .9!41 nt CIL Or'. — 7 • 4150© PAIR ***. APR , 76Pall) 071* 11.50 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only APPLICATION FOR STRUCTURAL PERMIT BUILDING jJ^/� // RECEt,VE j7sBV Q!)sal' E9+Cf1V�D� DATE ISSUED ADDRESSJ�'/J�,S// 0(LSP O-z/ 601:1 / /Q /TL G - OWNER BUILDING A.P.NO 5-2_0 -L- �DMAIL / ADDRESS �/�/� Vr AODRIES /a S / 0r-e ae. ! 04/ CITY rnsfA ///G s>I NE `V theX TRACT' � LOT y//J BLOCK // CONSTRUCTION NEW ADD ALTER (REPAIR MOVING DEMO!ISH LENDER X Ill BRANCH 77 JJ // / OWNER�� CiX��LIVA�[�/l/��//����/7y�/ ADDRESS et) ARCHITECT TEL. USE Ari PA-77(1 carbt a�/41 s--- OR OR ENGINEER NO. FIRE ADDRESS ZONE TVP GROUP A ,1t APPROVED %�i/-''' /774 CONTRACTOR , ei.. y//r C//p�//`/44.) BV `�` W DATE ADDRESS ) 57# 6 o ,/.t / TEL ZOe� NO.OF USE OF N_ CITY ����`T� . N( . �r ��'f� PLAN=_ BUILDIN / 'IIZ 14 a STATE _ CITY R[ YARDS APPROVED YARDS APPROVED 01/4/a--- LIC. Jt.,� LIC. NQ I77f9'lj LIC.NO.W • MAIN BUIL ING ACCESSORY BUILDING�f�/Gf-� W S1ZE ////// 4' NO.OF BLDGS (FROM C/L EET) 0. OF LOT �Sa/a0 NOW ON LOT RO FT. a USE OF /SA- /� Fr EXISTING BLDG. a S✓��F p,1/C R.SIDE 4IG. FT. to FSeparate permits are required for L.SIDE FT. FT. IN electric,plumbing and heating work. REAR 1(/FT. FT. r.. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& MAIN CLOGS. ACCESS. BLDGS. .47,-/e/.5 ^ /�/ / VAR.. DATE .l .C4�y' est, p, ((�rl. C.U.P. APPROVED Q ` 1 x). ( S,, CG'✓ 9f•.'"//;r�s/G1�'C/J _BY ROVIi�f/ 7� LoA- E /�-7� ✓/ ✓t/C/ W 0 I hereby acknowledge that I have read this application and state n N E4 that the above information is correct and agree to comply with m 00 all laws regulating building construction, and I shall not employ Z any person In violation of the workman's compensation laws of the State of California. 3 I hereby certify that I am properly licensed as a contractor under SQ. FT. a the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: " am exempt from the provisions of the State of California Business La and Professions Co Div n3, eater 9. n VALUATION PERMIT FEE $ /4L 0.4 PLAN CHECK ED Signature of �lJ o Permittee ! S/ . /f TAX $ 53 LL (/ (f F U Auth z en TOTAL PAID E s • A• � 1392 FEE RECEIVED COSTA MESA BUILDING-SAFETY DEPARTMENT JAN 1 7 1884 P.O.BOX 317 COSTA MESA,CALIFORNIA FINANCE DEPT. ' CITY OF COSTA MESA For Applicant to Fill In Completely APPLICATION FOR PERMIT . TYPE OR PRINT BUILDING BUiLDING 0 // For Office Use Only ADDRESS J a_ • W -p RECEIPT NO. P it;C .. COSTA MESA. CALIFORNIA 4 RECEI D BY DAT71 IVD TEISSUED JAN 1964 OWNER %IV \''‘ chcQJ c}Vt'l a a MAIL BUILDING - 1 os r C SADDREBS ]] jADDRESS %—; r FIRE � CITY ay1 ) AM. . • C. NO.c)4 3 . •. ZONE TYPE GROUP ‘,Vj APPROVED / ARCHITECT 1 , TEL.L 5.3 C6 ' BY DATE OR ENGINEER { \`\'e,r NO. rG,J d V 1'_\-i ZONING AL iS ria�1• 1 Y� T _ CONTRACTOR • C‘,- • a ! i �e ' � • S ` \ LEGAL ' ' �� �L� /�� A ADDRESS 3 - ; J or es DESCRIPTION J/, /!�. /� !/ Pr V Y\ s' v a IL 1Q-.I A.P.NO. ea CITY STATE TEL43 ( I A r� 90NOT TO SIHAVE DE 8 REAR P LNG SHALL BE LESS THAN LIG.NO. .2 (- O 14 Ci NO. `/3I`� 7 / O1 EAVES SIZE J0-gl v b - I NO.OP SEDGE. ALLOWED (U.B.C.REQUIREMENT) OF LOT _`V Ol /� NOW ON LOTYARDS APPROVEDYARDS APPROVED USE OF MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. • CENTER OF STREET 1,-, REAR 'n FT. - • R.SIDEIOPT. FT. . SIDE YARD I LEFT RIGHT /0 1 • • • ' L.SIDE .S PT. FT. RATIONX. . REAR 3./ ) PT. FT. NEW ALTEADDITION DISTANCE BET. BET.MAIN B DEMOLISH `MAIN BLDGS. ACCESS.SLOGS. _ • •VING VAR.# DATE ig:JzIel NG 5)-- les APPROVED EXTERIORift -..- APP-" ■ f ••COVERING • .. - 2V Jk'S_ ���-asDATE -1 r_ • L USE OF BUILDING AND WORK TO BE PERFORI 1=D \�iA %1 101 e,4Y11- Y2..., LA). CL' c1G4� / �/ r.l Q c I-/84& SQ.FT. 7 0°' I HREST ACKN• •• -••GE THA HAVE D THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE 7.F AND STATE T THE S CORRECT AND AGREE TO COM. PURPOSE OP ESTABLISHING A PERMIT FEE ONLY. G PLY WITH L CITY •'• :: A DST 8 LAWS REGULATING BUILDING ONSTRU-_�/1,1� VALUATION {'�/y�3 _ /, SIGNATU"E `) � PERMIT FEE $ ,.//n•Jr are) m PERMITTE .. i /�� - $/47,579 1 `^ *`v 0 AUTHORIZED AGENT TOTAL FEE $ n'