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Home My WebLink About3143 SUMATRA PL - Building Permits eta) `5�ItfF - CITY OF COSTA MESA BUILDING DIVISION > N P ,rDEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER IIIA PERMIT J / / B05-00351 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 3143 SUMATRA PL Status: ISSUED Suite: Applied: 03/04/2005 Vicinity: ROOF Issued: 03/04/2005 Parcel Number: 13915230 Zoning: R1 R1 Applicant: LACROIX, RAYMOND ISSUED BY: Address: 260 E.DEYER SANTA ANA, CA Phone: 714-966-2691 UNIT G Zip: 92707 Owner: FERREYRA, DEAN Address 3143 SUMATRA Phone: COSTA MESA,CA Zip: 92626-2336 Contractor: LACROIX ROOFING INC Address: 260 E.DEYER SANTA ANA,CA Phone: 714-966-2691 UNIT G Zip: 92707 License:• 804988 Arch : Eng: Address: Address: • Phone: Phone: Zip: License: License: • SCOPE OF PERMIT TEAR OFF EXISTING ROOFING,INSTALL 2 LAYERS OF 15#'FELT UNDERLAYMENT,&REROOF WITH 30 YEAR COMP SHINGLES(23 SQ). FEE SUMMARY Plan Check: $0.00 Calc Valuation: $5,000.00 Permit: $111.25 - - • - Claim Valuation: $5,000.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other: $0.00 - Inspection: $0.00 Total: $111.75 • 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 6-o 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) 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. . '�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 wt onset!compensatl IpQ nsura/r7pe carrier and policy number are: •Ca „ 3 5-c0 2 z C7 ?Ca-frier: �� / cis' Number: tP (This section need not be completed it the permit is valued at one hundred dollars($100)or less.) O 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 he Labor Code,I shall forthwith comply with these provislo�`/J _ Applicant'Signe -� 4 l/ / - �Deler a0Y 3/�d-I— WARNING: WARNING:FAILURE TO SECURE WORKERS' ENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000).IN ADDITION 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 Ihaa .4D nsed underprovi Ions of Chapter 9(commencing with Section 7000)of Division 3 oFt�th�8usIness and Professions Code,and my license Is In full force and effect.-Lc. cf0 Lf 7' A � - Class Contraotb7sSlgn`a:ural 'u"" �v ✓[l1• Me.".'-"j 3 s- CONSTRUCTION LENDING AGENCY: o 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 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 0 No Drivers 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,Gm 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? 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 akEermit 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 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. SI tura Of Legal Owner(s) Dat 3 CA ?— Arid/ .ushized,Appilcarit"T" CirDe �•.. CODE I INSPECTION TYPE PAIR aRITIALS CODES INSPECTION TYPE PAI€ INTITIAL$ 1616 Fixed System Final Fire Prevention _ 206 Final Mechanical 1266 Pool Spa Final �} 208 Final Plumbing 200 Final Re-Roof 7-/t4 �-� • 210 Final Electrical 201 Final Block/Retaining Well 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 OWNER ZUBAK, EGON A. _ )ATE JOB ADDRESS 31143 Sumatr., ?lace BUILDING PERMIT NO. 111962 GENERAL CONTRACTOR Owner-builder VALUE $ 3,3h2.-O9 rrt. AP No. 113-382-13 LOT TRACT FIRE ZONE DESCRIPTION OF WORK Conv.gar.to fa INSPECTIONS Signature DATE GROUP I TYPE ZONESoil R_J Gas SUBCONTRACTOR I PERMITS ISSUED .�+'?fC //-/7 f�/ DATE NUMBER Water Rough Corn. Refrig. 0 Air Cond. D Rough Heating Rough Plumbing Miscellaneous njQa Q 3230- ✓ Prop.Swr.Line 0 House Con. 0 St.Swr. 0 Sprinkling System Construction Pole _ Underground ❑ Power 0 Rough Wiring Vi../4 r� v/.-1 n..w,er 4'-10-61 JJ'63G ✓ TrenchesiS% Forms (] Steel Reinf. '[7f M1 s i _,c te/ Floor System I - Bond Beam ❑ Steel Reinforce 0 _ Sheathing Frame and Flashing / int— �— �._'i G 1 Lathing — In 0 Out ❑ I Plaster, brown coat /3 �y 1/� '/D 4 4rr Ref rig. 0 Air Cond. ❑ Final Heating, Final Plumbing Fixtures, Final _ Final Gas Test 444-c !j-/7 Electric Fixtures, Final g �� q Building, Final 9,(74 � VA OCCUPANCY FORM BU4-5M - 7-61 111962 1496? _ •• Fr RECEIVED JUL 241961 COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 317 COSTA MESA. CALIFORNIA FINANCE DEPT. CITY OF COSTA MESA For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING BUILDING 3143 410M A'r2/Y ` e- . ADDRESS COSTA MESA. CALIFORNIA For Office Use Only y. RECEIPT NO. I NO. OWNER 'F�ONP z✓ H'K I I /`J p..r MAIL ��jj//�� f [� R}{BIVE,gOBY DATE RECEIVED DATE ISSUED ADDRESS 4 JVII�}'�� TL ' Ii /J. I 7-7-- `Q / I 7.-.2y6,- ,/ TEL./ a 3 //�� }-i. CITY C.GS'r/1� ESR- NO/+.I S'876/ ADDREISS ITI C G l'I�,Lt-I've.) ARCHITECT - TEL. COSTA MESA. CALIFORNIA OR ENGINEER NO. ADDRESS . - FIRE'' j •• ZONE TYPE GROUP CONTRACTOR I•y/ //�Tt /�7� ��l� APPROVEDBY (11101- DATE(^�"/'�'-'G I ADDRESS LYONING • LI�.� �J ZOrp NO.OF USE OF NEWC.,e ctitc `I{ • CITY PLANS /BUILDINf{i'1. ( J _.Q.PJ_L( STATE TEL. • LEGAL `�/� Jn Z "VI^" 7-(1/ LIC.NO. y NO. ESCRIPTION Vt •2 � / �� T OF LOT SIZE MI /'` �'� , NOW ON LOTS USE OF P--age DActrie#9'L- YARDS [[[ J EVES EXISTING BLDG. _ APPROVED ALLO D SETBACK LINE FROM (CENTER LINE ST.) (( (]�,{ 4/-({,_.... / CENTER OF STREET . REAR YARD FRONT �� FT. IN • SIDE YARD I LEFT I RIGHT R.SIDE - / ,,((��a / FT. IN. DESCRIPTION OF WORK L.SIDE L.� IN. NEW I II ALTERATION I)VIADDITION I REAR • f FT. ,lIN. REPAIR I I MOVING i• SIZE BYPROV��A A�, DATE '" Tom/ SSIZE-DING Kiel ROOMS -SrS STORIES / Mi�' EXTERIOR WALL t I ROOF 'A .��a W COVERING .SC`s COVERING fFL, USE OF BUILDING AND WORK TO BE PERFORMED &PAI L°a-Mr . 'FN7�-/3-tzZ n, fl c-C - z 1 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COM- 'PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE S REGULATING BUILDING CONSTRUCT! VALUATION ' � SIGNATURE OF •� ` PERMIT FEE 5 %� B PERMITTEE N $ 3j �� PLAN CHECK $ (IP z AUTHORIZED AGENT $ / // '� re TOTAL FEE IS O OWNER ZUBAK EGON SATE 6-25-62 JOB ADDRESS 31113 Sumbwra_Pl. BUILDING PERMIT NO. 17409 4 GENERAL CONTRACTOR Owner-71dr. VALUE $ 990.00 AP No. 113-382-12 LOT TRACT FIRE ZONE DESCRIPTION OF WORK-Egg-Crate 100E over yard INSPECTIONS Signature DATE GROUP j TYPE V ZONE R-1 Soil PERMITS ISSUED Gas SUBCONTRACTOR DATE NUMBER Water — Rough Corn. Refrig. ❑ Air Cond. 0 _ Rough Heating Rough Plumbing Miscellaneous Prop.Swr.Line p House Con. ❑ St.Swr. ❑ Sprinkling System Construction e Underground C 10 PowerM Rough Wirin_ Trenches 1W Forms 0 Steel Reinf. Q pi - / Floor System Bond Beam 0 Steel Reinforce ❑ Sheathing Frame and Flashing Lathing — In 0 Out 0 Plaster, brown coat 'e rig. 0 Air Con.. 0 Fin. Heating, Final Plumbing Fixtures, Final Final Gas Test Electric Fixtures, Final Building, Final , 7 OCCUPANCY . FORM BUR.5M — 7-61 1(4') .1 :- 1744 FEE [FINED COSTA MESA BUILDING-SAFETY DEPARTMENT JUN2 5 1962 P. O. BOX 917 COSTA MESA. CALIFORNIA FINANCE DEPT. � ITY OF COSTA MESA A For Applicant to Fill In Completely PLICATION FOR PERMIT TYPE OR PRINT BUILDING ADDEG 3/43 rij vya , COSTA MESA. CALIFORNIA For Office Use Only �ac 4 2 RECEIPT NO. I PERMIT NO. �j OWNER 3/4-3- �• // /7 V e MAIL !ti/4-� C 1/ `. .L��I� I � RECEIVFy BY DATE RECEIVE 9ATEi188UED/�� ADDRESS w•�/ r��JpV ylry9 �T /Y/F} (�y� y/L/� G -",-.2S-4.2 I/9 5-1 CITY 774- M G(1 TNO. KI reel. ADDRESS -, /43 ,4-c--,tiC[.Q71, £1 ARCHITECT OWAi•e/� TEL COSTA MESA. CALIFORNIA OR ENGINEER pp�� Q 1�^- NO. // FIRE ADDRESS SI"P'l ZONE ��jTYPE / GROUP [/. CONTRACTOR ®� �yCrL•`` IAV ( (r.�✓[r-72 ByPROVED pa 1/ DATED/ Zbi/6:f Zn • ADDRESS ,,c),4.4‘.1 v !'�/,O ZONING 1� CP A91/C ` ZONFj�j ' FN.:: I USE OF NEW f�/L(a CITY 7 �� l '1! LBUILDING L_(Yf STATE �__ TEL. LEGAL 12 ho�—G `/ LIC.NO. NO. , DESCRIPTION 1 ac 32 OF V <toe G C/ NO. OF SLOGS. ./ / OF LOT YY// /� NOW ON LOT \A.P.NO. J f 3` VYOG - l USE OF � �J L�iYARDS EVES EXISTING BLDG. �WN/C APPROVED ALLOWED SETBACK LINE FROM _- _ (CENTER LINE 8T.) CENTER OF STREET REAR YARD FRONT c Q FT. N. SIDE YARD ( LEFT ( RIGHT R.SIDE FT. I DESCRIPTION OF WORK _ ffYUO- .�Au i L.SIDE '��]j '.�1�j1�, .�-�/I NEW I II ALTERATION I II ADDITION I ✓ REAR °J T. V 01 9 as tIIIN. REPAIR II MOVING I DEMOLISH BYPROVEI A .JJ,t L DATE C.-2.S.^b 2-- BUILDING / BUILDING 4,0 4/ NO. OF ` Di� SIZE. ��s�� ROOMS TOES COVERING EXTERIOR WA4,l di I ROOF COVERING r/�T�'Chiel .-r- ` USE OF BUILDING AND WORK TO BE PERFORMED Elm- OPCA/ 124 ) r'n.4 ¢neo tir7 I HEREBY ACKNOWLEDGE THAT I HAVE READ(THIS APPLICATION AND STATE THAT THE ABOVE 15 CORRECT A}ID ACRE TO COM- THE AMOUNT ESTABLISHINGB UNDER VALUATIONMIISF FOR THE PURPOSE OF A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND BTA LAWS GULATING BUILDING CONSTRUCT VALUATION SIGNATURE OF ox PERMIT FEE $ � PERMITTEE f/!/ t N $ PLAN CHECK $ AUTHORIZED AGENT /i �//J f TOTAL FEE $ E^ O aflairara LL R � VESn. COSTA MESA BUILDING DEPARTMENT +� r)--. _ \ P.O. BOX 317 FINANCE DEPT. COSTA MESA. CALIFORNIA • CITY OF COSTA MESA FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT ADDRESS �e aumatra Place • BUILDING COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY '''��y RECEIPT NO. P4891 OWNER simmer] and Land Co. • o RECEIVED BY DATE RECEIVED DATE ISSUED APR 2 4 1957 ADIL „7-7-t-702 V_ ��_s 7 MAIL Sl124 4 SO. Beverly TEL.Crestview BUILDING CITY T,nc d nrral ae' ('.Al T f NO r COnr ADDRESS • v L.-l' ARCHITECT LIC. OR ENGINEER 'iI fJill iamS NO.. COSTA MESA. CALIFORNIA FIRE ' ADDRESS J.12h. so, Reverl -0--T,os 97;a lor, ZONE ,T (l ZONE PLANS TYPE/ GROUP tl'Mplerl and LandCn-TY NO. /_ll)r � � PLANS CONTRACTDR' V U 7 lwa. JO. EeverlYTELCrestL"].eVl APPROVED ADDRESS Tres AnA'el es, Cal. NO. L' FIG n0 BY DATE LEGALLOT CORRECTIONS DESCRIPTION NO �� BLOCK TRACT 2'ir3 ' A.P.NO. SIZE / NO.OF BLOCS. OF LOT (,ono NOW ON LOT TIOf La USE OF r /1 EXISTING BLDG. ISL SETBACK LINE FROM r �l r/`fes CENTER OF STREET 1 REAR YARD Y) SIDE YARD RIGHT r I LEFT 6 I DESCRIPTION OF WORK NEW X ALTERATION ADDITION REPAIR MOVING VIII DEMOLISH BUILDING NO.OF ' SIZE 1205 ROOMS 5 STORIES 1 EXTERIOR WALL ROOF p t COVERING Stucco COVERING Rock USE OF NEW BUILDING Sirl,1 a PRmi _Lv T)vrel l i nu 12-P I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND ' STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUC• TION. VALUATION I • SIGNATURE OF PERMIT FEE $ '2f_nn PERMITTEE /0 f0 (e‘ PLAN CHECK $ 13.!1VO AUTHORIZED AGENT TOTAL FEE 539,00 Derr OWNER SUIVERT.AND-LAND CO. DATE 14-2h-57 `jIJ3 JOB ADDRESS ihRi Sumatra Place BUILDING PERMIT NO. #14891 GENERAL CONTRACTOR Owner $1d-r. VALUE $ 10,686.00 LOT 614 BLOCK TRACT 2353 Res. w/att. gar. GROUP I 8c J TYPE V ZONE RI FIRE DISTRICT /1917 PERMITS ISSUED INSPECTIONS DATE SUBCONTRACTOR DATE NUMBER Footing Trench 041; r- 7 7 Foundation Forms and Grade to Garage[ ge Rough Framing Owe 6 2* ' 7�� • Plumbing,Rough to Slab- Nn. S 5--Y . „., l�7► YLa , , 3/-30-S 2 9 i , Plumbing, Rough Complete PM(jj ,4 9-OCS, Temporary Pole Wiring, Rough 777% G-2.4ai Com. n4r.&1 iel .ki:c /S'a-3S7 Si ) a 3- ✓ iD Heating, Rough �' "e-5 b- -s7 /.t, ,4t. ((--CI--nZ e-t C•- FIT- a../ / 0 . 9$-- Heating,Final urb5 /0-2987 /twer, House Sewer,St. /04,5 0-20-_5 7 • ' Sin 4.• .. 3-6-57 P1 S 7 I 1 Septic Tank or Cesspool (iala61 Lathing, In Out 4.,E .21 - • Plastering i al f9 Plumbing,Final,Fixtures CompleteyVLC$ pr '�S'9 J/j�� Plumbing,Final Gas Test -dec... yf7M�,[(' /•. p -jfl /!/ Wiring,Final Bf4 if i.e. ^ _ _ ,t. 1-/--11 ' r Occupancy rte- .0_0...,:iy FORM 210 3M 10-55