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HomeMy WebLinkAbout1509 Tustin Ave - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa. Job Address: 1509 TUSTIN AV Suite: Vicinity: GARAGE Primary Occ: R3 Type of Construction: V -N Parcel Number: 42531110 Zoning: Applicant: OVERTON, MELINDA LEE Address: 1507 TUSTIN AVE COSTA MESA, CA Owner: OVERTON, MELINDA LEE Address 1507 TUSTIN AVE COSTA MESA, CA Contractor: OWNER -BUILDER Address: Zip: Phone: 949-548-9919 Zip: 92627 Phone: 949-548-9919 Zip: 92627 Phone: License: 000000 77 FAN UHIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: 02/27/2007 Issued: 02/27/2007 ISS BY: Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT PERMIT TO DEMOLISH ILLEGAL INTERIOR IMPROVEMENTS CONSTRUCTED IN ORDER TO REVERT BACK TO ORIGINAL FORM OF A 2 -CAR GA A 1 CAR GARAGE. WORK TO INCLUDE THE DEMOLITION OF OF INTERIOR WALLS, STORAGE AREA, BATHROOM AND BRING GARAGE DOOR GARAGE BACK TO ORIGINAL OPERABLE FORM. REF#: C06-0069 Total: $33,15 SETBACKS MAIN STRUCTURE Front 0-0 ACCESSORY Front 0-0 PARKING Existing: 0 PLANNING & ZONING Rear 0-0 Left 0-0 Rear 0-0 Left 0-0 Required: 0 ProQosed: 0 Right 0-0 Right 0-0 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 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 2446-46 (6/001 FEE SUMMARY Plan Check: $0.00 Calc Valuation: $800.00 ' Permit: $32.65 Claim Valuation: $800.00 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $33,15 SETBACKS MAIN STRUCTURE Front 0-0 ACCESSORY Front 0-0 PARKING Existing: 0 PLANNING & ZONING Rear 0-0 Left 0-0 Rear 0-0 Left 0-0 Required: 0 ProQosed: 0 Right 0-0 Right 0-0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92.28, § 1, 12.21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or it work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 2446-46 (6/001 DECLARATIONS WORKERS' COMPEN$ATION DECLARATION: r I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate o1 consent to seli-Insure for rrkers' compensation, as provided for by section 3700 of the Labor Coda, for the performance of the work for which this permit is issued. , ❑ t 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 #0 compfated if the permit is valued at one hundred dollars ($100) or less.) ❑ I certity 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' ----compensationlaws of Cali omia, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith p1y-with�th se provisi s. iApplicant Signature:— - Date:—,�_ WARNING' FAILURE TO S9 URE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE ($1 ,0001. 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 affect. 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: ___ _ ____ Y 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 lite a signed statement that he or she is licensed pursuant to tha provisions of the CDnlTBC10I5 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 safe (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 safe. 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.). ❑ 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 t0 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 exmpt under c. Business and Professions Code for this reason: Sirgnature: OwnerlD v hre lI ed y driver's license. Yes [:1No Driver's License No. Expires v _ O Si Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 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 Salety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to fila and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be tiled 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 tre 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 Coda 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 ❑ No .................................................................__..----------........................................................................----------...................................-.-.....--......--....................................................................... ................. I............... ..... 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication 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? Lj Yes 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? ❑ Yes ❑ No (If 'yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). It ...........................................................................................................................................................................................................................................--- --.........................................................................................----................................. 7 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? ❑ Yes ❑ No ........................................................................ -------........................................................................................ ........ ................................................................................ - ----- -.......................... 8 pf 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 ompl 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 ape for i tion pu res. I agree not to occupy or allow occupancy of any building authorized y this permit until final inspection, ,2 "L -7 Signature Of- Legal Owner(s) .r L --Date- - -- And1Or Authorized Applicant Date CDDEj. INSPECTION TYPE DATE INTILAL5 CODE! INSPECTION TYPE DATE INTITALS 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 DemoiNort 250 Final Building/Occupancy _ 7 t'wi1 3- C Oil- 9 ��- Q�, obav�f 1 50g & TiAs�V-L- Z-7-xts4,i" aS.AnV4-1 t�' 1 Cro r Ah i +` " ,ro % mA a) 150 1 •�ll • 11 i 'i� _ 1 e- n y r v IN APPROVED CITY OF COSTA MESA PLANNING DIVISION SUBJECT TO BLDG, DEPT. REG. r� NOTE: ADDITIONS, DELETIONS, OR CaRRECTIONS SHALL BE R _ APPROVED BY THE PLANNING DIV.` [�thtAt N J BY:� D:';I'E:2127 07 � u ,rrrv¢r }- gano�¢ boo }o : 2-cwL 1 -for LK»3 (4a .6. dexholUl- ) -Dw S-j-e,e— 150 1 •�ll • 11 i 'i� _ 1 e- n y r v IN CITY OF COSTA MESA _ BUILDING DIVISION F DEVELOPMENT SERVICES DEPARTMENT �•� PERMIT (714)754-5273 • Fax(714)754-4856 PLUMBING PERMIT Job Address: 1509 TUSTIN AV Suite No Vicinity: Parcel Nunmber: 42531110 Applicant: WALKER, MELINDA LEE Address: 1507 TUSTIN AVE Phone: 949-548-9919 COSTA MESA, CA Zip: 92627 Owner: WALKER, MELINDA LEE Address 1507 TUSTIN AVE Phone: COSTA MESA, CA Zip: 92627 Contractor: Address: •- Phone: Zip: License: Arch / Eng : Address: Phone: Zip: License: PERMIT NUMBER Poo -00037 77 FAIR DRIVE, COSTA MESA, CA 92626 ISSUED BY: Status: ISSUED Applied: 01/2012000 Issued: 01/20/2000 SCOPE OF PERMIT REAPIR GAS METER, GAS METER CONNECTION IS FROM 1507 TUSTIN AVE. BOTH METERS FOR BOTH ADDRESSES IS ON 1507 TUSTIN_ QTY FEE SUMMARY AMT ISSUE FEE $23.50 Backflow irrigation $0.00 Backflow Preventer $0.00 Bathtub $O.CO Clarifier System $0.00 Connect (Ice,Soda,etc) $0.00 Dental Units $0.00 Dishwasher $0.00 Drain, Floor $0.00 Drain, Rainwater $0.00 Drain, Roof $0.00 Drinking Fountain $0.00 Expansion Tank $0.00 Gas Earthquake Valve S0.00 Gas (1-4 outlets) 50.00 Gas (Over 4 outlets) SO.00 Gas Repipe S9.80 Gas Service SO.00 Interceptors (Grease, Oil) $0.00 Interceptors (Sand Auto ) $0.00 QTY FEE SUMMARY AMT Laundry Tub 1 Washer $0.00 Landscape Irrigation $0.00 P -Trap $0.00 Pressure Regulator $0.00 Process Piping (per 10 ft) $0.00 Receptors $0.00 Septic Tank $0.00 Sewer Cap for Demo $0.00 Sewer Connect $0.00 Sewer Private Line $0.00 Shower $0.00 Sink, bar $0.00 Sink, commercial $0.00 Sink, Floor $0.00 Sink, kitchen $0.00 Sink, servicelmop WOO Spa (private) $0.00 Spa (public) $0.00 QTY AMT QTY 0 Sump Pump $0.00 0 0 Swimming Pool $0.00 0 0 Trap Primer $0.00 0 0 Urinal $0.00 0 0 Vacuum Brkr Bkflow(1-4) $0.00 0 0 Vacuum Brkr Bkflow(5+) $0.00 0 0 Wash Basin $0.00 0 0 Wash Basin Set $0.00 0 0 Waste and Vent System $0.00 0 0 Water Closet (Toilet) $0.00 0 0 Water Heater 1 vent $0.00 0 0 Water Piping (Inst or Rep.) $0.00 0 0 Water Re -pipe $0.00 0 0 Water Service $0.00 0 0 Water Softener $0.00 0 0 OTHER $0.00 0 VIOLATION $0.00 0 PLAN CHECK $0.00 REINSPECTION $0.00 0 COMMENTS 1 SPECIAL CONDITIONS TOTAL CALCULATED FEES: $33.30 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-26, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 18O 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 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 it the permit is valued at one hundred dollars (S 100) or less.) ❑ I certify that in the performance of the work for which this permit is issued, I shell not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that it 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 DOLLARS ($300,000). IN ADDITION TO THE ODST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706OF 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. Lia. it Class N Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance a1 the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lander'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) o1 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 sate (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 amployeas, provided that such improvements are not intonda or offered for safe. 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.). 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.). ❑ I am exempt and sec. Business and Professions Code for this reason: Rte: — r ID verifi by driver's license. bytes ❑ No Dnv 'ten No. Ex it :( ^ Go=� Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 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 Safoty 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? ❑ 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 cubist 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 reglstratlon 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 ❑ No 5 Does or will the applicant or present or future building occupant require far the work which Is the subject of this a pliccation 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? IU Yos No (Section 65850.2 of the California Government Cade 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? ❑ Yes ❑ 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? ❑ Yes ❑ No 8 (If 'fres-, 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 o i nces relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described p party for fn ectian pu ses f agr t to occupy or allow occupancy of any building authorized by this permit until final inspection. Signal wner(s) AnVFFAulhorized Applicant Date CODE INSPECTION TYPE SIE IMMAL CODE + INSPECTION TYPE J INTITIAL� 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 f=inal 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 2446.46 M Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PE Project Addre- Applicant's U - Owner's Name Address ! rr - Arch/Eng. License No. Addr C cct Address emailingi City License N . LICENSED CONTRACTOR DECLARATION 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000 of ivlslon 3 of the Business and ro ssions ode, and my licenseor p1Yt1 affect. LI en ass (�J Da Signet WOR KEl35' COMPENSATION CLAFtATION ' hereby affirm that I have a certificate of consent to self -insure or a certifl of Workers' C ensation lnsuranc ir a ad copy thereof (Sec n 3800 /^ Polo, mpa JiCertified co y is hereby fern sh Celt ed c 1 d with Ity Build; vi IJ EXEMPTION FROM WORKE S' COMPENSATION DECLAR N (This section need not be completed if the permit is for one hun d ($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 tke Workers' Compensation Laws of California. Date Signature NOTICE. If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Comply with Such provisions or this permit shall be deemed revoked. 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 (Section 3097 Civ. C.) Lender's Name Lender's Address , OWNER BUILDER bECLARATION I hereby affirm that 1 am exempt from the Conlrattor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve,demolish or repa;r any structure, prior to its Issuance, also requires the appticant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 ,herefrom 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 .pdmalty of not more than flue hundred dollars ($500). I, as owner of the property or my employees with wages as their sole compensation wilt do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code; The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or;m- prove for the purpose of sale). .I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con- tractors) license pursuant to the Contractor's License Law). ❑ 1 am exempt under Section S. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above informs n I% correct. I agree to cg ply with alt city �1d county ordinances and st laws reiatjp build; onstrucNan, and rreby authorize repro- sentativ of this ill upon the above- nt�bned brnoertu for PE9MI,T T1 ! TRACT NO, LOT N0. BLD / a TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK 91;211 A.P. # Zone S Main Building: Accessary Building: Z TYPE OF PERMIT GRADING FOUNDATIO�Ni STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ ,OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ ZONE ADING CU.YOS. ACRES T Front N A Rear, I C Right K S Left R R E Ptng. Ref, # Park. Fees $ Q Remarks: Parking Req./Provided I Use of Building: R E 14I E PLUMBING FEES Planning Notes: Bar Sink Showers N T g Backflow Preventer Service Sink Backflow Irrigation Sewer Cap ELECTRICAL FEES Bathtubs Sewer Connection Automatic Washer Construction Pale Sub. Transformer ❑ 15.50 KW ❑ 50+KW Clarifiers Solar Collectors Dishwasher Solar Piping Conking Unit Meter ❑up'to 100amps Drinking Fountains Solar Tank Dishwasher Meter Dover 100 amps Floor Drains Swimming Pool w/Spa , Dryers ❑Gas ❑Electric Sub Panel Floor Sinks Urinal Fan Motors ❑0-1 HP ©1 4 - 8 Gas Service Outlets Watq, F.A.U. Inc. Solar El 9-15 HP 016.15+ interceptors Water H Fixtures i Device Boxes Microwave Pole Light Kitchen Sink Wate Ice Lavatories __- 'Outletsoi Range 9 P -•Trap Switches' Sign Roof Drains Garbage''Disp&sal Standing Sections Generator 110.5 KW El 5-15 KW Trash Compactor Rainspection Fee `&25 Issue Fee $ 3 / . Reinspection Fee $25 Issue Fee $ 3 MECHANICAL FEES Boiler Hood or Type t © Canopy Type 11 ❑ PUBLIC SERVICES REQUIREMENTS: zoning Approved By Application Approved By Application Issued B_y-_ r I flate Date .1 - _ _ Date �3 Duct -Under Ground Duct - Structural Refrigeration System 00.100,000 BTU ❑100,000 BTU Duct - Ventilating ',^ BUILDING PERMIT PLAN- CHECK .= PLUMBING PLAN CHECK--, ELECTRICAL t PLAN CHECK MECI-fANICAL PLAW CHECK SUMMARY $ $ $ $ $ $ $� $ OF FEES SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ Exhaust System ❑ Multiple ❑ System Repair/Alteration FirepUFact. Blt. ICBO # eating System & Ducting ;A0.1 00,000 BTU [3100,000 B Reinspection Fee 525 Issue Fee $ 3 CMF -0865-46 rev. 7/93 White - B`uild6g; Canary - Applicant; pink - Accounting; Goldenrod - Assessor ,% C/ U CONSTRUCTION AND PLANNING � APPROVALS - Permit # Date f Inspector p, Ins POO k- & SPA APPROVALS Permit # Date r Inspector 1. Temporary Electrical Service or Pole 1 52. Pool & Equipment Location �2- If Soil Pipe= Undrgrnd j 53. Steel Reinforcement 3,• Electrical Conduit�EStilsty, llndrgrncl. 54. Forms r 4 Electrical,Conduit-Undrgrnd. .r 55• Electrical Bonding 5., Steel Reiqfiorcement, 56. Rough Plumbing & Pressure Test 6., Ele0rical•UFE.R Grnd. ' 57. APPROVAL TO COVER-GUNITE 7:';Footings 58. Electrical Conduit-Undrgrnd, ti 8'Foundation ; r 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd'. - 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 'r 61. APPROVAL TO DECK 11. Propel tyBewer Line & House Connection 62. Backwash & Receptor -Final f 12. ,Sewer Cap � 63. Heater &hent -Final 13. Roof, Drains 1, 64. Plumbing System • Final ' 14. Rough Plumbing A 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17, Rough Wring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20, Rough Factory Fireplace 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 ❑ Oil #25. Roof Sheathingr 74, Overhead Hydro 26. T -Bar Ceiling (StructuralY 8( Mono coat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 2$. Lathing &Siding 177. IFIXED SYSTEM FINAL 29. Insulation 78.1 FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Piaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final f $0. FOOD CERTIFICATE ISSUED i 33. Final Electric Notes: t 34. Final Heating & Air Conditioning 1 35. Final Gas Pipe-fest ei -C4 rr) UEP, 36. Hood or Canopy Q 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 COUNTY OF ORANGE r r BUILDING DEPT. �� Permit No. ----------------- ----- 630 No. Broadway Application for Buil/Ing perm Santa Ana, California Phone: KI 2-6211 AND FOR A Certificate of Use and Occupancy 1. OWNER'S MAILING Dates- ----------- -------------------aPNE: -- - --------------------- CITY - Name------------------------------------------------------------------------------------ Name---------------------------------------------------------------------------------- - (Architect or Engineer) (Contractor) --- Address--------------------------------- City----------------------------------------------------------------------------- City ----------------------------------- ------------------------------------------------ State State �r Lic. No------------------------------------/Phone----------------------------------- Lic. No.'T--7--------- -- Phone.------------------- PROPOSED USE:-�/t'__ 2. JOB LOCATION_ -� .�11�'--'�t----------------- --- - (1• -louse No.) (N e of Street) (Tow or School District) 3. LEGAL DESCRIPTION: Lot �1�----- _�.1._".e•___Tract --------------------------------------------- -- - -----(Metes and Bounds Description—Use reserse side of form) 4- CORNER LOT JHROUGH LOT( ) SLOPE OF LOT 5. SIZE OF BLDG.:/ � � AREA:__ � ---SIZE OF LOT:_ l J__ _G___ AREA: Q_jfl�_________________ 6. HEIGHT OF BLDG.: __j!_____________________________CEILING HEIGHT:. ---- �_---------- ----- -____ --NO. OF STORIES____-_✓_____________ - r 7. NO. FAMILIES ------- __._______________________________._Size of Smallest Bedroom: J% 3;_42 --- Size of Kitchen:// 8. EXTERIOR WALL CONSTRUCTION: r__(9-6° d_ -------------- INTERIOR WALL COVERING ------- (Frame, Stucco, Etc.) .0 (Plaster -Drywall, Etc.) 9. SETBACKS: Front Yard from Center Line of Street------------------------------------------------------------------ -------------- -------- ___________.___ Nearest Side Yard -�1---------------- Rear Yard ---- yiCo--------- Distance in Feet Between Bldgs. on Same Lot _/(/-4.._ .___ -------- 10. A COMPLETE PLOT PLAN IS REQUIRED, SHOWING ALL STRUCTURES AND USE OF EACH. 11. For (a) Footing: Width __-11___--------------------- Depth in Ground ______41___ --------- Width of Wal! ----- _lt_.____._____ Accessory Bldgs. and (b) ds: ___ X_______________Spacing__-_/_�l_---0_V______"CC Material of Floor .. ___BlI--_._______ Size of'Stu_0_;:V Similar Structures: (c) Size of floor Joists: --- ,r%-- ----.--.----------- 0.e Spacing --1--------------.--------------"CC (d) �a'�/ fc { '!� Size of Rafters: ___ __ ___ _ __.__ ________________Spacing r -- << ___ ��__ _ _ _____ CC -- - - ------------ I2. VALUATION OF PROPOSED WORK:Includingall labor, plumbing, electrical wiring, heating, fire sprinklers, paint- ing and sewage disposal __f/--`_CJ�___, 13. I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION IN THIS APPLICATION IS CORRECT AND THAT THE CONSTR ION WORK WILL CONFORM TO ALL LAWS OF THE COUNTY OF ORANGE AND THE STAT CALIFORNIA APPLICABLE THERETO. Signed:---. :-- ------ --- ---- - ----------------------------------------------------- Plans Filed: --------------- /% U S� -- (Own) v y -------------------------- -- ---------------------------------------------------------------------- (Authorized Agent) FOR DEPARTMENTAL USE ONLY FEES:av � CHECKING BY Bldg. Permit $- GROUP-- APPLICA �_ HEALTH. i----------- Plan Check TYPE -------------- --------- .-- -- FIRE Total �/ �' DIST.ZONIN MARSHAL ------ - -- - - PLANS AND Receipt No. MAP--------- -- ---- - ----- --------�- --- - SPEC'5------- ------ -- --- TATE --- -- ------------------------ SHEET Paid to NO._________ :57- ------ CORRE IO ENGINEER -- -------- Date ------------------------------%2e,- ------------------------------- CAL..- - ------------------- VERIFIE ------------- PERMIT EG'r/ DATE - `' KI 5 ---- - ----- ------ ---------- - ,� OWNER STANSBURY, BENJAMIN M. Cl DATE 5-20-59 JOB ADDRESS 1509 Tustin Ave., BUILDING PERMIT NO. 93 6_ GENERAL CONTRACTOR The Kunnel Corp. VALUE $105359.00 AP. N0.117-261-10 LOT TRACT FIRE ZONE _ DESCRIPTION OF WORKReS.W att.Garage INSPECTIONS _ DATE GROUP & J TYPE V ZONE R Underground Soil /{{W U.G. Water I& Underground Gas SUBCONTRACTOR PERMITS ISSUED DATE NUMBER Overhead Water and Gas Rough Wiring X1Jd 14 v .1. %-1 7, Trenches f d�,orms' 4j'J=Steel Floor System Rough Heating Ik/ Steel Reinforce Chimney Re -Rod Rough Plumbing C Frame and Flashing k6 Lathing, In out 1 Frop. bwr. L ne HOugUf on. at. bwr• v( Cl v r,U ] i� Sprinkling System Heating, Final Plumbing Fixtures Final Gas Test Construction Pole Underground Power Rough Wiring X1Jd 14 v .1. %-1 7, Trenches f d�,orms' 4j'J=Steel Floor System sl V Steel Reinforce Chimney Re -Rod 4 �$ende&li r654T— Sheathing Sheathing Frame and Flashing k6 Lathing, In out 1 i /� f 1 .-p" Plaster, brown coat A - a� � � • U' ' � Plumbing Fixtures, Final Electric Fixtures, Final -f Building Final OCCUPANCY Form 210-3M--4-59 !, 9336 COSTA MESA BUILDING DEPARTMENT P. O. BOX 317 COSTA MESA. CALIFORNIA FOR APPLICANT TO FILL IN ADDRESS ` Ytin Cn,--tq Mpbnp b MAY z4W% '/FINANCE DEPT. CITY OF COSTA MESA APPLICATION FOR PERMIT BUILDING COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY RECEIPT NO. PERMIT NO. OWNER DRESS R EI r:o BY �=E RECEIV� DATE IS5U E0 A Angles Crest Hwy, CC hr� ,:.iTY La Canada TN&S V-4253 ING BU I ADDRESS ARCHITECT LIC- OR ENG wEERTh a Ku n n e l NO.1221 COSTA MESA. CALIFORNIA ADDRESS 6 Nw t B vd Costa e a M ZONE CITY LIC. ZONE NO, OF NO, O TYPE G$QHP p Cor()O. I2p CONTRACTORThe Kunnppe L 1l AODRESS 56 Nw f B i V NO.L i g_22 BAYPROVE r fC_ DATE �� 1 LEGAL LOT e a t t ached---- -- - CORRECTIONS DESCRIPTION NO BLOCK f A. P, NO. SIZE I OF K OF LOT NOW ON LOTS sE OF CITY OF STA MESA XIST I NG BLDG.n a FALLLL���((�� ,» p SETBACK LINE FROM 1 .��.� y 1 „ +SUB`IECT TO~ G. �i`F'T. REG. CENTER OF" STREET �� REA A D SIDE YARD RIGHT 1 LEFT 81 DESCRIPTION OF WORK BY f A Pt•RN TrCki. NEW ALTERATION ADDITION ^^ bhyy I REPAIR MOVING DEMOLISH BU]LDING NQ. OF 517E ODMS STORIES EXTERIOR WALL Wo0cid ROOF _COVERING stliccn COVERING USE OF NEW BUILDING __ Single f am IIv residence-"— with attache ar e VAR. Iia. ——f;}1NnOVGi] �� The Amwmt shown under valua#ion is for the IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND TI STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL y' Its etml e, 7�� F CITY ORDINANCES AND STATE LAWS NEGULATING BUILDING CONSTRUC- C ►IrRFrYi LIAfT�I \ " AL TI yy TION. P RMITTEE SIGNATUREOF The Kunn Cor P I FEE r!!�%%, d'^ PLAN CHECK $ r AUTHORIZED AGENT 53 —� '� TOTAL FEE S "p F