HomeMy WebLinkAbout2213 RUTGERS DR - Building Permits `� 9 • CITY OF COSTA MESA •
BUILDING DIVISION
> %j___DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
PERMIT B05-02163
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(714)754-5273 • Fax(714)754-4856 • www.d.costa-mesa.B.1hLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 2213 RUTGERS DR Status: ISSUED
Suite: Applied: 11/30/2005
Vicinity: DINING ROOM FOR UNITS A AND B Issued: 11/30/2005
Primary Occ: R2 Type of Construction: V-N
Parcel Number: 41906116 Zoning:
Applicant: RAMIREZ, JONATHAN
Address: 1151 DOVE STREET
Phone: 949-400-6081 ISSUED BY: _ ,17✓,/U�
NEWPORT BEACH,CA Zip: 92660
...
Owner SHARP, GREGORY J AND THERESA
Address 19 GEORGETOWN s - 1t11 '
•>Phone (949)856 0504
IRVINE CA - ' Zip 92612-2673
Contractor OWN ER-BUILDER_.
Address: -g> ti
Phone:
License: 000000
Arch :. - - Eng: ,
Address:t, Address:
• Phone: - • - -. ‘4-a:-1t Phone:
L.
Zip: " _ License: , _ License: -
SCOPE OF PERMIT
REPAIR-AND REPLACE EXISTING SLIDING GLASS DOORS LOCATED IN DINING ROOM FOR UNITS A AND B(TRIPLEX).NO CHANGE IN SIZE
OR HEADER.BOTH REPLACEMET OF.DOORS TO BE DONE CONCURRENTLY.
•
FEE SUMMARY ,-�
Plan Check $0 00 , "?1, Cafc Valuation $1,559.00
Permit 'Jr: $57.05 Claim Valuation: , •$1,550.00
SMIPrRes $050 . °
SMTP,Com. $0 00
Other $0:00 ..
Inspection's "`$0.00
Total: $57.55 ,
PLANNING ZONING
SETBACKS �v f
MAIN STRUCTURE Front 0 0 Rear 0 0,< aleft" 0 0 Righty 0-0
ACCESSORY C Front 0.0 Rear NO .0 Left 0 0 �' Right• 0 0��
PARKING •Existing 0 " , Required" , 0' Proposed 0�'
,
•
•
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
244646(6/00)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
r
❑ have and this ea is uete of consent to self-Insure for workers'compensation,4�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 ll the permit is valued at one hundred dollars($100)or less.)
•
certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so es to become subject to the workers'
IIIc-'compensation laws of California,and agree t if I sh• d become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions.
CApplicant Signature:: II (Deter-1 /(N34 0
"WA5Uii C''.FAILURE TO§IeCU WORKERS'COMPENSATION.. IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE 1 ),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:
O I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). •
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ 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 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:
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 ❑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 ❑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 a ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? jIP Yes LJ No
(Section 65850.2 of the California Govemment 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:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws end city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
ur ,. :gal 0,rrs)rpate -
-
And/Or-AuthorizedAppli t --" / Dae`
CODE# IBSPFCTION TYPE PEE trims COPES INSPECTION TYPE PAIL ffMTIAL$
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
t
'Y204 Final Demolition 250 Final Building/Occupancy / 5l( jw
'ece. ed Fax • • a 31 _10 •",0. tlS'✓EY35ICTi*ali:L'�E7CF41�:[i1M
FROM :CITY OF COSTA MESA FAX NO. :714 754 4856 Noy. 30 2005 08:45AM P1
DECLARATION OF AUTHORITY Bldg. Permit a
FOR AGENTS OF PROPERTY OWNER This Permit#
TO APPLY FOR PERMITS
Street Address: 22 13 1?U 1 Yf e�� U( . _ AP Number:
1. I (we), 61- 139 1 \e`t 1P ._, , declare that I em the Owner of Title of the above
referenced real prop rty, and that I(we)hereby authorize:
Name: J 0 VW ,/� q\AYt'1pt CL's 1 Telephone Number: _ (`l 1 `) �/co - 6c0_
Street Address: If YI VQV'e-�1,�_: SU;k 14F
City: ew,p 6a �rT-eCil 1� _...,__. State: ..__._ zip: 4L46(i
to obtain permits in my behalf,as owner/builder,for
al the above referenced property.
2. Should any parson become an employee engaged in the improvement of the property, I (we)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,es required by State of California laws.
.,3: As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other person, company or
corporation.
4. 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 es a result of work authorized by the permits from the City of Costa Mesa.
5. I declare under the penalty of perjury thattthe foregoing is true and correct.
Executed this 30 day of t3c.1'ty \o.,c 20 CDT ,at , C-VU'.C- ,California.
Print Name: (.7k reg SV(Q
Signature: Ale
n1
Date: Nnv,wtL, 20 2.005- •
Note: This authorization does not grant authorization to perform the work as owner,
it solely provides for limited power of attorney to anrxnn this permit in any behalf.
UAPJE bar.t Iloot
F CITY OF COSTA MESA
< � BUILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT PERI:NUMBER
4. OK.
PERMIT / B05-02055
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.BtHLDING PERMIT n FAIR DRIVE,COSTA MESA,CA 92628
Job Address: 2213 RUTGERS DR Status: ISSUED
Suite: Applied: 11/15/2005
Vicinity: EXTERIOR STAIRCASE Issued: 11/15/2005
Primary Occ: R-3 Dwellings/Cong Res<10 Type of Construction: V-N
Parcel Number: 41906116 Zoning:
Applicant: SUH, KEVIN 441/
Address: 4372 KATELLA AV a
Phone: 562-493-3210 ISSUED BY: �%
LOS ALAMITOS,CA Zip: 90720
Owner: SHARP, GREGORY J
Address 19 GEORGETOWN
Phone: (949)856-0504
IRVINE,CA Zip: 92612-2673
Contractor: NEMO CONSTRUCTION CO
Address: 4372 KATELLA AV •
Phone: 562-493-3210
• LOS ALAMITOS,CA
Zip: 90720 License: 686128
Arch : Eng: HAROLD PING HUNG WU
Address: Address:
Phone: Phone:
•
Zip: License: - License: C36693
SCOPE OF PERMIT •
REPAIR AN EXTERIOR STAIRCASE AT AN EXISTING TRIPLEX.
NO OTHER WORK AUTHORIZED WITH THIS PERMIT.
REF:C0-05-1541
FEE SUMMARY
Plan Check: $90.51 Calc Valuation: 37,000.00
Permit: $139.25 Claim Valuation: $7,000.00
SMIP Res: $0.70
SMIP Corn: $0.00
Other $139.25
Inspection: $0.00
Total: $369.71
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
•
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
244648(80e)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
:41.]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 Ls Issued.
My workers'compensation Insurance carrier and policy number are:
-carrier" STAT T-0 N D Ponds Number:, \ 34-07 Lie — 1_0 0c .
"(This-section need not be completed if the permit is valued at one hundred dollars($100)or less.) -
❑ I certify that in the performance of the work for which this permit is Issued,I shall not employ any person In any manner so as to become subject to the workers'
compensation laws of California,a agree th I if I s Id become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these pro ions.
Appff`e'n1 S(gnem�t- _ Date: l J o U '5 o
WARNING:FAILURE TO SE RE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED
THOUSAND DOLLARE(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 em license under provisions of Chapter 9(co mencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.tic-F) t'rb/a�? Cciellitif
•
Contracloes-Slgnatpre--_i i TDate: 1Uau . (5 . oS.
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 of sale.). '
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to Construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. Zl Yes 0 No Drivers License No. Expires:
Verification of Ownership by(type of d m t,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(38)feet high.(Chap.3.2.Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 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 Flre 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
(Sectiontihas the hand California Health aSafety
Co hazardouswith some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one
quantityacutely
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 On 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 bullding occupant require for the work which is the subject of this eppplication aggemlit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? L]Yes LJ No
(Section 65850.2 of the California Government Code requires that the requested information be fumished on applications for non-residential building permits).
8 —Will any part of the fadlity 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 QualityManagement 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: Data:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,end authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
iSigr3Wft Qt Ow (s) N 7 o9 V ata
Cmss.
LAnd/ uthorized Appllfbnt:a
QOM 1, lflSPECT10NTYPE PATE MOW S00E( INSPECTIONT'fPF PATE TALI
1616 Fixed System Final Fire Prevention _ 206 Final Mechanical
1268 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
204 Final Demolition _ 250 Final Buil Bullding/Occupencyabcf45. "*.
•
4L�w'� CITY OF COSTA MESA
/� BUILDING DIVISION
o y,�,4r DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
F I =� t
t. • PERMIT /
w-`x!t'moee \ P00-00618
(714)754-5273 • Fax(714)754-4856 • vnvw.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 2213 RUTGERS DR Status: ISSUED
Suite No Applied: 11/07/2000
Issued: 11/07/2000
Vicinity: FRONT YARD
Parcel Nunmber: 41906116 ISSUED BY:
Applicant: SHARP, THERESA
Address: 19 GEORGETOWN
Phone: (949)856-0504
IRVINE,CA Zip: 92612
Owner: SHARP, GREGORY &THERESA
Address 19 GEORGETOWN
Phone: (949)856-0504
IRVINE,CA Zip: - 92612
Contractor: OWNER-BUILDER
Address:
Phone:
Zip:
License: 0
Arch/ Eng:
Address:
Phone:
Zip:
• License:
GAS REPIPE SCOPE OF PERMIT
FEE SUMMARY
AMT QTY AMT QTY AMT QTY
ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0
Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0
Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0
Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0
Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum 8th Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin , $0.00 0
Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0
Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0
Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0
Drain, Roof $0.00 0 Shower $0.00 0 Water Heater/vent 50.00 0
Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0
Expansion Tank $0.00 0 Sink,commercial $0.00 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 $9.80 1 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: $33.30
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
2446-48(WOO)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
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 at one hundred dollars(5100)or less.)
❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions.
Applicant Signature: Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE G UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TOONE HUNDRED
THOUSAND DOLLARE(S100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060E THE LABOR CODE,INTEREST,AND ATTORNEYS 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.p Class
Contractors Signature: Dale:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work tor which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: Lenders 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 Ucense 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•lhe applicant to a civil penalty of not more than five hundred dollars(5500).):
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 Ucense 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 ono year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exem. der sec. p�7�--r --y- Business and Professions Code for this reason:
(Signature: �. ___
LExpires:—en —0 2-
Verification
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,Califomia Administrative Code).
❑ As owner-builder, 1 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 bo 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 Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mese 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 agermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 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:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspe i purposes I agree n to occupy or allow occupancy of any building authorized by this permit until final inspection.
liefi,41/41 (Lnef"Ar�" //r (e)
Signature Of Legal Owners) ..4 j Date y
And/Or Authorized Applicant Date
CODE I INSPECDON TYPE PATE grrIALS CODEC INSPECTION TYPE - PdIE EMUS
1616 Fixed System Final Fire Prevention 206 Final Mechanical /�
1266 Pool Spa Final 20B Final Plumbing 1 DIN 100
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
OWNER AMHERST DEVELOPMENT CO, ',Q_,_ h � t 'v� DATE 1.1•013-57JOB ADDRESS n.3 I6 .Nureezt '7J R. Y•F. BUILDING PERMIT NO. 6032
GENERAL CONTRACTOR Dike & Colegrove VALUE $ 10,702.00
AP. No. LOT 75 TRACT 2953 FIRE ZONE DESCRIPTION OF WORK Residence Watt gar.
GROUP I & J TYPE V ZONE R4 PLAN NO. 6063
PERMITS ISSUED
I. ECTIONS DATE SUBCONTRACTOR DATE NUMBER
Trenches gef,4-Forms Steel rV /)-7.-Ws-.7
Floor Systim
Steel Reinforce Chimney Re-Rod
Bond Beam
Frame-and Flashing ,S Dr
:r yy
Lathing, In ft-Out /• /S4,
Plaster, brown oat, , „ ,1-V-' v////$a
Underground soil'%>Y�W/G Pipe List/ /1/49/0
Top Out cOhr V -
Furnace P�— uiv��c.matt
M//•C 2-2/-ham" �• -I tJJ.•i T :s.
Gas Vents /� '/ �Q-T• PLC 5 t
Rough Plumbing /Of .2-/3 J7r ' o4.-c--. NOV 1 3 IE 5 11Z1283
Cesspool Septic Tank
Prop. Swt. Line House Conf1A4 St. Swr. 2-//-<--9 F,ea.n,, ecae&ts /—/3-5t i314 /
SprinklingaSyste
Heating Final /yj/f( S-iy��r�
Plumbing Fixtures, Final /Yl H-S 5--Lq-s-d'"
I Gas Test /S— diff' <=2.9t-- cg'
o...truction Pole G
Underground Power
71/;(13 Rough Wiring 1 Jfin 2 3 1958 636Fixtures, Final .,7
OCCUPANCY ',1J/7S S-09. -F
Form 210-5M-1-57
f
8067 trii
COSTA MESA BUILDING DEPARTMENT If a V S t4'=`
P.O. BOX 317 FINN EPT.
COSTA MESA. CALIFORNIA
CITY OF COSTA MESA
FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT
BUILDING Rutgers Drive A, B, C BUILDING
ADDRESS
p /3 COSTA MESA-. CALIFORNIA FOR OFFICE USE ONLY
pit, �O p('��
6
yy++,,.. RECEIPT NO. PIT
OWNER Towne Estates, Inc.
MAIL 1555 Placentia •
RECEIVED BY DATE RECEIVE�G}/ ,yOpTE-IS` E;
ADDRESS rYBUILDING //-2-1 --. . // J
CITY Newport Beach, Cal. NO. 6-3221 , ADDRESS 2L21�/ �0If ens
ARC' TE LIC.O.
H
OR VEER COSTA MESA. CALIFORNIA
nyr,lAr NO.
FIRE {
ADDRESS ZONE J
W. C Co. $534 ZONE NO'OF TYPE GROUP
K, Koll Const. VCITY LIC i PLANS . , ,
CONTRACTOR NO. ' ' E
TEL. APPROVE .N. /;�
ADDRESS same NO. same BY Oh'r DATE /Ai
LEGAL LOT ��yy�I CORRECTIONS JJ
DESCRIPTION NO, S BLOCK TRACT27oo
A.P.NO. A y`; CI 7
CSFSIZE VA RID 111
LOT oux100 NN
LOTO
ff
USE OF {ti�. p T •^t. ,
EXISTING BLDG. V lJ int 1 '..%' E.,
VI ( k4i :v ACC
SETBACK LINE FROM 1-E.
10
CENTER OF STREET 45 y E. REAR YARD •`
�,_ Af
�1 /
SIDE YARD RIGHT 10 LEFT 10 + ` t- -
DESCRIPTION OF WORK (A' - U��'T1-„ -y
VAR No _ APPROVED !O/ I
NE' X ALTERATION II ADDITION
REPAIR MOVING ryl DEMOLISH �f
SIZEDING 2480 sq ft NROOMS 12 STORIES 2
EXTERIOR WALL ROOF
COVERING stucco COVERING hot mop
USE OF N
BUILDING Apts. Triplex and attached
3 car garage. � e0 ,7 ''
•
G /o
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND
STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL
CITY ORDINANCES ANO STATE LAWS REGULATING BUILDING C•
TION. VALUATION
SIGNATURE • / / -Y` `/0_ / PERMIT FEE S �L� ��
PERMITTEE. ��i // /J/ X_/y((((����
S O'2 . PLAN CHECK S ,22d, /
AUTHORI E• AGENT / TOTAL FEE S 617; / VBMb
A ' ; 4 (PHONE CALL)
FOR -ri/��r,i�'/� • O a.
� �� DATLO
M _� �Lti ...�/ �Si.I. '.4 L_"
Z Z/g— �'`rr`te PHONED
PH
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FAX i RETURNED
PHONE 11 mnarLF i YOUR CALL
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MESSAGE /.a a—I /���
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,A 66 `, e ', I.• le
C ■ SEE YOU;
SIt Er , i / i rit{?. Item OD7154