HomeMy WebLinkAbout2320 RUTGERS DR - Building Permits � •. y\ r CITY OF COSTA MESA ' i L
o BUILDING DIVISION
• >:l 7 .,a DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
t1 P is t• PERMIT
!rs^� os# PO 0692
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 2320 RUTGERS DR Status: ISSUED
Suite No Applied: 10/15/2004
Issued: 10/15/2004
Vicinity:
01() -
Parcel Nunmber: 14147217 ISSUED BY:
Applicant: LEITHAUSER, MARIE M TR
Address: 2320 RUTGERS DR• •
Phone:
COSTA MESA,CA Zip: 92626
Owner: ' LEITHAUSER, MARIE M TR
Address 2320 RUTGERS DR
Phone: 714-546-5544
•
COSTA MESA,CA Zip: 92626
Contractor: OWNER-BUILDER .
Address:
Phone:
Zip:
License: 000000
Arch / Eng: - - - . - , . . - '
f
Address: .. - • - . -
. Phone:
Zip: _ .
License: -
SCOPE OF PERMIT -
repalce water heater. • - . ,
FEE-SUMMARY
AMT QTY - AMT QTY ! , - AMT QTY
ISSUE FEE . $23.50Laundry 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 Brkr 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 $12.30 1
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
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12-21.92)
EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00) .
DECLARATIONS ( j Ir ,44
•
WORKERS'COMPENSATION DECLARATION: .
I hereby affirm under penalty of perjury one of the following declarations: V4 `
❑ 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 i1 the permit is valued at one hundred dollars($100)or less.) . .
O 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 IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF 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.# 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
sub'ects the applicant to a civil penalty of not more than five hundred dollars($500).):
I,as owner of the properly,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 exam t der sec. Business and Professions Code for this reason:
sigma ` s i o S '
'owner ID verified by driver's license. cgCes 0 No ..rIL9'Ti.71RT:TL7 0) / xp : V-0./-0.4
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).
O As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑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 ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application ap-ermit 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
6 (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 inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
...aSigr :Of Leg- �wner(s) ( b ^ 45' ^ 0Dat el
ea
.: ,uthorized App ca.
CODE# INSPECTI•'TYPE PAIL INTRIALS CODES INSPECTIONTYPE • ' PAIL U4TIDSL$
1616 Fixed System Final Fire Prevention 206 Final Mechanical ((��
1266 Pool Spa Final 208 Final Plumbing , )0•19 'Q ti UN
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 _
ti •
• " 'DECLARATION OF AUTHORITY Bldg. Permit#
FOR AGENTS OF PROPERTY OWNER This Permit#
TO APPLY FOR PERMITS
Street Address: 2 3 2 0�j/�1� V -I"Q'�rs D rr AP Number:
1. I (we),, /�,L�u /`/, Dee--at.(ice-tile- , declare that I am the Owner of Title of the above
referenced real property,and that I (we)hereby authorize:
Name: I
n1 3 e I &-✓1 q e I— Telephone Number: 1 4 - 3 `"1 - b 3 T
Street Address: 17 LI I ?D M o n a '4°
City: C O S M C 5 A State: GA Zip: `1 a �7
to obtain permits in my behalf,as owner/builder,for Inc k( )I' AJn.-'k-/"
at the above referenced property.
2. Should any person 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,as 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 as a result of work authorized by the permits from the City of Costa Mesa.
5. I declare under the penalty of perjury that the foregoingris true and correct. CoExecuted this 1 5 day of U C.4-0 6-es 20 0`f ,at Co S(-rte /f P,$a. , California.
Print Name: 444 li7 tot m, L E / TNA k
/� /
1.
Signature: /` f-e >1'
Date: /S ---
Note: This authorization does not grant authorization to perform the work as owner,
it solely provides for limited power of attorney to secure this permit in any behalf.
077946(rev.11/00) •
- . CITY OF COSTA MESA
vt�� BUILDING DIVISION c •
• ^� DEVELOPMENT SERVICES DEPARTMENT
TA. PERMIT PERMI NUMBER
B98-01421
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 2320 RUTGERS DR Status: ISSUED
Suite: Applied: 08/11/1998
Vicinity: Issued: 08/11/1998
Parcel Nunmber: 14147217 Zoning:
•
Applicant: BURKE, MIKE
Address:
Phone: 949-642-7222
Zip:
Owner LEITHAUSER,.MARIE M TR
Address 2320 RUTGERS DR '
_ Phone: 949-546.5544
i .COSTA MESA,CA ' " Zip: 92626
// \
Contractor. ' LEE ROOFING'OF COSTA MESA
Address: 01653 SUPERIOR AV -
/�� Phone:
COSTAMESA CA Zip:, 92627
/
License: 349686 ,
Arch/Eng: • :
Address: - -
A .-Phone:
Zip:
License:
SCOPE OF PERMIT
TEAR OFF ROCK ROOF INSTALL TWO 15 LB FELT&REROOF WITH 25 YR COMP.SHINGLES.
FEE SUMMARY
Plan Check: $0.00 - Calc Valuation: 55,300.00
\ Permit: • $112.25 ; /' Claim Valuation: ,$5,3oo.00
:SMTP Res: $0.53
SMIP Corn: $0.00
Other: ' $0.00 •
Inspection:. ' `,$0.00
Total: $112.78 •
PLANNING & ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 • Rear 0-0 • Left 0-0 Right 0-0
ACCESSORY Front - 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 - Required: 0 Proposed: 0
NOTES: •
•
•
•
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or it work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
.$' 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.
\[Ay worker 'cf mpensatio9lInsurance caJg�er and policy number are:
Carrier: 74LTrr COl4AP hl/t)O_ Policy Number: /3-00 7 y 7d
(This section need not be completed ll the permit is valued et 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'
compo alifomla :nd :. : at If I should become subject to the workers'compens: - • •• -•s of Section 3700 of the Labor Code,I shall forthwith
corn•
• : i% c._�L Date: 6' 9d
A.:. - q URE TO SECURE W'KERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT" - 0 CRIMINAL PE •TIES D CIVIL FINES UP TO ONE HUNDRED
HOl1SAND DOLLARE(5100,000) •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 -. ' ensed under•revisions.1 Chapter 9(commencing with Section 7000)of Division 3 o e =•-'less and Professions Code,and my license is in full
fort: -• : a . c.d1 ! Class a G 3
on tractor's Signatur:• Pr/��yrAIP2 Cie
relir ''
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: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I em 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 drivers license. ❑Yes ❑No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made In connection with work authorized by this
permit,end 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:
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 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? ❑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,hes Section 25534 of the California Health and Safety Code been fully complied with? ❑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 appermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 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 and 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.
n:t a Of Leg: Owner(s) D
i.� •L.
A d/lir Authorized Applicant Date
g00E 6 i 'ii' •' SATE MAO COM INSPECTION TYPF QAg INImALS
1616 Ixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final ,.��,/, 208 Final Plumbing
200 Final Re-Roof 8—/f-gr `4&t# 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
'.
_ - Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITYtsitO COSTA MESA CO ST' UCTION PERMIT PERT ND.�/4,13
/ TRACT NO. • LOT NO. UNIT N6. 051 7/02/86 SeCp T�
•
Project Address - as I k . . -.P I y Y3) � �� 1 ~ .. .. __
TYPE OF CONSTRUCTION ❑ NEW U ADD Li ALTERATION L. REPAIR
Applicant's Mailing Addre s _ 11 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER
Owner's Name - i -r</, • Phone-994 � A.P.# Zone
it , 9 DESCRIPTION OF WORK/USE OF BLDG. S Main Building: Accessory Building:
Address ���/ Z
Arch/Eng. License Nod TYPE OF PERMIT U GRADING U�OUNDATION ❑ STRUCTURAL E Front 0
Address ❑ TENANT ❑ ELECTRICAL . ...PLUMBING ❑ MECHANICAL B Rear N
ALA I / IL/Fhone •&546,(I---- ❑-OTHER - A N
Contractor's Nam. C Right
Address(mailing) '��a� I ' ./ PROJECT DESCRIPTION SQ. FT. OCCUPANCY K G
istr )��� CONSTRUCTION TYPE VALUATION $ Left
City License No. R
t
LICENSED CONTRACTOR DECLARATION ZONE GRADING CU.YDS. ACRESE
l /s //,vn-�//,'1s(1� Ping. Ref.# Parking Req./Provided0
I hereby affirm thaI am licensedion underfprovisions Charterro9i (commencing Remarks: -(pL//](/ � /''/!^�' Planning Notes: r(�r 1 M
i
with sectionis 7000) of ,and of 3 of the Business and Professions Code, and r'C`K f r' RF.I-vFA/Fp .I II N 2 7 6 ` S
my license is in f l and effect. r
Licensee/CI of
Co Date{///�5$ Signature W( 'i ns- N PLUMBING ' FEES
I WORKERS' O MPENSATION DECLARATION Bar Sink Showers . ELECTRICAL ' FEES
I hereby affirm that I have a certificate of consent to self-Insure or a certificate • -
of Workers' Compensation Insurance, or a certified Copy thereof (Section - - 1
3800, Lab. C lAn a,/7�� Backflow Preventer Service Sink Automatic Washer Transformer ❑ 15-50 KW
\ Policy No. f Lf t+f- Company � r-r/�--� Backflow Irrigation i Sewer Cap0 50+KW
9 Construction Pole Sub.
rtified copy is hereby furnished. _
Cert' ' c p Jsy led with the city�yiyyJ.Jgpiyjsion Bathtubs Sewer Connection Cooking Unit Meter Duo to 100 amps
Date l�/-s Applicant //IEK�C �� '
E%EMP I--ROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors - Dishwasher • Meter Dover 100 amps
(Thissection need not be completed if the permit is for one hundred ($100) or •
less). Dishwasher Solar Piping i Dryers ❑Gas ❑Electric Sub Panel
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 Drinking Fountains i Solar Tank FanMotors 00-1 HP 01%-8
Workers' Compensation Laws of California. '
Date Signature Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar 09-15 HP 016-15+
- 'NOTICE:if,after making this declaration,you should become subject to the '
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures Microwave
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes Pole Light
1 hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is issued (Section 3097 Civ. C.) )
Lender's Name Interceptors- / Water Heater Outlets Range
Lender's Address - Kitchen Sink Water Service - Switches , - -
' OWNER BUILDER DECLARATION Sign
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal I Standing Sections
following reason (section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays Generator 00-5 KW 05-15 KW Trash Compactor
any structure, prior to Its issuance,also requires the applicant for such permit
to file a signed statement that he/she Is licensed pursuant to the provisions of Roof Drains
the Contractor's License Law (Chapter 9(commencing with Section 7000)'of ,.
Division 3 of the Business 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
LJenalty of not more than five hundred dollars($500).
I, as,owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 —
compensation, will do the work,and the structure is not Intended or offered - - Reinspection Fee $15 Issue Fee $ 3 '
for sale (Section 7044, Busines and Professional Code: The Contractor's MECHANICAL FEES
License Law does not apply to an owner of a property who builds or improves -- - ----- DEVELOPMENT SERVICES REQUIREMENTS:
thereon, and who does such work himself/herself or through his or her own
employees, provided that such improvements are not Intended or offered forBoiler • Hood or Type I ❑ Zoning Approved By - Date
sale. If, however, the building or improvement Is sold within one year of com- Canopy Type II ❑
pletion, the owner will have the burden of proving he/she did not build or Im- Duct-Under Ground Building Approved By • -sly Date
prove for the purpose of sale). {/L/�- q--..)-41/1
_� U
❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By t Data J'�fn
tractors to construct the project (Section 7044,Business and Professions Code: -
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU ❑100,000 BTU SUMMARY OF FEES '
builds or Improves thereon, and who contracts for such projects with a con- _ -
tractor(s) license pursuant to the Contractor's License Law). 1 am aware thatExhaust System 0 Multiple ❑ System Repair/Alteration BUILDING PERMIT $ SMIP $ -
proof o/ their Worker's Compensation insurance should be provided to me. — PLAN CHECK $ 7� PERMIT
❑ I am exempt under Section-- - B.& P.C.for this reason Firepl/Fact.Blt. ICBO# Fire Dampers PLUMBING $ COO ISSUANCE $
Date - Owner Heating System& Ducting Registers - - ENERGY P.C. $
PLAN CHECK 25% $
I herebycertify that I have read this application and state that the above 00-100,000 BTU 0100,000 BTI- ELECTRICAL $ GRADING $
information is correct. I agree to comply with all city and county ordinances ,
and state laws relating to building construction,and hereby authorize repre- - MICROFILM $PLAN CHECK 50% $ gO �_
sentatives of this city to enter upon the above-mentioned pro erty for - _
inspection pun_r, es Vi1//! MECHANICAL $ TOTAL FEE $
Signature ' / /AlL r 4 t�� Date -
Drivers'License or SS 9f - _ Reinspection Fee I $15 Issue Fee $ 3 PLAN CHECK 25% $
CMF 0865-46,rev. 10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor
L
CONSTRUCTION AND PLANNIN. )L& SPA
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
3. Electrical Conduit Utility-Undrgrnd. 54. Forms -;
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd. LA,
8. Foundation 59. Gas Pipe, O Undrgrnd.,Test
9. Water Pipe-Undrgrnd. - 60. Backwash Lines, P-Trap,'O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK "i
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 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 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 Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final • 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:C-14-37 aA)7(EG 46 pea 2a3 UPC L(o
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
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
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE& BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co --
51. CERTIFICATE OF OCCUPANCY
No. Date .
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
iiCITY OF COSTA M�$)ACONSTR ION PERMIT�, PER(al��ayJ�T NO. ss TRACT NO. LOT NO. UNIT NO. 5142 9/14/B7 24o50 IL
• P ect Address .0(.14:2n o/ (oIJV J O�ug
icant's Mailing Address tin,�' TYPE OF CONSTRUCTION LI NEW Li ADD ALTERA/7J'ON LI REPAIR r
\, _ / ' �/ /� LI CONVERSION ❑ DEMOLISH El OTHER /4-12(1,•2)f• A,P,.p, Zone
Owner's Name C��7T/-�Ae-LSe PhonwCo S{y1 e SCR IPTION OF WORK/USE OF BLDG. Q 4.' O II • —
S Main Building: Accessory Building:
Address It• A n o _ - / - .s.. �.. 7 E •Z
Arch/Eng. License No. TYPE OF PERMIT M GRADING U FOUND•TION II STRUCTURAL T Front O
Address //''++ / �y ❑ TENANT ❑ ELECTRICAL ID PLUMBING ❑ MECHANICAL B Rear _ N
Contraci6r's Nam,. / e,,,,,, --te1 )PPhoneS15flC ❑ OTHER 1 /�^//C✓� P VOL) Right N
Address(mailing) Q 7 /2• ��/radii 4• r e)2gjq(ocs PROJECT DESCRIPTION SQ. FT. r2 ) OCCUPANCY K G
^� / CONSTRUCTION TYPE VALUATION 5 .� 7nn / $ Left R
City License No. l �ds� y ZONE _ GRADING CU.YDS. ACRES - Ping. Ref. # Parking Req./Provided E
LICENSED CONTRA TOR'DECLARATION
I hereby affirm that tl am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: M
with section 7000) of Division 3 of the Business and Professions Code, and T
my license is in full feu- and•effect.
s icense Cl.ss - se No...-1.1i-r-.
S
A to - O O `•Signature 1-1 .11[41111T4.as PLUMBING FEES
ylD .ORKERS'COMPENSATION DECLA•ATION Bar Sink Showers • ELECTRICAL FEES
!iV I hereby affirm that I have a certificate • consent to self-insure or a certificate
1 of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink
3800, Lab. 9�) t/,/ -..1 q •7- /` Automatic Washer Transformer 0 15-50 KW
Policy No. (../09.•<&75-/- r•7ZO Company .5,/Pr& /(JnQ Backflow Irrigation Sewer Cap - 0 50+KW
Construction Pole Sub.
I . Certified copy is hereby the
cit
t \ Date a op isil.e with the city Bt4Dig• ivisigfl-:. /'\ ' Bathtubs Sewer Connection Cooking Unit Meter pup to 100 amps
Date 7 - ' t Applicant J DECLARATION
�K ))��--
E%EMP ON ROM WORKERS'COMPENSATI DECClarifiers Solar Collectors Dishwasher - Meter Clover 100 amps
(This section need not✓be completed if the permit is or one hundred ($100) or
IeDishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel
certify
I certify that In the performance of the work for which this permit is issued, I .
shall not employ ason in any manner so as to become subject to the Drinking Fountains Solar Tank Fan Motors 00-1 HP ❑1'/,-8
Workers' Compensationtion Laws Of California. �_ _
Date Signature Floor Drains Swimming Pool w/Spa F.A.U.—
Inc.Solar 09.15 HP 016.15+NOTICE: Il,f,after making this declaration,you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures Microwave
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes Pole Light
• I hereby affirm that there is a construction lending agency for the performance 9
of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets Range
Name an 9e
Lender's Address Kitchen Sink Water Service Switches
OWNER BUILDER DECLARATION Sign
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash
following reason (Section 7031.5 Business and Professional Code: Any city or. Garbage Disposal Standing Sections
county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays Generator 0.5 KW ❑5.15 KW
y structure, prior to its issuance, also requires the applicant for such permit ❑ Trash Compactor
file a signed statement that he/she Is licensed pursuant to the provisions of Roof Drains
.e Contractor's License Law(Chapter 9(commencing with Section 7000)of
Division 3 of the Business 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
enalty of not more than five hundred dollars($500).
I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3
compensation, will do the work,and the structure Is not intended or offered Reinspection Fee I $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES
License Law does not apply to an owner of a property who builds or improves •r
thereon, and who does such work himself/herself or through his or her ownDEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such Improvements are not Intended or offered for Boiler Hood or Type I ❑
sale. If, however, the building or improvement Is sold within one year of com- Canopy Type II ❑ Zoning Approved By Date
pletlon, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground • Building Approved By Date
prove for the purpose of sale). y
❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By 0 Date I� 4I1
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU Ufy]�1f1JiJl�( ��
builds or Improves thereon,and who contracts for such projects with a con- SUX '(J(J FEES
tractors license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMIP $
proof of their Worker's Compensation insurance should be provided to me. PERMIT
PLAN CHECK $ PE
❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.BIt. ICBG# Fire Dampers PLUMBING $ RMITISSUANCE $
Date Owner Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $
I hereby certify that I have read this application and state that the above ❑0-100,000 BTU 0100,000 RT ELECTRICAL $ GRADING $
information Is correct. I agree to comply with all city and county ordinances
and state laws relating totb'tern• [ructi ab, and- herebyiauthorize er yfor PLAN CHECK 50% $ MICROFILM S V.5-0
/�
Inspection of -. cit to ter u•O� the above-mentioned prhperty for [7{
Inspection ou .• /I 1 G MECHANICAL $ TOTAL FEE $
Signature Date I a A 1 '
Drivers' License or SS# Reinspection Fee I $15 Issue Fee $ 3 PLAN CHECK 25% $
CMF 0865-46,rev. 10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor ,..--
A
A
CONSTRUCTION APLANNING
NO. POOL& SPA
APPROVALS Date Inspector Date Inspector
APPROVALS tP-ermi�# APPROVALS Permit#
1;Temporary Elec?rical Service or Pole 52. Pool & Equipment Location
n i A
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 UFER Grnd. 57. APPROVAL TO COVE R-GUNITE
7. Footings .;y / 58. Electrical Conduit-Undrgrnd.
8. Foundation 'Cl 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undi'grnd. 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
12. Sewer Cap 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 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 Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION •
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED .
33. Final Electric Notes:
•
34- Final Heating & Air Conditioning • ; Y%
35. Final Gas Pipe-Test
I
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final I
40. Gas Service-Final I - • '
41. Solar Domestic-Final I .-
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System - •
:45. Sound AttenuationI
• IRECti•
46. Handicap Regulations )nCoiliji,, - inspections ' it
47. F.INAL STRUCTURE & BUILDING �� '
48.;Special Requirements Completed `
.49.'Electric Release to Edison +
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY _• - -
No. Date
OWNER AMHERST DEVELOPMENT CO. DATE 11-13-57 _
JOB ADDRESS 2320 Rutgers Drive BUILDING PERMIT NO. 6031
GENERAL CONTRACTOR Dike & Colegrove VALUE $ 13,690.00
AP No. LOT 74 TRACT 2953FIRE ZONE DESCRIPTION OF WORK Residence w/att gar.
1 LIP I & J TYPE V ZONE Rh PLAN NO. 6062
PERMITS ISSUED
INSPECTIONS DATE SUBCONTRACTOR
DATE NUMBER
Trenches ,1-Forms Steel an, V/V.-a•/S7 _
Floor System
Steel Reinforce Chimney Re-Rod
Bond Beam
.-Frame.and Flashing / 7.}- O/(Y/fl'
Lathing, In 0,<-44-Out alb{— 3/0/SV -
Plaster, brown/teat , / P wi Jrb'
Underground soiVofint/W/G Pipe Test,* 'WY/S.'
Top Out `i'W -
Furnace -��� ---• - — ---
Mur 7 -z/-sem -
Gas Vents ' , . >s2Z ' �.EC 5 '
Rough Plumbing MHT 1-//-Sg / /Cci2�(1-L. �. NAV 1 3 195 ! 12082 _
Cesspool Septic Tank
Prop. Swr. Line House Con.yf/f!St. Swr. 2._ //-CY fl„,...v..4.2-,...5 () /-/3-SJ . / 3/ 9'O
Sprinkling System (J
ig Final , cc 4-.4.-/-",--e4-.4.-/-",--eJ%
I .Hing Fixtures, Final /Yj)72 r-29--F /
Final Gas Test JS M/71--C c-1 '--c-r '7
Construction Pole ,ALI-.4- IL-/r 4-7r7/2"-- 0. n_
Underground Power
Rough Wiring /7 �U J X �4iSA�i�, /•<-ssR pk/ 23. 1952 SUE fry
Fixtures, Final 1It ft Li-_ILS+ 0
OCCUPANCY 7HAILS 3--2-t--sr
Form 210-5M-1-57
V .
6®62 u' EE RECLIl�f L.
COSTA MESA BUILDING DEPARTMENT ii 3 ,51
P.O. BOX 317 FINANCE DEPT. vi,,
. COSTA MESA. CALIFORNIA
CITY OF COSTA MESA
FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT
BUILDING
ADDRESS 2320 Rutgers Drive BUILDING
COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY
RECEIPT NO. PERMIT NO.
OWNER Amherst Development Co. `n'o3_1j,
RECEIVED BY GATE RECEIVED DATE 156�V]ED(,g_
MAIL
ADDRESS 419 E. 17th Street ---24-- -7_, ///-/7-&7 NOV 13 Ml
TEL. BUILDING
CITY Costa Mesa ND. LI 8-1159 ADDRESS
ARCHITECT Carlson
LID COSTA MESA. CALIFORNIA
OR ENGINEER NO.
FIRE
ADDRESS Garden Grave ZONE
��" Y LIC. ZON NO.OF TYPE GR/OUF" /�
CONTRACTORDikee and
hColegro`de ,NO. 7333 4/ OU v "'
419
ADDRESS
ECAs 4a Mesa �"rNO.LI 8-1159 APPROVE DATE vhf
LEGA` LOT 14 CORRECTIONS
DESCRIPTION NO. 74 BLOCK TRACT 2953
A.P.NO.
SIZE NO.OF BLOCS.
OF LOT 72 x 102 NOW ON LOT none
USE OF none C
EXISTING BLDG.
SETBACK LINE FROM pp���
CENTER or STREET JYA 55' REAR YARD[[ 29!
/_p�
-
SIDE YARD RIGHT 6' LEFT O'
DESCRIPTION OF WORK •
•
NEW X ALTERATION ADDITION
REPAIR MOVING [DEMOLISH
SIZEBUDING 1601 sq. ft. ROOMS 6 STORIES 1
EXTERIOR WALL stucca ROOF
COVERING COVERING Camp.
USE OF NEW
BUILDING Single family residence,
garage attached.
Plan No. 750BR
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND
STATE THAT THE ABOVE IS PRRECT AND AGREE TO COMPLY WITH ALL
CITY ORDINANCES AND ST WS REGULATG BUILDING CONSTRUU
TION. VALUATION
/ // /Jry
SIGNATURE OF /
y' � .� PERMIT FEE S
PERMITTEE C : ((( 32.00
$ 13,690.00 PLAN CHECK S 16.00
AUTHORIZED AGENT Dike and Colegrove, Inc. TOTAL FEE $ 48.00 N°'.-'