HomeMy WebLinkAbout1063 SANTA ROSA AVE - Building Permits CITY OF COSTA MESA
r. ►. BUILDING DIVISION
>:� r..aIDEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
F t „ /s PERMIT
v+b, o`F B04-01900
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 1063 SANTA ROSA AV Status: ISSUED
Suite: Applied: 11/09/2004
Vicinity: ROOF Issued: 11/09/2004
Parcel Number 41205210 Zoning: _� //
Applicant SCOTT FAIR ISSUED BY: �✓
Address: 21840 MACKENZIE
Phone: 714-329-7313
YORBA LINDA,CA Zip: 92987
Owner OZDERE, JACK A TR
Address 3358 MARIGOLD CIR
Phone:
COSTAMESA,CA Zip: 92626
•
Contractor: WESTERN ROOFING SERVICES
Address: 21840 MACKENZIE
Phone: 714-329-7313
YORBA LINDA,CA
Zip: 92987 License: 680441
Arch : Eng:
Address: - Address:
Phone: Phone:
•
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF EXISTING ROOF.INSTALL FIBERGLASS BASE,DOUBLE MODIFIED ROOF,AND CHANGE OUT RIDGE. 15 SQUARES.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $3,900.00
Permit: $97.25 Claim Valuation: $3,900.00
SMIP Res: $0.50 - - - • _
SMIP Corn: $0.00
Other: $0.00 i -
Inspection: $0.00 • -
Total: $97.75 7:2; • • '
•
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: - "
•
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 `„ f
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 ,; `I•bave 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.
A4y workers'compensation In rance carrier and policy number are:
-Gamese: C 1, G f[fL CL lte.-� PoNumber: L /'i 7'7,�D 6 c
(Thies ction need not be completed if the permit is valued at one hundred dollars($100)or less.) licy
Sri 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 Califoml ,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.
nt Sica gneture: 7:47r-cit.( �/e � � 1. -^ -•
// - 9 - 0 U�
WARNMIG'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($1D0,000),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 affirm2,that I amsliceenss��nde provisions CI f Chapter 9(commencing with Section 7000)of Division 3 of the Business and Prof sions Code,and my license is in full
� force end effect.Lic p $ - -; Class R - -�Cr__�
yr !, Contracto ature s- �C+- 9CL�v n Date--- "7r - 7 - o IV
CONSTRUCTION LENDING AGENCY:
9 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). •
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 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,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? ❑Yes ❑No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the Califomia 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 Califomia 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 apermit for such construction or modification
from the South Coast Air Quality Management District or from any other elr pollution control district or agency? L3 Yes LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signature LZNf Legal Owner(s) Date
CG /7c.�/
(W And/OrAuthorizedApplicaht"'-1� .. �•Datet-f4- 5'4-c'C../
CODE I INSPECTIONTYPF PAIL INTITIALS CODED INSPECTION TYPE - DATE - INTITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical .
1266 Pool Spa Final 208 , Final Plumbing
200 Final Re-Roof //GC7 • EA / 210 Final Electrical -
201 • Final Block/Retaining Wall - tad212. 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 '
\I
DRESS:NAME: OZDER1063 ESANTA PROSA AV UNIT:3 CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 054451
, AGO
ADDRESS: OZDEREARAKSI PERMIT NO: B 054451 PLAN CHECK NO: N GOVT: N SUPP: N
3358 MARIGOLD CIR
COSTA MESA CA 92626 CONSTRUCTION TYPE: 5—N PERMIT TYPE: STR PURPOSE: ALT
(714 ) 979-6870
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : T/O EXIST/RE—SHEATH &RE—ROOF W/BU & COMP SQ FT; 4 , 500
ADDRESS: UNIT:
CLAIM VALUE: 4, 500. 00 CALC—VALUE: 4, 500 . 00 GROUP OCC; R-3 /M-1
PERMITTEE: CHAMPION ROOFS ( 714 ) 898—S600
ADDRESS: 3257 VERDUGO COMMENTS: SMOKE DETECTOR(S) REQUIRED IN HOME.
*
LOS ANGELES CA 90065 ****************************** ************************* **********************
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTSSMOKE 'DETECTOR
7000)of Division 3 of the Business and Professions Code,and my license is in full torte and effect. SETBACKS
• CITYDate:LIC.: 042725 STELIc.; 429e; C C-3_9 A • R ]QI
Date:_j_o •— /y--9 Signature: '_ \ C—CeL4 MAIN BUILDING ACCESSORY Dui:J W-RE D---
WORKERS'COMPENSATION DECLARATION: I hereby allirm that I have a cenilicate of consent to self.insure or a cenilicate of Workers' FRNT; FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Compensation Insurance,or a certified copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
Poucy NO.: 1250297-91 EXP. DATE: 05/01 /92
COMPANY: STATE FUND PARKING REQ• PROV: PARCEL: 41205210 ZNE: REF NO:
❑ Cenihed copy is hereby furnished. 11 Certified copy is filed with th Building Division. PLANNING NOTES>
_- Date:_L2n77 -7/ Applicant: .6-T-1. c- Cin Ain **************4****************************************************************
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). D E V E 7•L OPMENT SERVICES REQUIREMENTS
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 •
subsea to the Workers'Compensation Laws of California. ZONING APPROVED. BY DATE:
Date: Signature:
NOTICE:If.alter making this declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE:
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 APPLICATION ISSUED B Y• - . DATE• / /
which this permit is issued(Section 3097.Civ.Cl. *********************4* *it • * f * ***************1 ***0
***
LENDER: *************************************** *** if
AA **********************************
ADDRESS: LEGALIZATION:N F E E S U M A R Y STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES-' GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,ore
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed PERMIT 72 . 00 0
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SMIP/NJON-RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN •- --
any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars(5500). ISSUE FEE
I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered forsale(Section7044.Business and Professional Code: The Contractors'State License Law TOTALS----> 72 . 50 0 . 00 0. 00 72 . 50 72'. 50' 5:.. . . 00
does not apply to an owner of a properly who builds or improves thereon,and who does such work himself/herself or through
his or het own employees. provided that such improvements are not intended or offered for sale.If.however the building or - •'!
pea pose offsale). BLDGPMT PLUMBING ELECTRIC MECHANICFIRE /TOT
ld within one year of cpmpletion,the owner will have the burden of proving he/she did not build or improve REVENUE
DIVISION
OD72. 50
SM IPGRADING PLAN—CHECK
/S C
for the pHECK
z72 . 00I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business . 50 r `
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'Slate License Law).l am aware *********************************************************************'B(.i*********
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
`:•J:
❑ am exempt under Section: B.8 P.C. j
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date. owner. SFR 4500 REROOF BY VALUE RESIDENTIAL NOZONE 1 .00 4 , 500 . 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES .
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Ouality Management District.Residential construction applications are exempt from it
these provisions. *pp*sions. I.
1',
IiG03/43::mo7-Gr`T?FE%0 - ".7. -
Date: Applicant: EXPIRED OF:`1E: the 15'9: lett:
I hereby certify that f have read this application and state that the above information is correct.I agree to comply with all city and county �.vtncomplete Inspections
ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned
-
property for ins retion purposes. �-.T }/�� �` •
A S A to �� - _._.� �(g
_--. Dam:_/O /Yf 9/ Signature: %.1\-/ s-/C _ l Q1 4 I lA
Driver's License or Social Security
164646 Whit-Building;Green-Code Enforcement:Canary-Applicant:Pink-Revenue;Goldonrod-Assessor
CONSTRUCTION AND PLANNING , PC S SPA
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Serviee or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd., ' 54. Forms
- 4.'Electricai Conduit-Undrgrnd.' -• ' 55. Electrical Bonding
'41.5. Steel'Reinforcemenc. • - 56. Rough Plumbing & Pressure Test
_ I
Q. Electrical UFERGrnd. 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 62. Backwash & Receptor-Final _
12. Sewer Cap1 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
x
20. Rough Factory Fireplace r -c - - i ' -- 'APPROVALS: ' Permit # -
J ' , . .l - v
21. Ducts,in,Strstctuie, - o _ . . go. Underground Hydro
22. Ducts, Ventilating - - f71. Prod uct:Piping OGas ❑oil ._
23.-Gas Pipe`Rough & Test ' - - 72. UndergroundF
Fliis � - ^ .
Jh V ^
24. Roof Framing T _ J3: Undergrnd.Storage Tank 0 Gas 0 Oil
25. Rogf Sheathing . '.11)!6_qf 60✓4 • •'74,"Overhead Hydro '>
26-T-Bar Ceiling (Structural) &-Monocoat - - • • 75.-Dry Chemical _ -
27. Frame and Flashing, _ ; 76. Dry Standpipe - , , ' 1
28. Lathing_& Siding- - -„ _ •• •• 77._ FIXED SYSTEM-FINAL- .. _ r'
'29. Insulatign - - 78rFIRE PREV. FINAL
:30. Drywall'Nailing -•- 'it* - HEALTH-E,.REQUIREMENT
.. r
-31. Plaster Brown Cobtt .. - ,79.-FINAL INSPECTION ' _ _
Hy .•. - a - r-
32. Electrical Power Meter-Final _ ' • .80.-FOOD CERTIFICATE ISSUED
33."Final Electric ,,u a i ; . ,%"' ' ' Notes: .>
. _ ;: -7;
"34.-Final Heating& Air Conditioning - . - 6; - = .
35..:Final Ga; Pipe-Test* - - •_' ,
,36. Hood or Canopy r • - > -1 • L --,
I ': -r. r .
37t-Final Factory Fireplace: •S'- „. '1 ' ` ' ;. _'
-38. Final Plumbing , '.0 �E- - �,
7.39. Water Setvice-Final' ' " • -' r: - -c
`
•
40. Gas Service-Final ^ .,. , ir n
x'41. Solar Domestic-Finals •• • = I
I - - - - ,
i
42. Backflow Preventer, ' . -
m - -
43. Backflow Irrigatior9 '• s: S - - - -
D C 1
' . }
,, 1 , 1 -
- _
,44. Landscape Irrigation-Sy �
stem :t ; >; _ _ C7 . „ . .
r 4
45."Sound Attenuation '- - - ' ' E X P f R E D'
I mplete'inspections
146.,Handicap Regulatinrfs}"i - - �. . _
47.-FIISAL STRUCTURE"?' BUILDING i-�y - 'r-
,, - _ face _ b
Z SiB
48: FINAL PLANNINd � 11 n I •i
r
-
49. Electric Release to Edison - i •r - 1
50.•Gas,Release to Southern California Gas Co -f, ,
51. CERTIFICATE OF OCCUPANCY - -
No. - Date
- Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. • G
CITY OF COSTA MESA - PERMIT NO. - TRACT NO. LOT NO. BLD 'S. - - 5295 ' 3/Q2/84 5.pU • TL
CONSTRUCTION PERMIT, oj�B�Z /9/7/24/47.? ' '
Project Address /296 3 - San'(.-aI_ Rn S4_ -✓I TYPE OF CONSTRUCTION ❑ NEW .0 ADD U ALTERATION_ H REPAIR - '
Applicant's Mailing
Address SSp L{l2.c rflJII�p L!T-p CI CONVERSION '❑ DEMOLISH ❑ OTHER Fe/ d� A.P.# • _ 1 Zone. •
(/ 02 Cl e-1-e-- PhoneV9-e4)7 DESCRIPTION OF WORK • - - $ Main Building:. - Accessory Building: Z
Owner's-Name -
Address VNO ' - - 0
TYPEOFPERMIT , ❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL T Front I N
Arch/Eng. License No. ❑ TENANT ❑ ELECTRICAL SI PLUMBING ❑ MECHANICAL B Rear - I
Address - - El OTHER - - A - N
(re41P rat/ 14 C r '�/i-,•I /Shone 7•r3.2cf// ' - PROJECT DESCRIPTION SQ. FT.' - - OCCUPANCY C Right - - G
Contractor's Name 11 •
ddress(mailing) /'Sc- kieST//J/) IA-9oo c3 CONSTRUCTION TYPE VALUATION $ Left R
A
L E
City License No. doe vsa ZONE GRADING CU.YDS. ACRES Ping. Ref.# Park.Fees $.• u
LICENSED CONTRACTOR DECLARATION Remarks: Parking Req./Provided 1
I hereby affirm that I am licensed under provisions of Charter 9(commencing • R
with section 7000) of Division 3 of the Business and Professions Code, and • Use of Building: E
my license is in full force and effe t. / p •
-
License Class 3/O License No/,S�/!3y I PLUMBING - I FEES Planning Notes: _ E
nate q---T3" Signature "'GJ 4�-47-1-H - - - -
PORKERS'COMPENSATION DECLARATION Bar Sink Showers N
T
a
,hereby affirm that I have a certificate of consent to self-insure or a certificate Backflow Preventer Service Sink •
S
of Workers' Compensation Insurance, or'a certified copy thereof (Section
- -
�j4 3800, Lab. C.)T T y Backflow Irrigation Sewer Cap _ I ELECTRICAL FEES
N Policy No. 4/9/6 Company -C _y ,+ •
'
iiiCertified copy is hereby furnished. Bathtubs Sewer Connection Automatic Washer,, Transformer 0 15-50 KW
Ce'r{toed c py Is filed with the'cityg nurltling Divis on 0 60,+KW
Date'/-/-k' Applicant [rPn PDo/ 7n c1e/�4T/0!l Clarifiers Solar Collectors Construction Pole Sub.
-EXEMPTION FROM WORKERS'.COMPENSATION DECLARATION Dishwasher • - -Solar Piping - CookingUnit Meter ❑d to'100'am s '"
(Thissection need not be completed if the permit is for one hundred ($100) or P P
less): DrinkingFountains
I certify'lthat in the performance of the work for which this permit is Issued Solar Tank Dishwasher Meter Dover 100 amps
shall not employ any person in any manner so as to become subject to the
-
Workers' Compensation Laws of California. Floor Drains Swimming Pool w/Spa Dryers ❑Gas ❑Electric Sub Panel
Date Signature - .
NOTICE: If,after making this declaration,you should become subject to the Floor Sinks Urinal ' • Fan Motors❑0-1 HP ❑1''/ -8
Workers' Compensation provisions of the Labor-Code, you must forthwith - - - - "- • - -
comply with such provisions or this,permit)shall be deemed revoked. Gas Service Outlets 'WaterCloset, - - F.A.U. Inc.Solar ❑9-15 HP 016-15t
CONSTRUCTION LENDING AGENCY - - -
I hereby affirm that there is a construction lending agency for the performance Interceptors / Water Heater , Fixtures ' Microwave
of the ,work for. which- this permit is"issued" (Section"3097. Civ. C:) '
•
Lender's Name. Kitchen Sink •• Water Service
Device Boxes Pole Light
LenderOWNER
BUILDER
Address - '4
OWNER BUILDER DECLARATION - Lavatories - l Outlets Range ,
I hereby affirm that I am exempt from the Contractor's License Law for the P—TrapREADY
following reason (Section 7031.5 Business and Professional. Code: Any city or . `. -. - y�rf"l�Y [p] pp,,11 �,--ff Switches ' Sign
county which requires a permit to construct,alter,improve,demolish dr repair , _ �i 7 �JV�, y, j,j —� '
'•,y structure, prior to its issuance, also requires the applicant for such permit Roof Drains c, - - , !' Garbage Disposal Standing Sections • '
file a signed statement that he/she is licensed pursuant to the provisions Of _ -- _ • -
Contractor's License law(Chapter 9(commencing with Section 7000) of • Generator ❑0-5 KW ❑5-15 KW Trash Compactor •
.vision 3 of the.Business and Professions Code) or that he/she Is exempt - P
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 Reinspection Fee ' ' - $ 3
senalty of not more than five hundred dollars($500). Pe $25 Issue Fee
LI I, as owner of the property or my employees with wages as their sole MECHANICAL Reinspection Fee $25 Issue Fee , $ 3
compensation, will do the work,and the structure is not intended or offered FEES - -
for sale (Section 7044, Business and Professional Code: The Contractor's -- • - PUBLIC SERVICES REQUIREMENTS:
License Law does not apply to an owner of a property who builds or improves Boiler - Hood or Type I El - i
thereon, and who does such work himself/herself or through his or her own Zoning Approved By • Date
employees, provided that such improvements are not intended or offered for Canopy Type II 0
sale. If, however, the building or improvement is sold within one year.of=al- Duct-Under Ground • Application Approved By Date
pletion,the owner will have the burden of proving he/she did not build or Im- ,
rove for the purpose of sale). ' Duct-Structural Refrigeration System Application Issued By (7.4.-.2 Date ,3-.2-79
I, as owner of the property, am exclusively contracting with licensed con- ❑0.100,000 BTU ❑100,000 BTU
tractors to construct the project(Section 7044,Business and Professions Code: Duct-Ventilating SUMMARY OF FEES
The Contractor's License Law does not apply to an owner of property who - BUILDING PERMIT I
builds or improves thereon,-and who contracts for such projects with a con- Exhaust System El Multiple O. System Repair/Alteration . $ L. SMIP $
tractor(s) license pursuant to the Contractor's License Law). - • • PLAN CHECK $ ^ �.,� PERMIT '
❑ 1'am exempt udder Section B. & P.C.for this reason Firepl/Fact.Bit. ICBG# ( PLUMBING $ J'Ov 'ISSUANCE $ 3 cD '
•
Date ' Owner, Heating System&Ducting PLAN CHECK ' $ ENERGY P.C. $
I hereby certify that I have read this application and state that the above CID 100,000 BTU 0100,000 BTU 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- • PLAN CHECK $ MICROFILM $
sentatives of this city to enter u n the above-mentioned property for .
inspection purposes. • ! ,( i /�
Signature `�!/ 7!• Date. MECHANICAL $ TOTAL FEE $;4/4k� 3
Drivers'•Licen Se or;55 •
Reinspection Fee '$25 Issue Fee $ 3 PLAN CHECK $
CMF 0865-46 rev. 7/83 - White-Building;Canary-Applicant; Pink-Accounting;Goldenrod-Assessor - - ,
•
CONSTRUCTION AND PLANNING - - F &SPA •
• APPROVALS. Permit# P<<b4'd 1 ' 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.
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 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
T. 23. Gas Pipe-Rough &Test 72. Underground Flush
24. Roof Framing 73. Undergrrid.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
35. Final Gas Pipe-Test
36. Hood or Canopy •
•
37. Final Factory Fireplace
•
38. Final Plumbing Wki/yy .eL'b
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final l
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
vni.I_ . nlLOSIn nit rrWig •.,-,I. . SS/ j11L
JOB ADDRESS 1063 Santa Rosa Ave. BUILDING PERMIT NO. 35651k
GENERAL CONTRACTOR Kenneth Nelson DESCRIPTION of WORK Bdrm. Add.
J AP Na.4.12-052-10 LOT TRACT FIRE ZONE VALUE $ 2,720.00
INSPECTIONS Signature Date GROUP I TYPE V ZONE R-1
SOIL SUBCONTRACTOR R PERMITS ISSgED
GAS Dote Number I Signature
WATER Plumbing
I
ROUGH PLUMBING
PROP. SW0.. LINE Q HOUSE CON. El
SPRINKLING SYSTEM
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND ❑ POWER ❑
ROUGH WIRING "kat irk - Heating and Vent.
TRENCHES FORMS la ,r
STEEL REINF. g / - ��
FLOOR Sys EM [�
BOND BEAM n STEEL REINFORCE n �/`
SHEATHING dr/l" %27-7L
FRAME AND FLASHING
LATHING - IN OUT 7f. /�j /.2.,,y..2122-
PLASTER, BROWN COAT ( /`�-J (2-2(.22 -
STRUCTURAL, FINAL Electric L/
HEATING, VENT., REFRIG. AND A.C., FINAL A ?, F , // `/2- 3yy/,3 .�- _
PLUMBING, FINAL AND GAS TEST f ///
ELECTRIC, FINALA b- 7?
BUILDING, FINAL f-7'_?3
4111111r •
__ 35654' PA[B it t:
'4M/ —6-7215§;;U0 177', 34.69
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely REC V BV DAT R CEIVE OAT SS ED
BUILDING / �`�` ,y-.-y ///4/7�j /�/
ADDRESS /D(A3 cei02/(/74( 1- n s#a 4 19//,
OWNER M4, LI/si. flc /7 e� g y A.P.NO.�IZ /mss Zr r� pP ST
Z AMAIL DDRESS o-��Nf / ADDRESNG S /O(n/3 S�}�7A Yso.r4
L.
CL U CITY NLEW E�S7 7,7`7 TRACT 66;71 LOT-CS BLOCK
ZZ
CONSTRUCTIONA//),Z..-
/ NEW ADp ALTER REPAIR MOVING DFmn,ISH
a m- LENDER /, n�� J`\/
JM BRANCH ill c .5:4F,eRy
J n OWNER
Q W ADDRESS ,/
d
CO J y ` VALUE Tao as-
_1.m ARCHITECT TEL. UE_E / $ f
Q OR ENGINEER NO,
3 to
Z2 Q ZONE FIRE 3 TYPE GROUP
Wa W ADDRESS �-7 /
APPROVED /G DATE /` 71'
W Z CONTRALTO A72.5./re,"/ BY
J p
CCI Z
:ix ADDRESS?/9(C. fp,_57_ 1l� 6e� -
W yl ZONE..., NO.OF USE OF NEW 3e✓Nsti
Z 1- CIT`(�tJJ/1/JL rj>..;24 NO. 7,97. t3� �� PLANS Z BUILDING /�plp/`..—
lU° STATE "�� �r CITY V YARDS APPROVED YARDS APPROVED
LB
O LIC.NO. a/fr?j 7 LIC.NO. MAIN BUILDING ACCESSORY BUILDING
S12E NO.OF BLOCS. (FROM CIL STREET)
OF LOT I /
NOW ON LOT FRONT /H1. FT. !i r rt FT.
USE OF „..,
EXISTING BLDG. r` r R SIDE Z� PT. FT.
I— SIZE OF Jam ' /” NO.OF
Z NEW BLOC.y}C-//in
ROOMS / STORIES / L.SIDE Alt" FT.70- �IC JT FT.
U EXTERIOR -.)' ��G / I ROOF N t' ti c er
EXT ERIN GAJY C� ROVER)NC"E` p REAR FT. FT.
J USE OF BUILDING AND WORK TO BE PERE DISTANCE BET. BET.MAIN&
0-
MAIN BLOCS. ACCESS BLOCS.
a r� n Oil
7"/ /�/ DATE
O /� ��/GQ0`7 ��/s�( O QI( CURP.# APPROVED
I— APPROVED '�-7 1--
LoBY �O „ DATE if
Z
_0
~ I hereby acknowledge that I have read this application and state $TAIL
O that the above information is correct and agree to comply with
( Jq)
all laws regulating building construction, and I shall not employi
F any person In violation of the workman's compensation laws of ��
M the State of California. / m
ZI hereby certify that I am properly licensed as a contractor under SO.FT. T o
the State of California Business and Professions Code, Divisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR 5
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:A e
CC
am exempt from the provisions of the State of California Business
and Professions Code,Division 3,Chapter 9. VALUATION g 5 W'C m
�� PERMIT FEE $ D
Signature oTJ �7 n / .J O m
Permittee �7/B"'�-s 710'J•/ $�/I �10 PLAN CHECK $ �(r E
Authorized Agent (J` (�` Q'/ LL
TOTAL FEE $ 544 Q
vpirPir
29578
COSTA MESA BUILDING-SAFETY DEPARTMENT _IAA -7-69M00 210* ****99. 1
P.O. BOX 1200 COSTA MESA, CALIFORNIA ¢262¢
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
F.
BUILDING For Office Use Only
5 ADDRESS 1061 Santa Rosa &Lei .
RECEIPT No. P¢ M iiQh
COSTA MESA. CALIFORNIA --- 7Hn /(S
RICE� pMyED SY DATE RECEIVED /DATE ISSUED
OWNER ( - - • [' t.. /2-J /n-000�- `I�y2/✓��-�3�////���?
BUILDING /0193 �M�S.4/LLR/ 60.... '2 ue
MAIL _ ADDRESS
ADDRESS • a i ' I r—�
1. erre Inc. Angeles 90016 NO.93(6-1`(104
ZONE-- 3 TYPE (/J OROUP�� 1
OR ENGTECTINEER E R Frank Gonzales N0�532716�]8 ByPROV[D DATE
1336 E. Chapman AvenueZONING
ADDRESS Orange Call fornia 9268 ZONE NO.OFUSE or NEW Res. w/
Rl PNS 2 NS I !WILDINOArtarh parse
CONTRACTOR George .L Heltzer & Assoc. e
/Donn 144 South La Brea Avenue
DESCRIPTION Lot 53, Tract 6637
CITY Los Angeles , California 90036 A.P.No, None
NOTE: NO RAV[OVERHANG SHALL BE LESS THAN
- LIC..NO. 201098 NO. 936-1104 30'TO HIDES REAR P.L.
' SIZE I NO.OF SLDOS. ALVES
LOWED (U.B.C.REQUIREMENT)
OF LOT Now ON LOT 0
YARDS APPROVED YARDS APPROVED
USE OF MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG.
(FROM C/L STREET/
SETBACK LINE FROM
CENTER OP STREET REAR YARD 18 I , FRONT 5 71-1T. FT.
SIDE MARDI LEFT 5' RIGHT 181 R.SIDE I p�/1 Rr. Fr.
DESCRIPTION OF WORK L.SIDE Qc. FT.
NEW XII ALTERATION -_ ADDITION �, REAR I A FT. FT.
1111,E DISTANCE BET. BET.MAIN a
REPAIR MOVING _pEMQLISM MAIN SLOGS, ACCESS.BLDGS.
BUILDING NO.OF VAR•# DATE
SIZE ROOMS HTQRI[e 1 C.U.P.# APPROVED ,
EXTERIOR WALL ROOF APPROVED
t
COVERING stucco COVERING wood shin_le BY / A DATE 'I .�
USE OF BUILDING AND WORK TO BE PERFORMED , r 0'
Dwelling and Attached Garage T
Plan 402ER - Lot 53
-I 1990 HQ.PT) 7f3 8/
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHO N UNDER VALUATION IS FOR THE j
AND STATE THAT THE ABOVE IS CORRECT*AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. ,i7JS,
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION
6.16.' co
BUILDING CONSTRUCTION.
5
SIGNATURE OF
PHRMITTPERMIT FEE
HB 377 `� J
X73 --
Da / PLAN CHECK S
AUTHORIZED AGR 99
��g�� i>� TOTAL FEE $