HomeMy WebLinkAbout1068 SALINAS AVE - Building Permits ` F CITY OF COSTA MESA
4
411011
BUILDING DIVISION
.- •' , • DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
J•{ PERMIT
``oq oxingSt B05-00139
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 1068 SALINAS AV Status: ISSUED
Suite: Applied: 01/25/2005
Vicinity: Issued: 01/25/2005
Parcel Number: 41206138 Zoning: R1 R1
Applicant: JANOSIK,STEVE ISSUED BY: C40‘,.....__C>-............._
-
Address: 1621 E ST ANDREW PL
Phone: (714)259-5120
SANTA ANA,CA Zip: 92705
Owner: TESCH, WAYNE RONALD TR
Address 1068 SALINAS
Phone: 714-556-3016
COSTA MESA,CA Zip: 92626 `
Contractor: ALUMINUM ROOFING SPECIALISTS/DIAL ONE WINDOW REP
Address: 1621 EST ANDREW PL
Phone: (714)259-5120
SANTA ANA,CA
Zip: 92705 License: 523043
Arch : - Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
REPLACE TWO WINDOWS IN THE KITCHEN AND FAMILY ROOM AND 1 SL_IDING DOOR IN THE FAMILY ROOM AT THE SAME LOCATION
WITH NO CHANGE IN SIZE.
. FEE SUMMARY
Plan Check: $0.00 - - - - - - - - _ - Calc Valuation: • $4,000.00
Permit: $97.25 Claim Valuation: $4,000.00
SMIP Res: $0.50 . ,
SMIP Corn: $0.00 _ - - -
Other: $0.00 -
Inspection: $0.00 ,
Total: $97.75 ,
PLANNING &ZONING -
SETBACKS - - - -_
MAIN STRUCTURE Front 0-0 Rear 0-0 Left ' '0-01 - Right 0-0
ACCESSORY Front 0-0 - Rear 0-0 Left 0-0 - , . Right ` 0-0
PARKING Existing: 0Required: 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 end final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5625
2446-46(800)
DECLARATIONS n fl
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.
and will maintain workers compensation insurance,as required by section 3700 of the Labor _ ormance of the work for which this permit Is Issued.
ars'compensation Insurance carrier and policy number are: �/
S�-r11"TF f'- PolicyNmbar: S 1Q- 0 Cr
•• action need not be completed if the permit is valued at one hundred dollars($100)or less.)
O I certify that in the p rt�ormance 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'
c• - - • :ws of California,and agree that if I sh uld become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
coif• ' the-= —
ry ions. L
•Icant Signator•• P `
Yl•1-T YLS� ""0.J
WARNING: ••E TO SECURE WORKE-r' PENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN - LOYbR�J—CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
• =• + Om I ARE(Marcia IN ADDITI•l, O THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
disoI•m•:•"_ m licensed under provisions of Chapter 9(commencing with Section 7000)of Divi on 3 of the Business and Professions Code,and my license Is in full
_, 241WL3=2:4
• sSign. •re:Date: I-1C--of
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 fore permit
subjects the applicant to a civil penalty of not more than five hundred dollars(5500).):
❑ 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,end 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. ❑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:
❑ 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 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 ❑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? ❑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 permit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? IJ Yes IJ 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 pen of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No
(If yes",the facility must meet the requirement of Sections 25534 and 42303 of the 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.
..••.t avr al Owner(a,)) D
nd/Or ut •riz d Applicant Date
;ODES IISPECTIONTYPE DATE INTRIA65 CODES INSPECTION TYP5 DATE INTITIAL4
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 , ,.�1
204 Final Demolition 250 Final Building/Occupancy bl—�iQC- �/�' ""A
CITY OF COSTA MESA
DIVISION PE IT NUMBER
r,�� , BUILDING
DEVELOPMENT SERVICES DEPARTMENT
F I ____.. i PERMIT 05-02357
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.B.WLDING PERMIT
77 ,;.urdhitt VE,COSTA MESA,CA 92626
Status: ISSUED
^t r3;' 3's.
Job Address: 1068 SALINAS AV =, Applied: 12/22/2005
.yla"
Sutter` A r. . Issued: 12/22/2005
Vicinity: ,s•k '7g?.
Type of Cons rrr�uct• V-N
Primary Number:Oct, R , 3oging'. R1
Parcel 41206138
Applicant: STEVE JANOSIK
Address: 1621 E ST ANDREW PL
Phone: 714459-5120 ISSUED BY: get
SANTA ANA,CA
Zip: 92705
owner: TESCH,WAYNE RONALDTR ' ' x' c
Address 1068 SALINAS - n
Phone ` ar
CF „a V Zip: ;92626
COSTA MESA • a
", aA
contractor. ALUMINUM ROOFING_SPECIALISTS-DIAL ONE WINDOW REP .r
Address' 1821E ST ANDREW PL„, a 5120
Phone: 714-259-5120 � ., •,,..?
.•
SANTA ANA,CALicense: 523043 .-/ •a'
,Zip_ 92705e:-a
••1",e5.•
Eng:
Arch . Address:
'�
Address -->":p• Phone: •.iic0' - Phone: ,
•' T > ` L•icense .
. a.
E " License: ' x , 0, k
Z ' r '
a .- SCOPE IT a .
rti
REPLACE 5 WINDOWS THROUGHOUT S.F.D.WITH VINYL,DUAL GLAZE TO MEET 1997 U B C aREQUIREs NT HEDR WILL REMAIN THE
SAME =�. 'Sex, `
.r - ,. '', FEE SUMMARYEE'EE , ..'
` $3 500:00
P 'EE r' Catc Valuation
Plan Check: $0 00 - x :, _. . ._- ay <, --4,s-Claim Valuation i' ,a $3 500 00
,, Permit " $97 25 �n :0 `
SMIPrRes r ,x,$050
SMIP',Com i$ ra . ..
- 000
Other 1x$000 _, ;,�� ��•
$0 a. .
Inspection � 00 � �tw.
if
e �i 3'Y' vt
Total $97a76' ! t
,a.
; f
PLANNING'&ZONING ,
3. y4. Y 4. T ^ :a,
SETBACKS Right 0 0
MAIN STRUCTURE Front 0 0 * > Rear 00 Left 0 0 cs{,
k �
t°"'^ ` R qrx Left 0 0» "1Right
ACCESSORY --Front1"0 D s Rear 0 0, - n _ t ' ,,,,,,c-P",95::;.
`x 't4 �,�0 - O Pro used �a
PARKING xi hn 0 Re uv ; h ,x 4 -,r,'t-
) ` x1 ,%?tri i' ..
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. licable codes, and all
INSPECTIONS: In order for the worn authorized under this permit to be considered legal, such work must comply with all app
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)7545626
2446-46(600)
DECLARATIONS ( ) l
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 hav`e`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.
t My.workers'compensatioY-n Insurance carrier and policy number are: �I
Center: -3'T RIF ro�� PolicyNumberrtAt 6 7.9-2 oar
-(nits section need not be completed it the permit is valued at one hundred dollars($100)or less.) ��^--"""---- --'1= -
❑ 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 p ons.
Applicant,Signatt ie: - at (Date:--- , --La
`WARNING:•FAILURE TO SE URE WORKE • PENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER.TO CRIMINAL PENALTIES AND OMRNES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADD 0 THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
(.hereby affiihi that'l am licensed-ii Prov qD�of Chapter 9(commencing with Section 7000)of Division.3 of.the.Business d Professions Code,and my license is In full
}}��
force arWeffecl'LIc.M •. `T J r LCtass a
Contractoi4' ignature:- - • en, • e _ _ -___, (—Date:—"
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($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.). •
Cl 1,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.).
❑ l 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 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 Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Flre 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? ❑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 aper mit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? lYes 0 No
(Section 65850.2 of the Califomia 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 Califomia 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.
Si nature Of Legal Owner(s) \\ ` D to _
P 04 QC /�C o2-0� A S ,
AnalOrplicant--r _ - _ 1 ate -
POE 1 INSPECTION TYPE - - --` _ PAI - INTRIALS gooc I INSPECTION TYPE Pam INTmALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site ___/
204 Final Demolition 250 Final Building/Occupancy Z ZZ. h O? J
ADDRESS OF SWUM 1068 SALINAS AV wit CITY OF COSTA MESA - BUILDING PERMIT
ImmnNAMElmcm: TESCH, WAYNE RONALD TR FLOOD: AH-38 PERM NO: B 08465)
CCjEss: 1068 SALINAS
1, • COSTA MESA,CA 92626 PERMIT NO: B 084651 PLAN CHECK NO: N GOVT: N SUPP : N
APDL.MARINO ADDRESS: 1 i CONSTRUCTION TYPE: V-N PERMIT TYPE: STR PURPOSE: OTH
ARCHITECT OR ENGINEER: . UC NO.: JOB DESCRIPTION : T/O ROOF RESHEATH INSTALL COMP SHINGLES SQ FT: 4 , 280
ARCA OR DPW ADDRESS: MMT:
CLAIMVALUE: 4 , 280 . 00 CALL-VALUE: 4, 280 : 00 GROUP OCC: R-3 /0-1
CDNDIACTpfSNAME LEMBECK CONSTRUCTION ( 714 ) 754-2/484
CaITRAcrolrs WRUNG 3004 DEODAR AV COMMENTS: SMOKE DETECTORS REQUIRED '
ADDRESS: COSTA MESA CA ucxC.: 400791 iiiirc%EieiEiciEictieifieieiEiciEieiEitifftii•iEiEdrich•ieieie3E****iki%iEiiiFiEiEiEie<iEiEif****itiEiEiexiercir* *i***iE *#ii**su** rf
92626 DMT D Z ONING R EQUIR EMENTS
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 SETBACKS
(commencing with Section 7000)of Division 3 d the Business end Professions Code and my license is in full force end effect
CITY LIC.NO.: 062595 uc.CLASS: B uc.NO.: 0791 `�yP • 1 /97 MAIN BUILDING ------ ACCESSORY BUILDING
Ct—ID '�—) contractor: q�VJ FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
• ]/�/d LEFT: FT IN RGHT: FT IN LEFT: ' FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under penalty of perjury that exempt from the Cont ors License Lew for the
fdlowip reason(Section 7031.5 Business and Professions Code:Any city or ecu which requires a permit to consthte6 eller.improve. PARKING REQ: P RO V: PARCEL : 41206138 Z N E: REF NO:
demolish.or repair any structure,prior to its issuance,also requires the applicant for such;earth to file a signed statement that he or she Q
licensed pursuant to the provisions d fire Contractors License Law(Chapter 9(commencing with Section 7000)d Division 3 d the PLANNING NOTES> %
erg .0iness and Professions Code]or that he or she is exempt therefrom and the basis for the alleged exemption.My violation of Section > "
21.5 byanYappicant for apermit subjects the applicant to a chit penalty of nor more than fire hundred dollars(S500]). icy.{E******irfcjciFificicicicjEicleiiiiicir****sricxicicie 'te'icii'*ii'iEsrjEiciEieic**ix:****iriciciciiiiicit,c<iciC rie:4ii icicicicr
L] •I,as owner of thegopeny or myemployees with wages es their sole compensation.will dothe work.end Me structure is not intended
or offered for sale(Section 7044,Business and Professions Code:The Contracture License Law does notappty to an owner of moody DEVELOPMENT SERVICES REQUIREMENX S
who builds or improves thereon,and who does such work himself or herself or through he or her own employees,provided that such '
improvements ere not intended or offered for sale.If,however,the Milling or improvement is sold within one year of completion, he ZONING APPROVED BY DATE: `=/
a
wnerbuilder will have the burden of proving he or she did not build or improve for the purpose d sae).
❑ I,as owner of the property.am exdus rely contracting with licensed contractors to cmdrud the project(Section 7044.Business end /
Professions Code:The Contractors License Law does not apply a an owner d property who builds or improves thereon and who BUILDING APPROVED BY DATE: ...‹../
contracts for such projects with a contractor(s)licensed pursuant to the Contractors License law). / 9
❑ lamexempt under nee ion: B.AP.C.,for tisreason: APPLICATION ISSUED BY: tii1, JI:% DATE: apt /�( 7
*********ir************R****tmn**sr***,w*at'm* 'sr*** st *+ter xx ************sr r- x****ii
Dale: Owner:
I do hereby certify thatam aware I aaware of and understand the requirements of California Health and Safety Code Sectionsand
25505.25533, LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT;`i'
25534,and that I or any future building occupant will/will not(circle one)need to comply wlh said slate codes and the requirements for-
apermit for construction ormodification from the A'v e�itky enegementDistric.Residentialconsructionappicatiormareexemptfromthese BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
provisions' PERMIT 99 . 75 . 50
Date: Applicant: SMIP/NON-RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penally of perjury one of the following dederelnne: PLAN
ElI have andvdl maintana certificate «d consent to sea-insure for workers' provided for by Section 3700 of the Labor IUILE NGE
Code.for the performanceofthewokforwhchthispeasheissued. BUILDING DIL% > PERMIT ISSUE PLAN CHECK TOTAL PAID DUE
Q I have and will maintain workers'oompensation insurance,as required by Sectd th
Section 3700 e Labor Code,for the pedormanee d the TOTALS 10 0 . 2 5 •0 . 0 0 0 . 0 0 10 0 . 2 5 10 0 . 2 5 00
work for which this permit is issued.My workers'compensation insurance canter and policy number are:
Carder: GOLDEN EAGLE EXPIRES REVENUE DIVISION TOTALS--> COLLECTED : 100 . 25 OVER/SHORT: . 00
Policy Number: Kiwi— 37494h—Q7 10/01 /98 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SNIP/TOT GRADING PLAN-CHECK
iris section need not be completed I the peon*is for one hundred dollars MOO]or len.) 99 . 75 . 50
4 I eerily that in the performance d the work for which this permit is issued,I dull not employ any person in any manner eo as to
V become subject to the workers'compensation lawn of California. ree that II I should become subject to the workers' ***r.*******************************************************i!**************it.****
a
ebn provisions of section 3700 of
the Labor Code.I ehpll I n comply with th 'roriaie�a 9�//�y N D I V I D U A L F E E BREAKDOWN
Date -40 51 Applicant : e�
` yo/aa
ming:Failure to secure workers'compensation coverage la unlawful, shall subject an employer to criminal pentai n and TYPE QTY D ESCRIPTIO N • UNIT COST TOTAL COST
CIO Nus up to one hundred thousand dollars(Sf00,000),In addition to the coot of compensation,damages as prorated for In
gectlon 3706 of Me Labor Cads,in wnS and attorney's lees SFR 4280 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 4 , 280 .00
CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of perjury that there ea mratmctin lending agency for the END OF FEES
performance of the work for which the peril is issued(Section 3097,Civ.C).
LENDER'S NAME:
LENDER'S ADDRESS: '
I certify that I have read this application and slate that the above information is coned.I agree to comply with al city and county ordinances
and state laws relating to building construction and hereby authorize representatives of the city to enter upon the above-mentioned popery
for inspection purposes.
tea, JIM BIZZELL 09-10-1997/81:58 Pfl/ '
r, IPy(itName ere ' —n..� kCPiB:[�1 f16`-25
\,1�( /1 I ) � PERMIT:08 4012187
Signature d / nUAppirantfConlracor 465A
(5151-46.WId) White-Building 8 Safety:Gree-File:Canary-Appicant:Pink-Revenue:Goldenrod-Assessor
y
•
CONSTRUCTION AND PLANNING- POOL
AP?ROVALS Permit# • Date Inspector. - APPROVALS Permit# Date Inspector
1. Temporary Electrical Service orPole . 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, 0 Undrgrnd.,Test
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 v . : 62. Backwash & Receptor-Final
12. Sewer Cap - - 63. Heater & Vent-Final
13. Roof Drains - .. - •64. Plumbing Systeni •- Final
14. Rough Plumbing - , - 65. Electrical-Final .
15. Rough Electrical-Conduit . - '66: Solar System-Finallift
16. Rough Electric Wiring - i `67. Fencing.& Access Approval ' - • ,
17. Rough Wiring Sign - _68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling - 69. POOL/SPA SYSTEMSFINAL •
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 PREY. 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
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. Backf tow Preventer '
-43. Backflow Irrigation •
44. Landscape Irrigation System .- . .
45. Sound Attenuation • "
46. Handicap Regulations
47. FINAL STRUCTURE& BUILDING 7 6+7 /' 1 .
48. FINAL PLANNING I.
�JJ
49. Electric Release to Edison • '
50. Gas Release to Southern California Gas Co • '
•
51'. CERTIFICATE OF OCCUPANCY .
No. Date - .
OWNER RELTZER ENTERPRISES-COSTA MESA DATE 9-26-69
JOB ADDRESS 1068 Salinas Avenue BUILDING PERMIT NO. 30892
GENERAL CONTRACTOR Same DESCRIPTION of WORK Residence W/Attached Garage
AP No. - • LOT 31 TRACT 6638 FIRE ZONE . VALUE $29,563.00 _
INSPECTIONS Si.nature Date GROUP I & J TYPE V ZONE R-1 _
SOIL Si ' SUBCONTRACTOR PERMITS ISSUED
GAS Date Number Signature
WATER N qMS Y-iY-zc/ Plu binq a /
ROUGH PLUMBING y.^J��'�/y C (01-7C7 _ .3 rr- &Z/R4c-
PROP. SWR. LINE IZ HOUSE CON. "Z/ /� JO `�A / 4-8, 2 s- --aypx —
SPRINKLING SYSTEM ��ZZ�� ✓ % /
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING / .4fi7 ( -4-'20
TEMPORARY SERVICE OR POLE
UNDERGROUND n POWER ❑
ROUGH WIRING�l ifi/e 4'2;-7b /. Heating and Vent
TRENCHES u-I FORMS 81 STEEL REINF. ® 1 4-7-70 /.yt7g //�f1 yy)__ /j‘1J `7d9oe.n '�
FLOOR SYSTEM + 7 9-16-71 a/a a [Lr( . Le 4Vs-! 7Gf/.9 '��
BOND BEAM n STEEL REINFORCE n
SHEATHING �. q 66/. .0
,
FRAME AND FLASHING i'�
F�T (o sfI .c
LATHING - IN OUT 4r'I 1, {r ��'itto
PLASTER, BROWN COAT ,., ti47 fro
STRUCTURAL, FINAL r, trir / �J
HEATING, VENT., REFRIG. AND A.C., FINAL fie Jt , pl/\71 �((Y/D rY/2(p/ _
PLUMBING, FINAL AND GAS TEST Imi/ /y
ELECTRIC, FINAL *14 to -7_2n
BUILDING, FINAL I- yr'17/
•
I`t; NOV12-69`°`°00 429* ***152.25
30892 CRSA
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
RECE �'�`' D�AJE f}IV $$�� DATE ISSUED
BUILDING 1068 Salinas Ave. YA % JI�/ ,
ADDRESS 11 SEP 2 6 1969
Heltzer r
Enter ises-Costa Mesa PERMITWOn^
OWNER P A.P. NO. .'I�10.9,
MAIL BUILDING
Z
ADDRESS 740 No. La Brea ADDRESS /O��' O
L 23
a U CCITY L.A. Calif. NO.937-2171 TRACT 6638 LOT 37 BLOCK
H
Z QN
Bank EW IADD ALTER I REPAIR-I MOVING DFMOI ISH
CONSTRUCTIONEUnited California ,V/
H LENDER
am Main Office
J D BRANCH
J to OWNER e"
--i
LU ADDRESS 6th and Spring VALUE +,y
ARCHITECT TEL USEj� q/�
J Q OR ENGINEER Frank Gonzales N0.532-6878
Ell
E
Z Q
ply
1336 Chapman, eswIr ADDRESS ZONE TYPE / GROUP
a I+
w z George J. Heltzer & Assocs. APPROVED
J (]
CONTRACTOR g BY DATE
CC Z
J cr ADDRESS Same as Above
W ulTEL. ZONE NO.OF USE OF NEW Single Pani.
ZH CITY NO. R1 PLANS 2 BUILDINGRes. w/att.Gar.
STATE CITY YARDS APPROVED YARDS APPROVED
N K LIC. NO, 201098 LIC. Na170/7 MAIN BUILDING ACCESSORY BUILDING
D 0 i (FROM C/L TREET)
SIZE NO.OF BLDGS.
OF LOT NOW ON LOT FRONT 5 )-FT. FT.
USE OF [-.------
EXISTING BLDG. R.SIDE FT. FT.
I- SIZE OF NO.OF
II
Z NEW BLDG. ROOMS STORIES L.SIDE FT. FT.
VEXTERIOR WALL ROOF 6 q
_ COVERING I COVERING REAR R.> FT. FT.
J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
a
Q. DGMAIN BLS. ACCESS. BLDGS.
Q Residence with attached garage VAR.# DATE
0
C.U.P.# APPROVED
U) Plan NO. -4-0lr 903 —BY
WW1.1) nnTE ' (J//
'� / 62
a (��/� I
o
U I hereby acknowledge that I have read this application and state
7 that the above information is correct and agree to comply with
CC all laws regulating building construction, and I shall not employ /' 9'd 5/;
any person in violation of the workman's compensation laws of v
Nthe State of California. J/�1 to
zI hereby certify that I am properlY licensed as a contractor under SO. FT. T o
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, and that such licenses are in full force and effect,or I' THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the provisions of the State of California Businesscc
and Professions Code, Division 3,Chapter 9. VALUATIONe,-0
PERMIT FEE $
Signature of — O�/r 6
Permittee $��J /�/
PLAN CHECK $ rSJ .h 7,,r—< E
Authorized Agent ta/Y�/,3(p ` "'3r`- o /sp, ZJ LL
` J TOTAL FEE $
• COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
• APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely RECEIVED BY DATE RECEIVED
DATE ISSUED
BUILDING // �NrtJ1
ADDRESS /G fJ ) Sty ,l . C( 0
PERMIT NO.
OWNER A.P. NO.
MAIL BUILDING
_ADDRESS ADDRESS qq�
0-U CITY NOL TRACT (14� 3 nI LOT 3 9 BLOCK.
ZZ< CONSTRUCTION NEW ADD ALTER I REPAIR (MOVING DEMO!ISH
O cn LENDER 't
am
J D BRANCH
J N OWNER
m J ADDRESS VALUE • "
•Xi ARCHITECT TEL. USE $
J Q OR ENGINEER NO.
O Q • FIRE
w 2 ADDRESS ZONE TYPE GROUP
0_ I-9
LU Z APPROVED
J O CONTRACTOR BY DATE
CO
J m ADDRESS
w w TEL. ZONE NO.OF USE OF NEW
o= CITY NO. PLANS BUILDING
ZF
w-0 STATE CITY YARDS APPROVED YARDS APPROVED
(/s X LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING
7 O (FROM C/LISTREET)
SIZE I NO.OF SLOGS. /C(/. �)
OF LOT NOW ON LOT FRONT " FT. FT.
USE OF
EXISTING BLDG. R SIDF /S FT. FT.
I— SIZE OF NO.OF Lam_
Z NEW BLDG. ROOMS STORIES L.SIDE 1 FT. FT.
EXTERIOR WALL ROOF �'1 ,�
_V COVERING COVERING REAR d"U FT. 6, FT.
J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN 8.
D_
a MAIN BLDGS. ACCESS.BLDGS.
Q VAR.# DATE
O C.U.P.#/ � APPROVED z /7
N v �3 APPROVED Ct-ti' � V/ 9/! 6
Z
0
C-)
I hereby acknowledge that I have read this application and state
D that the above information is correct and agree to comply with
CC all laws regulating building construction, and I shall not employ
F any person in violation of the workman's compensation laws of
N the State of California. b
zI hereby certify that I am properly licensed as a contractor under SQ. FT. o
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: 0
am exempt from the provisions of the State of California Business 2
and Professions Code, Division 3,Chapter 9. VALUATION re
N
PERMIT FEE $ D
Signature of m
Permittee $ PLAN CHECK $ E
o
Authorized Agent u.
TOTAL FEE $