HomeMy WebLinkAbout1676 SANTA ANA AVE - Building Permits e . ;
z J, CITY OF COSTA MESA
BUILDING DIVISION
t I ..'^4 ' DEVELOPMENT SERVICES DEPARTMENT
898-007R7
JPERMIT PERMIT NUMBER
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(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
•
Job Address: 1676 SANTA ANA AV _ Status: ISSUED
Suite: Applied: 05/08/1998
Vicinity: Issued: 05/08/1998
Parcel Nunmber: 42521304 Zoning: •
Applicant: FISHER, ED
Address: 22755 la palma av
Phone: 714-692-6656
YORBA LINDA,CA Zip: 92887
Owner: UYESUGI, RUBY
Address 355 E 16TH PL
Phone:
COSTA MESA,CA Zip: 92627
Contractor: E.L. FISHER CONSTRUCTION
Address: 22755 la palma av
Phone: 714-692-6656
YORBA LINDA,CA Zip: 92887
License: 496265
Arch/Eng :
Address:
Phone:
Zip:
License:
SCOPE OF PERMIT
INSTALL 4 LIGHT POLES FOR A NEW PARKING LOT BEHIND WELLS FARGO
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: Soso
Permit: $99.75 Claimed Valuation: Ss,000.00
Other $0.00
Inspection: $0.00 •
Total: $100.80
PLANNING &ZONING
•
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTES:
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
fora 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
J
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is Issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carder and policy nun•er are:
Cartier: — _ Policy Number.
(?his section need not be completed if the permit •:flar one hun• ••dollars($100)or less.)
❑ I certify ih. I.
a oerforms - his. it isissued td shall not employ an y person
ro in any mannertiso to become subject to the worker"'
hwith
comply I= s ro sloe Id b •me subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply nth?hes. .rovislons. `.
Applicant Signature: — _ •_oarY Date: U- 9 V
WARNING:FAILURE TOOT?' ORDERS'•• P `• E' •EIS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARS •OOM,IN ADDITION TO THE COST• ENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CO - •-S DECL• - •
•I hereby a40.••• at lic.•.y d• ' , • (commencing with Section 7000)of Division 3 of the B i t:nd Professions Code,and my license is in full
force and ttect.Liu.p A �TJ7'� Class a
Contractor's Signe u '. ?t"' Date: _ - :Ti�=
ak
.
CONSTRUCTION LE • G AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to Its Issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business end 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 properly 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 then thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number: ,
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑yes ❑No
(Section 25534 of the California Health and Safety Code provides That the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which ere required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 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? 0 Yes 0 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 Duality 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 es 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 •yAUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct.I afire: • omp ,•-141,11,..c:ws an• t ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
abov. •_-.>r•-• • operty or in urposes.I atree not to occupy or allow occupancy of any building authorizedze� bythispermit until final inspection.
01, yr e :.: Owner(s) a _ (� Date
` �B
: orizetl Applicant Date
rem E ItISPEttION TYPE DATE !MALI LODE I INSPECTION TYPF DATE lCAI$
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 Signm 222 Final Site
•
204 Final Demolition 250 Final Building/Occupancy
244646
I . , 9
CITY OF COSTA MESA
Y 4y BUILDING DIVISION
r I 1 DEVELOPMENT SERVICES DEPARTMENT
B911-08788
4 PERMIT PERMIT NUMBER
(714)Ab7'"5'4�552773 •• Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 1676 SANTA ANA AV Status: ISSUED
Suite: Applied: 09/11/1997
Vicinity: Issued: 05/08/1998
Parcel Nunmber: 42521304 Zoning:
Applicant: FISHER, ED
Address: 5165 WESTWOOD LN
92887 • Phone:
YORBA LINDA,CA Zip: •
Owner: UYESUGI, RUBY
Address 355 E 16TH PL
Phone:
COSTA MESA,CA Zip: 92627
Contractor: E.L. FISHER CONSTRUCTION
Address: 22755 la palma ay
Phone: 714-692-6656
YORBA LINDA,CA Zip: 92887
License: 496265
Arch/Eng:
Address:
Phone:
Zip:
License:
•
SCOPE OF PERMIT
SITE IMPROVEMENTS. REF PC 3730-97.
GRADING AND PARKING LOT IMPROVEMENT PLAN FOR WELLS FARGO BANK
BUILDING. INCLUDES NEW LANDSCAPING. PLANNING SPECIAL REQUIREMENTS REQUIRED
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: so.00
• Permit: $484.75 - Claimed Valuation: $40,000.00
Other: $0.00
Inspection: $0.00
Total: $493.15
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTES:
•
•
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or 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
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 canler and policy number are:
Cartier: Policy Number.
(This section need not be completed ti the permit -Pkt one hundred dollars($100)or less.)
❑ I certify that In • ....rm.-.: of the
�0) this ••rmit is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensatio, s of Califom: and agre Id became subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply wi,' --e provisions.
y Applicant Signature: _� •�'. Date: 6
-/ WARNING:FAILURE T. - I`� •• P NSATI vas.
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($1X,000),IN ADDITION •TH •.•O-••MPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARAT• .
I hereby affirm that I a etJytQer.`` n mencing with Section 7000)of Division 3 of the mess and Professions Code,and my license is in full
,� farce and effect. r b �` Class 4
illitContractor's Signe_= '.' .. Date:
els •
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following mason(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 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet In depth Into which a person Is required to descend,will be made In connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,ora volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health end Safety Code,with some exceptions,requires registration with the Costa Mesa Flre Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑Yes 0 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 pan 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 Safely Code),
7 If a permit from the South Coast Alr 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 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 end Emissions.
Signature: Date:
CERTIFICATE OF COMPLI• 1'' L •:•.•TION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct.I a ree to comply wi ws end c ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
a • , :i rposes. .gree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
�,
i e.al(Nalads) S B YS
/g g Date
� •Ifithorized Applicant •
Date
COOL i INSPEC11nN TYPE DATE ILIAL$ CODE f Ih252141LTYPE BATE Iti1OA{$
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 BIocktRetaining 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 1117 Pt
—
2446-46
_ r
- 4s „ CITY OF COSTA MESA
• "R
::; . BUILDING DIVISION
F' "�y'^�� DEVELOPMENT SERVICES DEPARTMENT ERR-003.5,3
� at
•�. •
PERMIT PERMIT NUMBER
(714)754--5273 •• Fax(714)754-4856 6.
77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 1676 SANTA ANA AV Status: ISSUED
Suite No Applied: 05/08/1998
Vicinity: Issued: 05/08/1998
Parcel Nunmber: 42521304
Applicant: FISHER, ED
Address:
Phone:
Zip
Owner: UYESUGI, RUBY
Address 355E 16TH PL
Phone:
COSTA MESA,CA Zip: 92627
Contractor: E.L. FISHER CONSTRUCTION
Address: 22755 la palma av
Phone: 714-692-6656
YORBA LINDA,CA Zip: 92887
License:496265
Arch/Eng: '
Address:
Phone:
Zip
License:
SCOPE OF PERMIT
ELECTRICAL FOR 4 LIGHT POLES IN EXTENDED PARKING, RE:898-00787
FEE SUMMARY •
Quantity Quantity
ISSUE FEE $22.00 Temp Dist System/Lighting $0.00 0
Temp service test $0.00 Busway/100 ft $0.00 0
Res.a/c package $0.00 Standing Section $0.00 0
New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0
New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0
Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0
Lighting Fixts $0.00 0 up to 50 kva/kw $0.00 0
Recept Outlets $0.00 0 • up to 100 kva/kw $0.00 0
Switches $0.00 0 over 100 kva/kw $0.00 0
Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0
Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0
Service to 200a $0.00 0 Misc.Conduit $0.00 0
Service to 1000a $0.00 0 Misc.Conductor $0.00 0
Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0
Motors to 1 hp $0.00 0 Circus(mech ride or lights) $0.00 0
Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0
Motors to 50hp $0.00 0 Fireworks Stand $0.00 0
Motors to 100hp $0.00 0 Other Electrical Fee $0.00
Motors over 100hp $0.00 0
Communication drops $0.00 0 Investigation Fee $0.00
Sub panel to 200a $0.00 0 Plan Check Fee $0.00
Pole Light Pkg $134.00 4 Reinspection Fee $0.00
Sign Circuits $0.00 0
Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $156.00
Intermed Pole $0.00 0
COMMENTS/SPECIAL CONDITIONS
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
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 end policy number are:
Cartier. Policy Number
(This section need not be completed if the permit is .u: at one . . .•dollars($100)or less.)
❑ I certify that ink.:-rn ..-• . of •- •o • ••Ich this per it is issued, I shall not employ any person in any manner so as to become subject to the workers'
ccoompensati.•'_'ws•. ,, ould bec• e subject to the workers'compensation provisions of Se Ion 37 o he Labor Code,I shall forthwith
comply _ c(
Applicant Signature: %. . ,# Date: V
WARNING:FAILURE TO' Cu- ""--.- •--.%•E •L GE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(S -•.'..),IN ADDITION TO THE COST• - SATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTR' • • S DECLARA ' I
''
I hereby affirm :t : li.: seg.:r p,�•.�• '•j :y. • (commencing with Section 7000)of Division 3 of the Busirit,d Professions Code,and my license is in full
force and e :ct.tic.4 ' J•` $, Class 4 (�`
Contractor's A��, Dale: Jf � 6—
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).
Lenders 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 properly who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,Le.-properly 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,faisework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the 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 appermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 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? 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 ,.RIZATION 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 al I. s .nd city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-.'-,•1;•-• •ro.,• , 1 F sea.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
/ 1t t •. •4011�e.al rr•. /1 Date
d/Or r-• 'zed Applicant Date
CODE t INSPECTION TYPE DATE IMALS con INSPECTION TYPE DATE ItIMS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1286 Pool Spa Final - 208 Final Plumbing•
200 Final Re-Roof 210 Final Electrical O—18-9B
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
2445-4a
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
PERMIT NO. TRACT NO. LOT NO. UNIT NO.
CITY OF COSTA MESA(/-t // CONSTRUCTION PERMIT BS 37S34- A.P.# � Zone
Project Address ! / Cs J t'i wrier �fV f: - S Main Building: Accessory Building:
O �II al /1 1` TYPE OF CONSTRUCTION LJ NEW ❑ ADD LJ ALTERATION U REPAIR E Z
Applicant's Mailing Address /77.`i st�Y P�QfL 11 1laVf/trL 7q
D2 i/ t/114 a yc ac ' ]oo ❑ CONVERSION (d DEMOLISH ❑ OTHER T Front - O
Owner's Name G iS / [-+J Phoc1 .A4. 'oA+$ DESCRIPTION OF WORK/USE OF BLDG. r1-cvLAC) ,S j1.1G LT rAf-'fIL`y BB Rear N
Address Ja70 .g�15-G'JL S1f7JTA 1IIU� / G ► .NCC . L.e
TYPE OF PERMIT ■ GRADING N FOUNDATION ■ STRUCTURAL C Right N
Arch/Eng. License No. K G
Address • n-A CI TENANT CI ELECTRICAL El PLUMBING CI MECHANICAL $ • Left
Contractor's Name R
/ LAIJD GLfnUJG Phone%-61 1062- OTHER of-61L.0 1t DI") 10 . Ping. Ref.# Parking Req./Provided E
Q p t PROJECT DESCRIPTION SQ. FT. L 2-. I o�
OCCUPANCY 0
Address(mailing) 1�7g:7 SAY P11 t2t�. Cl Ps ^+ �/"" � C O N ST RUCTION TYPE F D...44--i L VALUATION $40 ir3 • I.c.)t] I Planning Notes: M
�
City License No. 11 S cZONE GRADING CU.YDS. ACRES T
LICENSED CONTRACTOR DECLARATION I S.
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks:
•
with section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force and effect. `. .a • ELECTRICAL FEES
License Class �M Icen�e No. J� ZS •
-
s- 144 'IC {[ yam 1 PLUMBING FEES Automatic Washer Transformer 0 15-50 KW
Date 1- 9 Signature
WORKERS' COMPENSATION DECLARATIONBar Sink Showers Construction Pole Sub.' ❑ 50+ KW
I hereby affirm that I have a certificate of consent to self-insure or a certificate
of Workers' Compensation Insurance, or a certified copy thereof (SectionBackflow Preventer Service Sink Cooking Unit Meter pup to 100 amps
3800, Lab. C.) ' -
Policy No. Company Backflow Irrigation I Sewer Cap 5 Dishwasher Meterp
8 Certified copy is hereby furnished. �? —
Dover 100 amps
Certified copy is filed with the city Building Division. /- . Bathtubs Sewer Connection Dryers ❑Gas ❑Electric Sub Panel
Date Applicant • Fan Motors 00-1 HP 01%-B
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors
(This section need not be completed if the permit is for one hundred($100) or F.A.U.
less). Dishwasher Solar Piping Inc.Solar 09-15 HP 016-15+
I certify that in the performance of the work for which this permit is issued, I Fixtures
shall not employ any person in any manner so as tbeco o subject to the Drinking Fountains Solar Tank Microwave
Workers', m nsatiIsn_Laws of California.
Cf.&I_ O t Device Boxes
Date Signature esu Floor Drains Swimming Pool w/Spa Pole Light
NOTICE: If,after making this declaration, you should be ome su ct to the e Outlets Ran
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal 9
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY Gas Service OutletsSwitches
Water Closet Sign
I hereby affirm that there is a constructions agency for the performance Garbage Disposal of the work for which this permit Is issued (Section 3097 Civ. C.) Interceptors 'Water Heater • 9 p Standing Sections
Lender's Name
Lender's Address Kitchen Sink Water Service j' Generator 00-5 KW 05.15 KW Trash Compactor
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash , -
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays
any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains
the Contractor's License Law (Chapter 9(commencing with Section 7000)of
Division 3 of the Business and Professions Code) or that he/she is exempt . Reins
therefrom and the basis for the alleged exemption. Any violation of Section Paction Fee $15 Issue Fee $ 3
7031.5 by any applicant for a permit subjects the applicant to a civil
oenalty of not more than five hundred dollars($500). I DEVELOPMENT SERVICES REQUIREMENTS:
6
LJ I, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee $ 3 ]
compensation, will do the work, and the structure is not intended or offered Zoning Approved By Date
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES ' Building Approved By Date
License Law does not apply to an owner of a property who builds or improves JJ (�C
thereon, and who does such work himself/herself or through his or her own - Application Issued By Date C L'.2-( Yv
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I ❑ -ft
sale. If, however, the building or improvement is sold within one year of corn- Canopy Type II ❑ SUMMARY FEES
pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground
orove for the purpose of sale). BUILDING PERMIT $ SMIP $ --
L I I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System PLAN CHECK $ PERMIT
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑o-100,000 BTU 0100,000 BTU - PLUMBING $ IR tr9 ISSUANCE $
builds or improves thereon, and who-contracts for such oroiects with a con-
tractor(s) license pursuant so me Contractor's License Law). I am aware that Exhaust System ❑ Multiple❑ System Repair/Alteration PLAN CHECK 25% $ ENERGY P.C. $
proof of their Worker's Compensation insurance should be provided to me. ELECTRICAL $ GRADING $
❑ l am a 2mpt under Section B.& P.C.for this reason Firepl/Fact.Bit. ICBG dk Fire Dampers
'1 - MICROFILM $
PLAN CHECK 50% $
Date —ItOwner Heating System& Ducting Registers
❑o-100,000 BTU ❑100,000BTL '� MECHANICAL $ TOTAL FEE $ ^��—
i hereby certify that have read this application and state that the aboves PLAN CHECK 25%
information ic Blatin ogbui toicomply cost withcall anddy and county irepre-
sentatives
$
and state laws relating
it tot building construction, - herebyiauthorize yfor
sentatives of this ci�ty�$rt��o Jant upon the above-mentioned property for
InspectionInspection purposes. /r7 /� 2-2*-09 Signature /�' Date
Drivers' License or SS# Reinspection Fee $15 Issue Fee $ 3 .:t Oi 00026643-00026645 To T 33.50
0865-46,rev. 5/88 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor DATE: 02/21/89 TIDE: 09:55
CONSTRUCTION AND PLANNING POOL &SPA
APPROVALS Permit# Date Inspector i 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, ❑ Undrgrnd.
•
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection ��',,,., 62. Backwash & Receptor-Final
12. Sewer Cap ?) /Cye /l elj, 63. Heater & Vent-Final
13. Roof Drains (,( i� /L 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16.1 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 I FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test - 72. Underground Flush
•
24. Roof Framing 73.. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 771. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing 1 HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION -
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric I Notes: 9 �9 !'/- 14 �rn��T
34. Final Heating & Air Conditioning (/ �//� !v
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer !
Id I
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 ..i! •
51. CERTIFICATE OF OCCUPANCY
•
I
No. Date 1
ORANGE COUNTY BUILDING DEPARTMENT , APPLICATION FOR PERMIT
-y"' 636 North Broadway - �"I
_,BUILDING 1
SANTA ANA, CALIFORNIA
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
' II RECEIPT NO. cPt$M IT/
Z.6
y %� � 6� '� //�� 'ADDRESS V/ / O. _ Y
SCHOOL DIST. �fq ?Lk /1��� ECEIVEb BY DATE REC'D.. DATE ISSUED
'- OR TOWN (.�1./`�J^) ("L / -� /lI //'���9 /� n/ /� (-�
r NEAREST/7//L +�.,,a-it .' .44 /. +� C / / / " `.' �i�/ fl 7 )2 �•+J
CROSS ST A J�/c -
OWNER ' /,/Ji•°ti jN/i t) -/-"Y (ADD ADDRESS / (c)76 A !/✓//"� oi- /V ALO-- 4
ADDRESS /0) '//^ ��.y ,^, "-✓4. [/I/ OR TOWN ��O ,-cz //'/ £-f L
L t" //�� y�-`� SCHOOL DIST.
CITY
rel � it ?\Nd7k NEAREST
5?IC, CROSS ST. / 7' t
ARCHITECT OR LIC.- ZONE NO. OF TYPE GROUP
ENGINEER / 5-t.1-,_//: NO. �yJY I PLAITS
• ADDRESS `I II ��/y/ # C I• ,Qi'--Q APPROVED SILyik. ///�
• CONTRACTOR by/j1 _ NO BY / yI D.aTE7 ��i
U{ CORRECTIONS
ADDRESS •
LEGALI LOT ry �vWFL✓Tn✓leµ1
DESCRIPTION NO. O S"I BLOCK I TRACT
(ATTACH METES @ BOUNDS)
SIZE OF LOT ��` NO. OF BLDGS
` .
J �CreS I NOW ON LOT..
USE OF ,L,v'----I NO. OFµ! I NO. OF - - -
EXISTING BLDG/ h. , FAMILIES/ ROOMS
SETBACK LINE FROM: / D REAR YARD/00-Y
CENTER OF STREET �// SIDE YARD i/h+'
DESCRIPTION OF WORK a
ii
-` NEW I/A I ALTERATION I I ADDITION I • sr. '^ Z
2.
I I MOVING I I DEMOLISH I �� r
REPAIR n
BUILDING S I 1/ i D ROOMSF i� STORIES
SIZE L if
L
STORIES
COVERING WA L..61-/45:4.74
COVGERINCjTcpgr J//N(i/Y•
• USE OF NEW �
BUILDING To' r (/'I d r . r `l f r%"DDN( 1
APPROVALS
• FOUNDATION: LOCATION INSPECTOR DATE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS FORMS, MATERIALS.
APPLICATION AND STATE THAT THE ABOVE IS CORRECT UNDER-PINNING 1 _
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FRAME: FIRE STOPS. W 4I l _{z
AND STATE LAWS REGULATING BUILDING CONSTRUCTION. BRACING, BOLTS l T 9
/.�f�/l </A 1 LATH. INT. _ �j
SIGNATURE Os �///• _Q� / LATH. EXT. 0I Js r-21 - .
PERMITTEE LL
' PLASTER. INT.
AUTHORIZED AGT. PLASTER. EXT.
PERMIT FEE ¢ G. MASONRY REINFORCED
VALUATION $ PLAN CHECK 8
BOND BEAM
/ ��//
.,,M v. . TOTAL 7 FINAL ; lA Slo
FEE ¢
it ` �l�i 0 ' SEP 22 . 53
W
4
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J
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• a a
a
•
•
• ,
STREET-
• •
PLOT PLAN
Show location and distances from
property line and between buildings. •
- z