HomeMy WebLinkAbout2712 SKYLARK CIR - Building Permits � �tJ. CITY OF COSTA MESA -
y- �`. BUILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT
4. PE IT UMBER
B98-01873 t/
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 2712 SKYLARK CI Status: ISSUED
Suite: Applied: 10/15/1998
Vicinity: Issued: 10/15/1998
Parcel Nunmber: 13963230 Zoning: R1 R1
Applicant: PEAL, PAUL
Address:
-. .-. Phone: ..
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Owner: Po4�F6N BWTR
Address 2712 SKYIARK CIR
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COSMESA CA ,-: - Zip: 92626 �� <�
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/ f A/OR - �' / / / ,>�" \
Contractor t ORANGE COUNTY ROPING, INC.
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Address: P.O. BOX 12087,'
,/ t7 'i ��_-' Phone: 714-771-0281 -� �� �� ��`,_
' // _/7,ORANGE;CA. Zip',' 92859
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Llcensec•528433
Arch/En9 -..,� - . . I . ,
Addres
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i/ • ! 'Phone: J N
t - Zip: _ I �:
} . , ( ' -- & \t'/ ,,.r1. ' -i- (
License: �; - ' -
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• SCOPE OF PERMIT V
/ - . '/TEAR OFF RESHEATH WITH 1/2".CDX.PLYWOOD&REROOF.WITH 25 YR COMP. ' - ,
n i.. -
•
• - - FEE SUMMARY h7 , . - ,.
Plan Check: • - $0.00y,; ! ) "-'-Calc Valuation :- $5,860.60
`• b Permit ` ,'$112.25 - _ 7/ / - Claim Valuation. . r', $580060
' SMIP Res: . $0.58
SMIP Com: $0.00
`' ,Other:' .$0.00 - % '; �},
Inspection: : A. '$0:00 '•�'
2
':Total: $112.83 _ ' /2/'
`'.A
/
1'
v„ V'PLANNING &ZONING
VSETBACKS , - `'-
MAIN STRUCTURE Front '0-'0 Rear --0-0' - - ' Left - 0=0 Right' - 0:0/ /6'/
ACCESSORY Front 0--0 ,Rear• ;-0=0 Left - 0-0 ', • Right 0=0'
PARKINGExisting: 0 - Required: 0 r 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'COMP SATIORI3ECLARATION: •
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.
D2/`1 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 work pe ati�Qn In�5/ nce er and policy number are: �1 /�
Carrier: Y,+� Policy Number: lY 7'�d
(This section need not be completed it 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 - • : • end a! :e t a i •ould •ecome subject to the workers'compensation provisions of Section 3700 o the Labor Code,I shall forthwith
comply with •:se provisions,
Applicant Signature: s �' Date: AP /
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMI 'I PENAL IES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(5100.000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under•rovisions 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.# r S.. , •' - Class# t:— 9
Contractors Signature: Date: /O 7,/<jfj'
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).
Lenders 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 drivers 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.Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
'-)
0 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 ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apernit 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 Califomia 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 ❑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 ell 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.
400 say Of Legal •• pate
And/Or Authorized Applicant D
ODES INSPE_-ECmN TYPE TYPE DATE MALE CODEC INSPE[mON TYPE ge¢ PIMA
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final �p 208 Final Plumbing
200 Final Re-Roof /7-t (6 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 FInal Demolition _ 250 Final Building/Occupancy
2446-46
��i Lr4CITY OF COSTA MESA
°9 . 4 BUILDING DIVISION
t.' ' DEVELOPMENT SERVICES DEPARTMENT
PERMIT P IT NUMBER
e
698-01848
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 545 STURGEON DR Status: ISSUED
Suite: Applied: 10/12/1998
Vicinity: Issued: 10/12/1998
Parcel Nunmber: 41802314 Zoning: R1 51
Applicant: MALONE, SEAN
Address:
Phone:
Zip:
Owner: BOLTON,1CHARLES V JR
Address 545 STURGEON AVE ' �
- - Phone: -
COSTA MESA,CA Zip: 92626 - _ :
• - _ A,A
Contractor:. FOUNTAIN VALLEY ROOFING
Address' 11237 SLATER AV ' ' '
Phone: '"
,,, -FOUNTAIN-VALLEY CA Zip: 92708 ,
`. H License:- 675241 ,�
Arch/Eng: - - i
Address: .
\, " Phone: , , / -
Zip:
License:
SCOPE OF PERMIT '
• .T/OFF INSTALL 1/2"CDX&INSTALL 25YR COMP.&BUR TO THE FLAT SIDE.
FEE SUMMARY ,
Plan Check: $0.00 . . Calc Valuation: - $8,066.00
Permit: $149.75 . • Claim Valuation: $8,066.00
SMIP Res: $0.81 '."
SMIP Com: $0.00 .
•
. Other:" • $0.00 . }
Inspection: - $0.00 � ,
Total: $150.56
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
DECLARATIONS •
tj
WORKERS'COMPENSATION DECLARATION: - j
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are: G
Cartier: S"—file E FL„ID UN 11— p/ ' 000/0 KO Policy Number 2O .S / 6
(This section need not be completed If the permit is valued at one hundred dollars($100)or less.)
❑ I certify that In the pert° ' ce of th= • •r 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 Cal;fmia,and =gree tha f i sr• Id beco• e sub':- to the workers'compensation provisions of Secti 3700 of a Labor Code,I shall forthwith
comply with these prov" '•ns.
Applicant Signatu _�'—__� • Date: /0/ / 9
WARNING:FAILUR TO SECURE WORKERS'COMPENSATI• • E- E IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALT S 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 ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.# 6 7—C Z V Class# C-3 9
Contractor's Signature: � � Date: /0//i/97
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).):
❑ 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. ❑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 B,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 e
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 end 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? 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? p Yes O 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
e (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 CJf'LANCE 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/imply 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 • °party for in urposes.I agree not to occupy or allow occupancy of any building authorized by this permit u it final inspection.
i_nater= '. • •r s) — /C® D'e
Afar
And/Or:•t zed Applicant Date
;ODE 6 INSPECTION TYPE Qeg REALS T,OOE• INSPECTION TYPE ge¢ IDIS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof Z 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
2446-48
Ir's •
=�: CITY OF COSTA MESA
BUILDING DIVISIONSickg v
DEVELOPMENT SERVICES DEPARTMENT p6
�• PERMIT PERMIT NUMBER
��o�m�mmcc�� B98-02048
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE, COSTA MESA,CA 92626
• BUILDING PERMIT
Job Address: 1600 SUPERIOR AV Status: APPROVED
Suite: •
Applied: 11/12/1998
Vicinity; Issued: 11/12/1998
Parcel Nunmber; 42536115 Zoning:
Applicant; KIDWELL, JOHN
Address; W/SANTA ANA ROOFING
Phone: 714-558-3707
Zip:
Owner ELERDING, CHARLES E JR TR
Address 38 LINDA ISLE
Phone:
NEWPORT BEACH,CA Zip: 92660
Contractor,. SANTA ANA ROOFING
Address; 00923 N. LOGAN
Phone: 714-558-3707
SANTA ANA CA Zip: 92702
• License: 463596
Arch/Eng;
Address;
- Phone:
Zip:
License:
SCOPE OF PERMIT
TRAR-OFF EXISTING AND REPLACE W/NEW 4-PLY ROCK.WORK IS TO BE DONE ON UNITS 301
THROUGH 618.
• FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $losoo.00
Permit: $174.75 - - - Claim Valuation: - $10,800.00
SMIP Res: $0.00
SMIP Com: $2.29
Other: $0.00 -
Inspection: $0.00
Total: $177.04
•
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
Z
DECLARATIONS "v
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
Q 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 end will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are: /
Cartier: /. tDr trtc w. Policy Number: '!./L) —OWC-06
(This section ha9d not be completed if 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 provisions.
Applicant Signature: Date: /7' / Z��
WARNING:FAILURE TO SECU-. -ORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLIARE(SIM,...),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.# ' - Class It C 3 9
Contractor's Signature: .' / Date: //"/2-
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: 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 properly 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.).
Q 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,talsework,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 end pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No
(Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
Q Yes Q 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 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 ❑No
(Section 65850.2 of the Califomia Govemment Code requires that the requested information be fumished 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
B (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.
Signal Of ner
Le ( ) Date
/ s //-,2--'
And/Or Authorized Applicant Date
you F ujSPFnTInN TYPF NATE UITUIALS CODE It INSPECTION TYPE DATE I=IIIIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 77 ( 208 Final Plumbing
200 Final Re-Roof r'4. I 1- SY C- 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site _
204 Final Demolition 250 Final Building/Occupancy _
2446-46
,C
CITY OF COSTA MESA REQUEST FOR OCCUPANCY
TRACT NO. `6`6c7'3 DATE /���, 772&
LOT NO. a�
ADDRESS 27/2 Q*YC&JCt ce cc c
The developer of the above entitled tract desires to sell the above set forth
lot prior to the time that the tract has been completed and its streets
accepted by the City of Costa Mesa.
The undersigned, by executing this agreement , acknowledges that (he-she-a
(was or AO advised that this tract has
not been given final inspection nor has it been accepted by the City of Costa
Mesa as having complied with the conditions of approval which were imposed by
the city at the time the final tract map was approved.
The city assumes no liability for the enforcement of the conditions necessary
for approval other than those conditions protected by surety bond.
The undersigned agrees to indemnify and hold the city harmless from any claim
resulting in damage or personal injury to the undersigned by reason of the
aforementioned uncompleted condition.
BY YV'V flj a Gl _AIYLI
urchaser
RECEIVED BYj tCO00 #3_ "a
CITY OF COSTA MESA Developer and/o authorized
representative
Nov 1 G 1972
AM PM BY 1• AFIJ0/4714O
718190.9/11011121314i516 Lender
OWNER Ikemori, Gordon DATE 1/15/73
✓\JOB ADDRESS 2712 Skylark Cir. BUILDING PERMIT NO. 35966
GENERAL CONTRACTOR Owner Bldr DESCRIPTION of WORK Patio Slab & Cover
1AP No. LOT 55 TRACT 6663 FIRE ZONE VALUE $ 1200.00
INSPECTIONS Signature Date GROUP TYPE ZONE R-1
pSOIL PERMITS ISSUED
�GAs SUBCONTRACTOR
Date Number Signature
1 WATER Plu8-4,,
mbi q / ,c/�
I ROUGH PLUMBING /.7At.�n.Q1 l3!' ,, . ///!�.% 6.21/a3
PROP. SWR. LINE ❑ HOUSE CON. ❑ A 6` /
SPRINKLING SYSTEM %1 .< /.LL-73
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND ❑ POWER 0
ROUGH WIRING Heating and Vent.
TRENCHES ❑ FORMS fl STEEL REINF. fl r1 C;�.. .2f"-71
FLOOR SYSTEM
BOND BEAM n STEEL REINFORCE n
SHEATHING
FRAME AND FLASHING
LATHING — IN Jl OUT fl
PLASTER, BROWN COAT
STRUCTURAL, FINAL Electric
HEATING, VENT., REFRIG. AND A:C., FINAL
PLUMBING, FINAL AND GAS TEST n ex, /-Z6'73
ELECTRIC, FINAL 9
BUILDING, FINAL /t 7,'LZ• /8
y ,
•
35966 •
PaB
- iAll15-7-%rr_s^00 677 *1 B.50
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
.7 • APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely RECEIVED BY DATE RECEIVED D EISED
BUILDING , Asi /{I�f
ADDRESS • G Q _w p
1 ER Km U
OWNER nit. 4,_0A41O/V IAEMo/2r A.P. N.. c�/ �'} (�/,
MAIL I1' AD BUILDING RS �..r �7/ `j J/� LAie/C- P
ADDRESS .SNME ADDRESS OG/ o� {, ( /
Z / Z
a_to CITY TEL. TRACTLOT LOT✓ C BLOCK
COST/3 /`/651,0 NO. 979-o/6(_
ZQ CONSTRUCTION NEW ADD ALTER REPAIR MOVING RFMOI ISH
O N. /.
LENDER NA
OIG 1
a m / //
J 7 BRANCH •
,_,,z'4 1.... 7.E4'4cC
J(1, OWNER f
67
a W ADDRESS
m J � e /VALUE
J m ARCHITECT TEL. S D 'FiL/ $
a OR ENGINEER /vv/✓E No.
fn
Z FIRE
Z a ZONE TV E • GROUP
W 2 ADDRESS
CL 111 APPROVED I r/ 7�
W Z CONTRACTOR Ol/y/�0.04.-
03
Q BY ire....)
DATE ` //
J Q
mZ ..
J Fr ADDRESS
W ZON / NO.OF USE OF NEW . O
ZFCITV NO. • j`—( IPLANS� BUILDING ' /
W-Q STATE .. CITY • YARDS APPROVED YARDS APPROVED
(n D- LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING
0 Q (FROM C/L STREET)
SIZE - • NO.OF BLOC'S.
OF LOT • NOW ON LOT J FRONT •`' FT. Arr. FT.
USE OF i
EXISTING BLDG. S/NkIF- Aril CI /OWPi- -ie4 " - 3,--7- FT,
I— SIZE OF "4970 COVF.Q NO.OF • '//�'
Z NEW BLDG. 'L I/O m ROOMS 1 STORIES I • �J' CET.
a EXTERIOR WALL ROOF 7
o COVERING AION& COVERING g--3 FT.
J USE OF BUILDING AND WORK TO BE PERFORMED • - BET.MAIN&
as pi77o SL AA Ce.vNLy_ /9N� BLDGS. ACCESS. BLDGS.
a DATE
Q aT/o _COV art CHL f(/"///UNh, APPROVED
Imo -• • l DATF /✓�3
N
Z •
O •
I— I hereby acknowledge that I have read this application and state �fATE '
that the above information is correct and agree to comply with /
CC all laws regulating building construction, and I shall not employ /••t 0
I •' any person in violation of the workman's compensation laws of 01
N the State of California. to
Z TAX O
I hereby certify that I am properly licensed as a contractor under SO. FT. o
the State of Calif() nia Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9,and t such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: a
rc
am exempt fro provisions of th State of California usiness VALUATION
and Professions e, Division 3,Ch ter 9. co
• //I�� PERMIT FEE $ 12r CO DN
oCCJ N
Signature of ''I- m
Permittee //i fi -Let $—jft• 'r m y PLAN CHECK $ 4•LSC/ o
Authorized Agent ` � / 81.6Q LL
TOTAL FEE $
OWNER 1ST LOS Angeles Corporation DATE 3_�3_72
JOB ADDRESS 2712 Skylark Circle BUILDING PERMIT NO. 34304
GENERAL CONTRACTOR The Buccola Co. DESCRIPTION of WORK Res.w/att.garage
AP No. LOT 55 TRACT 6663 FIRE ZONE . VALUE $37. 350.00
INSPECTIONS Si-nature Date GROUP I&J TYPE V ZONE 13-1
SOIL " LI 72 SUBCONTRACTOR PERMITS ISSUED
-
GAS 1,r/ Date Number Signature
WATERNyi✓/Jyic�7/ ))�� _o ��� Plum In ///� �-y/-�-/�
ROUGH PLUMBING i//S p IS`7Y /rQ /��(�af®il(,G'K/,[1 a%/�G/4£&2 6./
PROP. SWR. LINE Q HOUSE CON. /j 7 47-‘71-- '�S9J r. D 2,-72 tia/f//0
SPRINKLING SYSTEM O�
MISCELLANEOUS
ROUGH HEATING AND AIR CONDITIONING Ma 2/e )1.."
TEMPORARY SERVICE OR POLE
UNDERGROUND ❑ POWER ❑
ROUGH WIRING d _ $f/bt 14- heating and Vent.dd,,aa,,tt��
TRENCHES°i FORMS is. STEEL REINF. zJ,y'' f %SG �d ` y�/O7-)a 7Q ,..,"--
FLOOR
FLOOR SYSTEM t- /g 'J'Jp(D/.('Q C[/ 7-/I-7g In
BOND BEAM fl STEEL REINFORCE n ,/ 4
SHEATHING
FRAME AND FLASHI te
y ,`YLATHING IN OUT 9 L%//PLASTER, BROWN COAT - CO
STRUCTURAL, FINAL '1-4-'7240a irla
HEATING, VENT., REFRIG. AND A.C., FINAL Al /II � , 7241_72' 91/48d�'
PLUMBING, FINAL ANO GAS TEST n ��' /�L / t�
ELECTRIC, FINAL - /0/'rt)t_
null nING FIRIAI i n 7(1rle"'
PLAN NO. 10BR
LOT NO. 55 34304 h„ PAID
22-7200 927* ***184.37
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely
REC203 Y DATE EIVDATE ISSUED
BUILDING a IY3r/j_7
ADDRESS a,.2 772- Skylark Circle
PERMITf�1Q.e ^
OWNER 1st Los Angeles Corporation A.P. NO. 4 S
MAIL BUILDING -7
ADDRESS 01 Wilshire @ Grand ADDRESS///2 SKyc✓J.e/t. C/Lct6
Z //// L
-0 CITY Los Angeles nN O.625-7341 TRACT ‘b b� LOTJ,� BLOCK
zC CONSTRUCTION NEW ADD ALTER REPAIR MOVING DEMOLISH
O N LENDER 1st Los Angeles Corporation ✓
am
J D BRANCH
J N OWNER Sr Z L-G9?ie•
m J ADDRESS#1 Wilshire @ Grand - / 7 �•�'� n� VALUE 32)J m .ARCHITECT TE USE '9/ Liv/ � 2_o $ 0
QOR ENGINEER Earl -G. Kaltenbach No`547-8046U N FIRE ,//W M ADDRESS1823 E. 17th, Santa Ana ZONE TYPE i! GROUP ,
d Ly [ APPROVED
J
Z CONTRACTORThe BUCCola Company BY DATE
m Z
J cc ADDRESS45O1 Birch Street
W ZONE NO.OF USE OF NEWteX. G✓/q77-
0= TEL. i _ PLANS BUILDING
.2
CITY Newport Beach No.540-8833 - 3CA.e6:4/2.
w 0 STATE CITY YARDS APPROVED YARDS APPROVED
cn 2 LIC. NO. 146423 LIC. NO. 2104 MAIN BUILDINGACCESSORY BUILDING
M C/L STREET)
7 O OF LOT 831 x 991 IRR I NOW ON LOTSIZE Na OF BLS OFRONT• I FT. 710 zr L. FT.
USE OF
EXISTING BLDG. EL SLOE a 0 FT. FT.
F SIZE OF NO.OF FT.
2 NEW BLDG2z465 sq, ft ROOMS LL STORIES 2 _
EXTERIOR WALL ROOF
U
_ COVERING COVERING Shake REAR 21 FT. FT.
—I USE OF BUILDING AND WORK TO BE PERFORMED • BET. MAIN& -
d
MAIN 0 ••. ACCESS.BLOTS.
Q friC /af DATE
0 � APPROVED [//'7
NAPPROVED / DATE / /.:71---
p • • ' REQUIREMENTS
r /
UI hereby acknowledge that I have read this application and state STATE ` 797
that the above information is correct and agree to comply with
all laws regulating building construction, and I shall not employ / y f �jltr�
I— any person in violation of the workman's compensation laws of i (� (p”
N the State of California. N
I hereby certify that am •properly licensed as a contractor under �S Q..FT. — o
the State of California Business and Professions Code, Divisicn 3, THE A c . OWN UNDER VALUATION IS FOR m
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: a
am exempt from the provisions of the State of California Business VALUATION
and Professions Code, Div ion 3,Chapter 9. m/s
PERMIT FEE $ N
Signature of 7 at
Permittee �� $ 3 /, .3 PLAN CHECK $ 61:0',...) E
J/� o
Authorized Agent
TOTAL FEE $ O- / y 0 's PIC LI-