HomeMy WebLinkAbout1079 SANTA ROSA AVE - Building Permits s� F CITY OF COSTA MESA
BUILDING DIVISION
>:l,,,,,.' ` DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
PERMIT
°` Roman , _1 ` P02-00601
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
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PLUMBING PERMIT
Job Address: 1079 SANTA ROSA AV Status: ISSUED
Suite No Applied: 09/23/2002
_ Issued: 09/23/2002
Vicinity: . - v- _
ISSUED BY:
Parcel Nunmber: 41205206
Applicant: BATIOFF, JOHN
Address: 970 E MAIN ST
UNIT 200 Phone: (800)833-4572
GRASS VALLEY,CA Zip: 95945
Owner: DEPT VET AFFAIRS OF CALIF
Address %MORRIS,RALPH F 0
COSTA MESA,CA Phone: 714-545-6970 O. 141
1079 SANTA ROSA AVE Zip: 94295-0001 Sp" q
Contractor: WATER HEATERS ONLY INC
Address: 970 E MAIN ST
UNIT 200 Phone: (800)833-4572
GRASS VALLEY,CA Zip: 95945
License: 374573
Arch/ Eng:
Address:
Phone:
Zip:
License:
SCOPE OF PERMIT
CHANGE OUT 40 GAL WATER HEATER
FEE SUMMARY
AMT QTY AMT QTY AMT QTY
ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0
Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0
Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0
Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0
Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0
Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0
Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0
Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0
Drain,Roof $0.00 0 Shower $0.00 0 Water Heater/vent $12.30 1
Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0
Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0
Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0
\'. 4
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(aroo)
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.
crl 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' m nsattio�nInnsurance carrier and policy number are: c,
Cartier. c-VCA P,olicy.Nur ber: I(0 CI S 0-(Z,,.}^Com,
(This section need not be completed i/the permit is valued at one hundred dollars($100)or less.)
❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,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 provisi .
,Appuw#FSfgr�attas: cDate:_ G ^2-3? 1-
WARNING:FAILURE TO SECURE WORK S COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed un rAovisions ff Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full
foiceand'affectrG t y� S ]-'7 jFs-# + L'j C. r}-/ C
�Cpr1N , . :Signature:", �A�_ 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 end 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).):
O 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.).
o 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.).
O I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit.and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes ❑No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑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.
.alio. at. . .f.....
4 If an RMPP is presently required,has Section 25534 of the California Health
a
lth andd 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 air pollution control district or agency? r.�Yes LI No
(Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑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 D 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.
neur gal Owner(s) ���ate
CAn Or.Authorized'Applicant 'Date
CODE/ INSPECTION TYPE: PATE R11IDB4$ ;ODE. INSPECTIONTYPE PAIL 1MA4fl
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
CITY OF COSTA MESA
4� 96 BUILDING DIVISION
).°
w -�, 6 DEVELOPMENT SERVICES DEPARTMENT P RMIT NUMBER
/ ,j.. PERMIT
°. BO0-01815
Sc'er'Oaa ,E O"
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.�UILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
a
Job Address: 1079 SANTA ROSA AV Status: ISSUED
Suite: Applied: 11/13/2000
Vicinity: Issued: 11/13/2000
Parcel Number: 41205206 Zoning:
Applicant: FERGUSON, LEWIS
Address: ISSUED BY:
Phone: 714-754-1000
Zip:
Owner MORRIS, RALPH
Address 1079 SANTA ROSA
Phone: 714-545-6970
COSTA MESA Zip: 92626
Contractor: A PLUS SERVICES INC./A PLUS ROOF
Address: DBA: FOUNTAIN VALLEY ROOFING
FOUNTAIN VALLEY,CA Phone: (714)775-1947
11237 SLATER AV
Zip: 92708 License: 675241
Arch : - Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
REMOVE SHAKE ROOF, INSTALL SHEATHING AND 25 YEAR COMP ROOF.ADD ONE SKYLIGHT-BRISTOLITE ICBG 2469.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $2,919.00
Permit: $83.25 Claim Valuation: $2,919.00
SMIP Res: $0.50
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $83.75
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTES:
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord. No.92-28,§ 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00)
DECLARATIONS "
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
• work for which this permit Is issued.
❑ I have and will maintain om
workers'cpensa'•n insurance,as required by section 3700 of the Labor Code,for the performance of the work for w permit is Issued.
My workers'compensatio workers'
core car':r a .• cy number are:
Carrier: *�. Policy Number: t _..i
(This section need not be completed it the pe ip is valued at one hundred dollars($fOO)or less.)
❑ I certify that in the performance of the w•rk 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 Calif. ia,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 provisiv*. t1 /✓1/
AppLai mSfgnature: �.__...a� L s ' - .:_• Date: ' oCb
WARNING;FAILURE TO SECURE WORKERS'COMPENSATION COVE-. = IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(5100,0110),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:
1 hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.# Class#
ContraCLOI Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
O I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. __ _ Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
O I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding.falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 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 agermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? IU Yes LI 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 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.
laS' nature Of Legal Owner(s)
1/11
3/
(10
And/Or rizedAppucant- Date
CODE E INSPECTION TYPE DATE INTITIAL$ CODE! INSPECTION TYPE PAIL IWTTTIA14
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final g 208 Final Plumbing
200 Final Re-Roof /i" L/—ov 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
•
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1 e Sc3o 1469
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DIVISION OF BUiLDi.NG SAFETY
CITY OF COSTA MESA
APPROVED
N1mitt)5 By Date (( f I�j
I U ci S a..e{a Rd5'Qet of plans an cit cations MUST be kepi an this jr::i a.all times land i1 is unlawful lo
make any changes or alteration on same without written permiss;on from the Division of Building
Costa Me5 and Safety,City ofCosta Mesa.
The stamping of this plan and specifications SHALL NOT be herd to permit or to be an approval
of the violation of any provisions of any City of Costa Moa-Ordinance and/or State law.
These plans and permit shall expire by timitalion wit aeconi;nil and void if the building or
work is not commenced and a;,:rain;o ctive per U3C§303(d)within 1.30 days of issuance.
11 0I B IS�
rfil ►
1 arra OFBMLOING: 1079 SANTA ROSA AV Wit CITY OF COSTA MESA — BUILDING PERMIT
OWNERS NAME IF IMAM: ELLER, LOWELL A FLOOD: AH-38 PERM NO: B 081201
'mat P 0 BOX 1111
LAKE FOREST,CA 92630 PERMIT NO: B 081201 PLAN CHECK NO: N GOVT: N SUPP: N
WPL.MAILING ADDRESS: CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: OTH
ARCHITECT OR ENGINEER: LiC.NO.: JOB DESCRIPTION : T/OFF & INSTALL 3 PLY. ROCK ROOF SQ FT: 2, 400
ARCN.OR ENG.'S ADDRESS: WIT:
CLAIM VALUE: 2, 400 . 00 CALC—VALUE: 2, 400. 00 GROUP OCC: R-3 /U-1
CONTRACTOR'S NAME: DALE' S ROOFING ( 714 ) 534-6398
COMPACTORS MING 11550 ANABEL COMMENTS: X
ADDRESS: GARDEN GROVE CA L1C- 10,: 503508 ****+F**+Ex*+E+t+t+E***+EAE+Ex*RE*Rt+E*+t**Rt*********RERt***fir+E+E)E****+E+ERE*RE)rx)t)t****** REN•*fir****SEN
92643 LIME ZONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penally of perjury that I am licensed under provisions of Chapter 9 SETBACKS
(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my liaise S in hdl bate and affect.
C.NO.: 045868 LIC.CLASS: C-39 UC.NO.: 503508 EXP: 09/97 MAIN BUILDING ACCESSORY BUILDING
De.: / %5 -97 commo 47440t. /(1207; Cy _ FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
ER BUILDER DECLARATION:I hereby affirm under peraky of perjury that I am exempt from the Contracts'License Law for the
dbw;n9reason(Section?031sSuellen and Professions Code:Any oily«amywith requires apermit toconnect,afer.improve. PARKING REQ; YIIUV: PARCEL: 41205206 ZNE: REF NO;
demolish,or repair ls any structure,prior to its issuance.also requires the applicant for such peato fib a signed staenenl that he or she PLANNING NUT ES>
is licensed pursuant to the prm+aiona of the Contractors License Law[Chapter 9(commencing with Section 7000) d the
of Division 3
Business and Professions Codel or that he or she is exempt therefrom and the basis Is the alleged exemption.My violation of Section '> •� i
]031.5byany applicant for eperma subjects the applicant loedpdit
civil me than fee hundred dollars[S5031). **************.*****************************************************************
❑ I.as ovmer of the properly or my employees with wages as thei sole compensation.will do the work,and the structure is not intended D E V E'L O P M E N T SERVICES R V I C E S R E //��y U I R E M E N� T S
or offered for sale(Section 7044.Business and Professions Code:The ContractorsLicense law does rot applyto en owner of property M
who builds or improves thereon,and Ma does such work Nmself or herself or through his or her own employees,provided that such !^ .7_
improvements ere not intended or offered for sale.I.however,the building or improvement is sold within one year of completion,the ZONING APPROVED BY DATE: ,c"
owner-builder will have the burden of proving he or she did not build or improve for the purpose of sale).
❑ Les owner of the properly.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and
Professions Code:The Contractors License Law does not apply to an owner of 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).
❑ lameempunder Section: B.AP.c.,for Niareawn: APPLICATION I SUED BY: �E, DATE:
Date: cAmw: **************************************** ` * *********************,. .--\*
LEGALIZATION:N F E E SUMMARY
I do hereby codifym that I aaware of and understand the requirements of California Neanh and Safety Cade Sections 25505,25533,and
STRUCTURA • SEGMENT:Y
codify
25534,end that I or any future building occupant will/veil not(dmn one)need to comply with said state codes and the requirements for
e permit famnswdan or modification from the AiOta yManagement District.Residemil ammctionappintions are exempt from Nese BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SHIP/RES, GRADING
prof" 's. PERMIT 74 . 75 , 50,
Dem: Applicant: SMIP/NON—RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penaltyd perjury one of the following declarations: PLAN
❑ Ihave and veil certificate dconsent compensation.as provided far byse000ns700of the Labor IUILE FEE
tici.
for the performance of the work for which this permit is issued.
�-� BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TO = PAID v DUE
14 Ihaveend Mlmeiman workers' insurance.as required by Section 3700 d the Labor Code,far the performance of the TOTALS----> 75 . 25 0 .00 0 . 00 . 25 75 . 25 „ . 00
" work Is which this permit is issued.My wonre:
workers'compensation insurance Cartier and policy number a
Cartier _STATE. FUND EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 75 , 25 ER/SHORT: . 00
Poky Number (17'11Q7Q—QR 11 /01 /97 BLDG4 PMT PLUMBING ELECTRIC MECHANIC FIRE' ' /TOTTGRADING PLAN—CHECK
s
( section need nit /St
be completed i the permit is for one hundred dollars ool or less.)
I comfy that in the performance d the work for which this permit is issued.I shell not employ any pe) in aunty manner co as to
become subject to the workers'compensation law of Caldamia,and agree d I should •�r!,.subject to the workers' *******************************************************************************
compensation provisions d Section 3700 d the labor Code. nhwah ply
Poi—/j `} 7 Applica t: G I INDIVIDUAL F E E BREAKDOWN
Warning:Failure to secure workers'compensation coverage Is unlawful,end shall subject an employer to criminal penalties and TYPE QTY DESCRIPTIO N UNIT COST -TOTAL COST
civil fines up to one hundred thousand dollars($IO4000A M addition to the cost of compensation,damages es provided for In ,cr
Section 3705 of Ne Lobar Cods,lnhnaL and ettomsy'e/see SFR 2400 REROOF BY VALUE RESIDENTIAL NOZONE 1 .00 4. 2 ti
0
CONSTRUCTION LENDING AGENCY: I hereby elfin under penally of perjury that there is a mretnWion lending agency for to ENDOF FEES
d work performance the fur which this permit is issued(Section 3097,CN.C).
LENDER'S NAME:' ' v'
•
LENDER'S ADDRESS: ` . 1 I
•
Icertiythallhewnadtisappiicationand stale thatteabove inomationis cored.Iagresecompywith almcounty ;- JAN;151997 . -
and mate lees relating to buidi g construction and hereby authorize representatives of this dry to enter upon the above-mentioned property
for inspection purposes. -... .R
ALE MIL ER
Fr CIT(.OF COSTA isAESPi
�� Date /-75--- 97 !A
Signature al Owner/ vApican K�
(5151-4e.WP) White-Buildup A Safely:Green-File:Canary-Applicant:Pink-Revenue:Goldenrod-Assessor 1`� J
CONSTRUCTION AND PLANNINGPOOL & SPA '
i APPROVALS Permit #- _ Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical.Service or Pole 52. Pool & Equipment Location
2, Soil Pipe-Undrgrnd. .a 53. Steel Reinforcement
S Electrical Conduli;Utility-UndLgrnd. - 54: F•
orms
, -...p4: ectricat Condui Ur rgrnd.c 55. Electrical Bonding I;
.t 5:Seel Reinforcerrier5('' 56. Rodgh Plumbing & Pressure Test •
26-•;Electrical UFER-Gtrtt3. 57. APPROVAL TO COVER-GUNITE -
4t'77'Footings 'T'T' •^- 58. Electrical Cond Oit=Undrgrnd.
_ 8. Foundation 59.- Gas Pipe, 0 Un r`grnd.,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 'C r. • -
0 63. Heater & Vent-Final
•
•
13. Roof Drains64. Plumbing System • Final
14. Rough Plumbing: 65. Electrical-Final / .
15. Rough Electricatconduit Y'
66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Acc s5` pproval
17. Rough Wiring Sign68. APPROVED FOR PLASTERING
TB. Rough ElectricaET Bar Ceiling- 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating& Air Conditioning FIRE DEPT. REQUIREMENT 41
20. Rouy_h factonp FirEplace +' ;0 i5 ^°t: t:APPROVALS:::,` Permit # ' t• it
- . , C t c it- R k c ,-x rr t ;1 K r,J H- > x
21. D,uctd, ntStruetur t; .,
iS x p ,-.x 70. %lndergroArnf F{ydro n
22. Ducts-' Ventilating- - .^.-1" r. - d:" it 71. Product•,,�ipingClfas :YJ Oil
23. Gas Pipe$ougth &Tgst r� t C" "+k `' " ri^
q w tr _ _rk 72. Underground Fduglr, >
24. RootFraming•• -' k• • Fir- ^ { > _^ c�J J• 73?, Undergrrd.Stora0Tanl D Gas ❑ail
25. Roof�Sheathing ,-/,%�'f-97,(iC�'•,' 74 �Overhead•Hydroj r
26. S-BarCCeiling (Structural) & Mbnocoat 77 ^T r., t- �!X 7 ,c,-.,Dry Chert-"ical K '" C cC
-
27. frame and, Flashing r ^, C �• m 76 Dry Star{Zpipe�-�',w k -' r p
.
.28. lathing& Siding t :. -_C - r .7: 77- FIXED SY -STEM FINAL r'
'
29. Insulation - p - _r. - 1'1 x 7- FIRE PR EV. FINAL x > 7;
. ' * %r. H HHEALTt3DEPT.^REQUIR MENT
30. Drywall Nailing •� Fr
31. Plaster Bwwn.coat x .c.: r
. r, f•-. ; I ` r. 791 ▪1 FINAL IAJS¢ECT4ON `.1 t, 5
id -r - itz 2 r: 80t FOOD CERTIRICATE ISSUED
F• I32. Electrical-Power Meterfinaf x ,
33. Eina ,E1 trice • '- I ; _ Notes: C �."�,.- a: - C+
c.
34. Final Heating-& Air Conditionings < - cC - �•i_, 5 CC
35. 'Final-Gas Pipe-Test ` I I ;�. i' _
t �•: 1 I t ..f:
-•36. Hood.or Canopy ., t7 n�- ._ ,-� ". v �: t,- c D CV-
_
:r
_ - y �. < r-. * -1 n;
37. f1nal;Fact'ory FirePldct. - rq Ik SD 4 z
= 38. Final Plumbing t: « i I 5 - '< tc 0
m
39. Watei Sel ,ice-Final l I T x ' " L'r -r `^ 0
'.40. Gas Service-Final , n - -. r., I Gv _:.o
-41. Solar Domestnc•Finar = A C' i ft: ,..z
`:V k '
42. Backflow Preventer r - '' I l-- y ji-, • x C
_ - p r-. r'fin, e r
43. Backflow Irrigation v `=•-> ' r'e' . - _
r w C, ..---
1
1 44. Landscape Iriigatioq:Systemeim r - i _ Cr rx3 r 'ij -
. Sound Attenuation:1' s. - 5,•r ;r T K -• -I . tzy C r k C5 3
'46. Handicap,Regulations e X _; c• •�v r
r •-s
47. EINALSTRUCTURE & BUILDING 6...44.Q- carex ° rr
48. FINAL PLANNING, : :i C i-. . 'a:• ' rt., r.-_,
- , • C x
49. Electric Release to Edison - - x ` t
3 'p - M -t _ r -i - --
50. Gas Release ta.Southern California.Gas Co T <: • - ,37.----. ...-;--,-..-.,-.3-
-- - - . . - -n Y -_
51. CERTIFICATE OF OCCUPANCY- -:_. -
No. Date
29574 P�,�
COSTA MESA BUILDING-SAFETY DEPARTMENT » -7'6967FAIDOO 206 *99.C1
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINTBUILDING
BUILDING For Office Use Only
ADDRESS 1079 Santa Rosa al.a.J1.U.L-
RECEIPT NO. PER9
74
COSTA MESA, CALIFORNIA .---
, 1910XWEDEY DATE R CElvep ISSUED
OWNER Heltzer Enterprises-Costa Mesa l �� ha
6—br� /� 2J--ate
BUILDING /079 j- L yv� �� //-
ADDRESS 144 C(n i-h T Rren AvPniip 11114 Nall f�(t!(� /�e¢w rVly,
FIRE
CITY Los Angeles 90036 rTio936-1104 ZONE TYPE GROUP
ARCHITECT TEL. A(]11[.1 BY APPROVED DATE
OR ENGINEER Frank Gonzales NO1332-6878
1336 E. Chapman Avenue ZONING /
ADDRESS (1rgngo COlifnrni2 99MR ZONE I NO.OF I USE OF NEW Res. W/
CONACTOR Georg. J. Heltzer & Assoc.
Rl PLANE 2 ""m°""m° Attarh.Garage
TR
ADDRESS 144 South La Brea Avenue E'LEGAL
Lot 49. Tract 6637
CITY Los Angeles , California 90036 A.P.NO. None
NOTE: NO HAVE OVERHANG SHALL BE LESS THAN
uc NO. 201098 TEL
936-1104 SO TO SIDE OREAR P.L.
EAVES
SIZE I NO.OF SLOGS. n ALLOWED (U.B.C.REQUIREMENT)
OF LOT NOW°"LOT YARDS APPROVED YARDS APPROVED
USE OF MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG.
(PROM C/ STREET)
SETBACK LINE FROM , FRONT Li FT. FT.
CENTER OF STREET REAR YARD 201
SIDE YARD LEFT S' I RIGHT 18' R.SIDE fPT. PT.
DESCRIPTION OF WORK L.SID[ �3' PT. Fr.
NEW X ALTERATION _ ADDITION REAR i PT. PT. i
DISTANCE BET. BET.MAIN Q
MAIN BLDQL, ACCESS.SLOGS.
REPAIR MOVING DEMOLISH
BUILDING NO.OF VAR.# DATE
SIZE ROOMS STORIES 1 C.U.P.# APPROVED
EXTERIOR WALL ROOF APPROVED , 'n
COVERING stuCCO I COVERING WOOd shingle_ BY �,(/W� � w' DATE � 'L 3O
USN OF BUILDING AND WORK TOMCP ERFORMED p . D W
Tlurall;nE and ArtarhPd Garage w
Plan 40211R - Lot 49
J /4%oSQ.PT. ,70g5,3 a' 7
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWS UNDER VALUATION IS FOR THE j
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. `31
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION -- G
BUILDING CONSTRUCTION. �1
SIGNATURE OF 00 PERMIT FEE $ P.
PERMITTEE 7 ---
••••,"'
�/ 5
PLAN CHECK $
AUTHORIZED AGENT �J 12` % �.e G
TOTAL FEE $ G�