HomeMy WebLinkAbout992 SPRINGFIELD ST - Building Permits( �
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 992 SPRINGFIELD ST
Suite No
Vicinity:
Parcel Nunmber: 14172411
Applicant: SCOTT, JEANNETTE
Address: 502 S LYON ST "
SANTA ANA, CA
Owner: NILI, ROBBIN A
Address 992 SPRINGFIELD ST
, COSTA MESA, CA
Contractor: COLLIGAN WATER
Address: 502 S LYON ST �
� SANTA ANA, CA
Arch / Eng : ,
Address:
PLUMBING PERMIT
Phone: 774-750-2233
Zip: 9270'I
Phone:
Zip: � 92626
Phone: 714-750-2233
Zip: 92701
License: 663091
Phone:
Zip:
License: � �
Status: ISSUED
Applied: 03/26/2004
Issued: 04/15/2004
ISSUED BY:
SCOPE OF PERMIT
� INSTALL NEW WATER SOFTNER. -
� � ' � ,'=FEE SUMMARY „ � '
c� � � � AMT � QTY . � �� . ' AMT QTY , AMT QTY
ISSUE FEE � $23.50 � � , Laundry Tub / Washer $0.00- � 0 . , - Sump Pump $0.00 0
Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 � Swimming Pool . $0.00 0
BackFlow Preventer $0.00 0 P-Trap �$0.00 0 Trap Pnmer � , $0.00 0
Bathtub .$0.00 0 Pressure Regulator � $0.00 0 . Urinal � � $0.00 0
Clarifier System � $0.00 0 � �Process Piping (per 10 ft)> �$0.00 . 0. �_ ' Vacuum Brkr BkFlbw(1-4) $0.00 0
Connect pce,Soda,etc) $0.00 0 � Recepto�s` � . - $0.00 0 - . � Vacuum BrkcBkFlow(5+) $0.00 0
Dental Units � ' $0.00 - � - 0 � Septic Tank : $0.00 0 . Wash Basin� $0.00 0
Dishwasher ��'� $0.00 � 0 . Sewer Cap for Demo $0.00- 0 � Wash Basin�Set $0.00 0
Drain, Floor $0.00 0 Sewer Connect �' �� $0.00 .0 � Waste andVent System $0.00 0
Orain, Rainwater $0.00 0 Sewer Private Line $0.00 ��- 0 � Wate� Closet (Toilet) $0.00 0
Drain, Roof $0.00 0 Shower , $0.00 0 Water Heater / vent 50.00 0
Drinking Fountain $0.00 0 � �Sink, bar $0.00 0 �- Water Piping (Inst or Rep.) $0.00 0
Ezpansion Tank $0.00 0 Sink, commercial . $0.00 ` 0 Water Re-pipe $0.00 0 �
Gas Earthquake Valve $0.00 0 Sink, Floor - $0.00 0 Water Service $0.00 0
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 tor tha work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspeetions and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of ihis permit.
FOR INSPECTIONS CALL: (714) 7545626
2446dfi (6/00)
WORKERS'COMPENSATION DECLARATON:
I hereby attirm untler penalty of perjury one of the foliowing declarations:
❑ I have and will mainlain a carliticate ot consent to self-Insure tor workere'trompensation, es provide0 for Oy section 3700 ot Ihe Lebor Code, lor the peAormence oi Ihe
ork tor whiCh IhiS pertnit is issuetl.
I have entl will maintain workers' compensation insurence, as requiretl by section 3700 of the Labor Code, for the pedortnance of the work lor which this pertnil Is issued.
My workers' compensation Insuwnce carder and policy number are:
Carrier: Policy Num�er:
(Th/s section need not be cromplered il fhe permif is velued et one hundred dollars ($100) oNess.)
❑ I certify Ihat in ihe peAormance of the work for which this pertnit is issueQ I shall not employ eny person in any manner so as to become suDject to ihe workers'
compansetion laws of Californie, and agrea ihat if I should 6ecome subjett to Ihe workers' compensation provisions of Section 3700 of the Labor CoOe, I shall forthwith
comply with ihesa provisions. /�
ApDlicent Signature: � Dete: � r j�— V�
WARNING: FAILURE TO SEC ORKERS' CAMPENSATIIXJ CAVERAGE IS UNLAWFUL AND SNALL SUBJECT AN EMPLOYER TO CflIMINAL PENALTIES AND GVIL FINES UP TOONE HUNORED
TFIOUSANDWLLAFE�51 ),INADDITIONTOTHECOSTOFCOMPENSATION,OANAGESASPfiOVIOEDFORINSECTION3lO60FTHELABOqCOOE,IMEREST,ANDAiiORNE1^SFEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aNirm that I am licensetl under provisions of Chapter 9(commencing with Section 7000) of Division 3 ot Ihe Business and Professions Code, anA my license is in full
torca end ettect. Uc. a � „ � . D Class N
Contractofs Signature:
CONSTRUCTION LENO
❑ I hereby aHirm thai
Lenders Name:
Signature:
Date:
is a construction lending agency tor ihe peAormance of ihe work tor which ihis pertni� is issued. (Sec. 3097, Civil Code).
Lenders Address:
Date:
OWNER-BUILDEP DECLARATIONS:
I hereby atfirm thet untler penalry ot perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for ihe tollowing reason (Sec. 7031.5, Business end Professions
Code: Any ciry or counry which requires e permit to construct, alter, improve, demolish, or repair any structure, pnor to its issuance, also requires the epplicaN tor such pertnit
to file e signed statement that he or she is licensetl pursuant to the provisions of the Contractors License Lew (Chapier 9(commencing with Section 7000) oi Division 3 of the
Business antl Professions Code) or Ihat he or she is eaempt therefrom and the basis lor Ihe alleged exemption. Any violetion of Section 7031.5 by any applicant for a pertnit
subjects ihe epplicant to e civil penelry of not more ihan five hundrad dollars ($500).):
❑ 1, as owner of ihe pmperty, or my amployees with wages as Iheir sole compensation, WILL DO THE WORK, antl the structure is not intentled or ofleretl for sale (Sec.
7044, Business an0 Professions Code: The Contractors License Law does not apply to an owner of properry who builtls or improves Ihereon, and who tloes such work
himself or herself or ihrough his or her own employees, prwided that such improvemenis are no� intended or otteretl for sale. If, however, �ha builtling or improvement is
sold within ona year of completion, iha owner-builder will have ihe burden of proving that he or she did not build or improve for purpose of sale.).
❑ I, as owner ol the property, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 704d, Business antl Professions
Code: The coniractors License Lew tloes not apply to an owner ol property who builtls or improves ihereon, and who coniracis for such pmject with e coNractor(s)
license pursuant to the Conirecbrs License Laws.).
❑ I am ezempt untler sec. Business and Protessions Code for this reason:
Signature: Date:
Owner ID verilied by drivets license. ❑ Ves ❑ No Drivers License No.
Verification of Ownership by (type of tlocument, i.e. - property taz �ill or tleed):
Expires:
DIVISION OF INDUS7RIAL SAFETV PERMR CERTFICATON:
❑ I hereby certiy ihat no excavation five (5) or more feet in depih into which e person is required to tlescend will be made in connection with work authonzetl by this
permit, and that no builtlinq sWCWre, scaMolding, falsework, or demolition or dismantling ihereot, will be more than thirry-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title 8, Califomia Atlministretive Code).
❑ As owner�builder, I wiil not employ anyone to do work which would require a permil from Ihe Division ot Intlusirial Safety, as notetl above, unless such person has e
permii to tlo such work trom the division.
Signature: Date:
Division ol Industrial Safery Permit Number:
CERTIFICATE OF COMPLIANCE AND AUTHORIZA710N OF EMAY: I certify under penalty of perjury that I have read ihis ap0�ication and state Ihat ihe information given is
wrrect. I agree to comply with all state laws and ciry ortlinances relating to builtling construction, and authorize representatives ol Ihe Ciry of Costa Mesa to enter upon Ihe
ebove-tlescnbed property for inspection purposes. I agree not to occupy or allow occupancy of any building authonzed by this permit until final inspection.
Legal
COOFiI. IHSPEC110N TYPE
7616 Fixetl System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Roof
201 Final Block/Re�aining Wail
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition
Q� INTIfIALS �ODEt �NSPECTONTYPE
206 Final Mechanical
�g �
208 FinalPlumbing ��7�`�
210 Final Electncal
212 Finel Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.�{�LDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
JobAddress: 992 SPRINGFIELDST
Suite:
Vicinity: BATHROOM
Parcel Number: 14172411
Applicant: ALLEN BAILEY
Address: 310 S JEFFERSON
SUITE 52-F
PLACENTIA, CA � -" �
Owner: NILI; ROBBIN A
Address 992 SPRINGFIELD ST
COSTA MESA, CA
Contractor. ALLEN BAILEY
Address: 310 S JEFPERSON
SUITE 52-F
PLACENTIA, CA
Zip: 92870
Arch :
Address:
Zip:
Zoning: R1 R1
Phone: 714-336-3462
Zip: 92870
Phone:
' � Zip: 92626 . ,
Phone: 714-336-3462
License: 777542
Eng:
� � Address:
Phone:
License:
Status: ISSUED
Applied: 10/20/2003
Issued: 10/20/2003
ISSUED BY:
Phone:
License:
SCOPE OF PERMIT
REMOVE EXISTING, INTERIOR, NON-LOAD BEARING WALL TO EXPAND EXISTING SHOWER AND REMODEL BATHROOM. RELOCATE :
EXISTING FIXTURES ONLY. ' � - - - - ' - � � � � � ,
Plan Check:
Permit:
� SMIP Res:
SMIP Com:
� � ' Other: `�
Inspection:
�.,
Total:
$117.81
$181.25
$0.92
$0.00
�$0.00
$0.00
$299.98
SETBACKS,
MAIN STRUCTURE Front 0- 0
�. .
ACCESSORY Front . 0-.0
PARKING Ezistin t ' 0
FEESUMMARY
- Calc Valuation: $s,zoo.00
Claim Valuation: Ss,zoo.00
_�r:v. � .-..
� _
PLANNING & ZONING
Rear 0-0 � . Left 0-0 Right
�' Rear 0- 0 Left 0- 0 Right
Required: 0 Proposed: 0
0-, 0
0- 0
NOTICE: The work authorized by ihis 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
requlred inapectlona and finel approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
zms-as (aoo)
. .
WORKERS' COMPENSATION DECLARATION: I '
I he�eby aHirm under penalry of perjury one oi ihe following declarations:
❑ I heve antl wlll maintain a certiticata ot consent to self-Insure for workers' compensation, es provided for by section 3700 oi the Labor Code, for the perfortnence of the
work for w�ith lhls permit Is issuetl. I
❑ I have flnd will maintain workers' compensation insurance, as required by section 3700 oi Ne Labor Code, Por ihe perforr�ance of the work for which this pertnit Is Issued.
My workers' compensatlon Insurance rarrler and policy number ere:
Cerrier. Palicy Number:
(This sectlon need not be comp/ered i! the permit !s value0 at one hundred dollers ($100J or less.) I
� I certity that in the peAormance of the work for which this pertnit is issued, I shall not employ any parson in any manner so es to bacome subject lo the workers'
wmpensation laws ot Celitomla, end agree that it I should become sub�ect to Ihe workers' compensation proWsions oi Section 3700 of the Labor Coda, I shell forthwith
comDly with these prov/isigpq��
6�
Applicen� SlgnaNre: Date: � � •7�/�^O �
WAqNINa: FAILURE TO SECURE WOflKERS' COMPENSATION COVERAGE IS UNIAWFUL PND SHALL SUBIECT AN EMPLOVER TO CFIM�NAL PENALTIE D GVIL FlNES UP TOONE HUNDRED
T!K%1SMID DOLLARE (5100,OW�.IN ADDRION TO THE CQST OF COMPENSATION, DAMAGES AS PflOVIDED F-0R IN SECTION 3]O60F THE UBOR CODE, IMEREST, AND ATTORNEY'S fEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirm ihat I em licensed under provisions of Chapter 9(commencinq with Section 7000) of Divislon 3 of the Busin I s a9d� rofessions Cotle, entl my license is in full
force and ettact. uc. » ' 77 S`/ Z class a I P3
ContractoYs Signature: �f�/l3 Date: I /O `20 – 03
CONSTRUCTION LENDING AGENCY: I
❑ I hereby aflirm that Ihera is a consiruction lending agency for the performance ot t�e work for which this pertni� is issuid. (Sec. 3097, Civil Code).
Lentlefs Neme: Lender's Address:
Slgnature: Dete:
I
OWNER-BUILDER DECLARATIONS:
I hereby aflirtn Ihat under penelry of perjury that I am EXEMPT FROM 7HE CON7RACTORS LICENSE LAW for Ihe tollow I g reason (Sea 7031.5, Business antl Professions
Cotle: Any ciry or counry which requires e permit to consWct, alter, improve, tlemolish, or repair eny swcture, prior to its issuence, also requires the epplicant for such permil
to file e signee statement thet he or she Is licensed pursuent to ihe provisions of the Conirectors License Law (Chapter 9(commencing with SecNon 7000j of Divlsion 3 of the
Business end Professions Code) or that he or she is exempt therefrom and the basis lor ihe allegatl e:emption. Any violatii n of Sactian 7031.5 by eny epplicant for e permit
sublecls the epplicant to a civil penalry oi not more ihan tive hundred dollars ($500).):
❑ I, as owner of the propetly, or my employees wiih weges as their sole compensation, WILL DO 7HE WORK, and the stmcture Is not intendetl ar atteretl for sale (Sec.
7044, Business and Protessions Cotle: The Coniractors License Law does not apply to an owner of properry who build's or improves Ihereon, end who tloes such work
himsetl or herseN or through his or �er own employees, pmvitled that such improvemems ere not intentletl or oNered tor sale. It, however, the building or improvement is
sold within one year of completion, the owner-builder will have the burtlen of proving that he or she did not 6uild or imDja�e for purpose oi sale.). '
❑ I, as owner of the property, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to consiruct the {�rojact (Sec. 7044, Business and Professions
Code: The contrectors License Law tloes not apply to en owner of property who builds or Improves thereon, and who cl Nracis for such project wiih e contrector(s)
license pursuam to ihe Contrectors License LawsJ.
I em e:empt d c. Business antl Professions Code for ihis reason:
ignature: ���i'�—
ExPires: �-Zf3–OfS
Verification of OwnerShip by (rype of doament, i.e. � propeny lex bill or deea): �
i
DIVISION OF INDUSTHIAL SAFETY PERMIT CERTIFICATION: I
❑ I hereby certify that no excavetion five (5) or mora teei in depth into which a person Is raquired to descend, will be made in connection wiih work euthorized by this
permit, end ihat no building structure, scaflolding, talsework, or demolition or tlismantling Ihereof, will be more than ihirty-six (36) teet high. (Chap. 32, Grp 2, An 2, Sec.
341, Ttle B, California Atlministrativa Catle). I
❑ As owner-builder, I will not employ enyone to tlo work which would require a permit irom the Division oi Indusinal Setety, as notetl above, unless such person hes e
permil to do such work tmm Ihe division. I
SignaNre: Date:
Division of Industnal Sefery Permit Number: I
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
7 Will the epplicam or present or tuture builtling occupani neetl to tile and certity a Busineu Plan tor emergency respons II to release or threatenetl releese of e hazartlous
materlell ❑ Yes ❑ No
(Section 25505 of Ihe Califomia Health and Sefery Code requires, with some ezceptions, ihat a Business Plen be tiletl with ihe Costa Mesa Fire Department by every
business which has at any ona time dunng a reportetl year a quan�iry of hazardous matenals equal �o or greater t�an a�weight ot 500 pountls, or e volume o155 gallons,
or 200 cubic feet ot compressad gas et standard temperaWre and pressure). �
............................................................................................................................................................................................................................................................................... _...........................................................................................................
2 Does or will the applicam or present or future building wcupant neetl to tile e regisiration fortn for acutely hazartlous meterlals7 ❑ Yes ❑ No
i
(Sectlon 25533 of Ihe Califomla Health end Safery Cotla, wlih some exceptions, requires registration with the Casta Mese Fire Depertment by each business whlch at any
one time has on hflnd a quanliry ol ecutely hazerdous materials equal to or greeter lhan e weight of 500 pountls, or a volume of 55 gallons, or 200 cublc feel of
wmpressetl gas et standartl temperature antl pressure). �
..............__............................................................................................................................................................................................................................................_................�...........................................................................................................
3 Does or wi0 the appliCaM or presenl or fuNre building ocCupan� need to prepare an RMPP (Risk Manegemen� end Prevei tion Program for ecutety hazerdous matenals)7
❑ Yes ❑ No
(Section 25534 of Ihe Califomia Health antl Safery Cotle provides Ihat ihe Costa Mesa Fire Department may require Ihe preparation, cerliticeiion end tiling with the Fire
Department of an RMPP by businesses which ere required to register acutety hazardous marerials with the Fire Department.
................................................................................................................................................................................................................................................................................�...........................................................................................................
4 II an RMPP is Oresenily required, hes Section 25534 of the California Healih end Safety Cotle been tully complietl with7 � � Yes ❑ No
..................._.........................._............._.................._................_......................................�............................................................................................._................................._.................................................................._......................................
5 Does or will Ihe epplicant or presant or tuture building occupant require for Ihe work which is Ihe subjecl ot this �plication apermi� for such conswction or motliiicatlon
from Ihe South Coest Air Oualiry Management Disinct or from any other eir pollution cnnirol tllSMct or egency7 LJ Yes I LJ NO
(Section 658502 ot lhe Celitomia Govemment Code requires that the requeste0 iniortnation De tumishetl on applications for non-resitlentiel builtling permit5).
.........................................................................................__ .............................._..............................................................................._____.._................_...... ....................... ........................................................._........
6 W ill any pan ot the faciliry lo be conswcted under this pertnii be within 1000 teet tmm the outer bounderies of a school? I 0 Yes � No
pf'yes", t�e faciliry must meet Ihe requirement of Seciions 25534 antl 42303 oi ihe Calitornie Health and Safery Cotle).
.................... ...... .... .......................... . .........................................................................................................................................._.................................
7 If e permit irom the South Coast Air �uality Menegement DisMct or olher eir pallution control disMct or agency is reQuirad for Ihe work which is the subjed of thls
.applicallon..haveellofthe.disclosures.prescribed_byCalifomia.Healthantl.Satery.Cotle_Section42303,beenmade7 .�.Yes .�,No
8 pl yes", anach certihcate of compliance trom the appropnete av pollmion wmrol oHicer). I
CERTIFICATE OF COMPLIANCE: I ce�ity ihat under penalty ot perlury ihe informetion given above is correct. I agree II comply with all stete laws and ciry ordinances
regarding Hazartlous Matenals antl Emissions.
Signawre: Date:
CERf1FlCATE OF CAMPIJANCE AND AUTHORIZA710N OF ENTRY: I certity under penalry of perjury that I have read this aDD�ication and state that ihe intormation given is
wrrect. I egree to comply wlih all s�ate laws antl ciry ortlinences relating to bulltling construction, end auihorize representatiJes of Ihe Ciry of Coste Mesa to enter upon the
above-descnbed Oroperty for inspection purposes. I agree not to occupy or allow occupancy of any building euthorized by this iermit unlil tinal inspection.
/jy / gnaWre Of Legal Owner s__ /� I1 Zv De��
C(� AnNOr Authodzed ApDliwnt I Date
COpE I. INSPECTIONTYPE [Id¢ ��Q FQQf,j INSPECTIONTYPE QS¢, �
1616 Fized System Final Fire Prevention 2o6 Final Mechanicel
1266 Pool Spe Finel 20B Final Plumbing
200 Final Re-Roof 210 Final Electnwl
201 Finel Black/Retaining Well 212 Finel Flre Prevention
202 Final Factory Fire Place 220 Final Planning Approvel
203 Finel Sign 222 Final Site
204 Finel Demolition � 250 Final BuildinyOccupancy f�-0�%�0 �J �
I
(714) 754-5273 • Fax (774) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COS7A MESA, CA 92626
PLUMBING PERMIT
Job Address: 992 SPRINGFIELD ST
Suite No
Vicinity:
Parcel Nunmber: 14172411
Applicant: ALLEN BAILEY
Address: 310 S JEFFEf2SON
SUITE 52-F
PLACENTIA, CA
Owner. �NILI, ROBBIN A, .
Address 992 SPRINGFIELD ST
COSTA MESA, CA
Contractor: ALLEN BAILEY
Address: 370SJEFFERSON
SUITE 52-F
PLACENTIA, CA
Arch / Eng :
Address:
Phone: 714336-3462
Zip: 92870
Phone:
Zip: 92626
Phone: 7143363462
Zip: 92670
License: 777542
Phone:
Zip: '
ticense:
Status: ISSUED
Applied: 10/20/2003
lssued: 70/20/2003
ISSUED BY:
� �
i
SCOPE OF PERMIT
REMOVE EXISTING, INTERIOR, NON-LOAD BEARWG WALL TO EXPAND EXISTMG SHOWER'AND � -
REMODEL BATHROOM. RELOCATE EXISTING FIXTURES ONLY. REF.: B03-01827 .,� ' ,-
PLUMBING TO INCLUDE: RELOCATEI SHOVJER. � � - ." .
ISSUE FEE
Backflow irrigation
Backflow Preventer � �
Bathtub .
Clarifier System
Connect Qce,Soda,etc)
Dental Units
Dishwasher
Drain, Floor
Drain, Rainwater
Drain, Roof
AMT
$23.50
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
FEE SUMMARY
QTY AMT
Laundry Tub / Washer $0.00
0 Landscape Irrigation $0.00
0 P-Trap � $0.00
0 Pressure Regulator $0.00
0 .Process Piping (per 70 ft) $0.00
0� Receptors . . $0.00
0 . Septic Tank $0.00
0 Sewer Cap for Demo $0.00
0 Sewer Cannect � $0.00
0 Sewer Privale Line $0.00
0 Shower � $9.80
�
aTY AMT
0 , Sump Pump - ` � ! $0.00
0 Swiriiming Pool i� $0.00
0 - , Twp Primer � $0.00
0 " � Urinal � ' - $0.00
0 . Vacuum Brkr BkFlow(1-4) $0.00
0 Vacuum Brkr Bkflow(5+) $0.00
0 � Wash Basin $9.80
0 Wash Basin Set $0.00
0 Waste and Vent System $0.00
0 � ' Water Closet (Toilet) $9.80
1 Water Heater / vent $0.00
QTY
0
0
0
0
0
0
1
0
0
1
0
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 o( 760 days.
INSPEC710NS: In order tor the work auihorized urWer this permit to tre considered legal, such work must comply with all applicable codes, antl al!
required Inspeetlona and final approval must be obtained. Failure to obtain inspections and tinal approval will result in ihe expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
244&d6 (6/00)
WORKERS' COMPENSATION DECLARATION: �
I hereby eftirm untler penelry of perjury one of the following daclarations: '
❑ I heva entl will malnlain a certificate of consant to se&Insure for workere' compensation, as provided for by section 3700 ot the Lebor Cotle, tor the pertormance ot ihe
wOrk for which lhi5 permit i5 iuued.
❑ I heve flnd will maintein workers' compensetion insurance, as required by section 3700 of Ihe Lebor Cotle, for the peAortnance of ihe work tor which this permit is issued.
My workera' wmpensatlon Insurence cerrler and policy number ere:
Carrier: � Policy Number:
(This section nee0 not be crompleted ll the permiNs velued et one hundred dol/ers ($100) ar less.)
�� certih/ that in lhe pertormance of the work for which this pertnit is issued, I shall not employ any person in any manner so as to become subject to the workers
wmpensatian laws oi Calitomia, entl agree that If I s�ould becoma subject to Ihe workers' compensation provisions of Sectlon 3700 ot the Labor Code, I shall ionhwith
�' comply wilh lhese pmvisi/opa��/.'
ApplicentSigne�ure: G/ /J ���J9�—� - Date: ��'���—d �
WARNING: FAILURE TO SECURE WO ( RS' MPENSATIIXJ COVERAGE IS UNLAWFUL AND SHALL SlIB1ECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNORED
Ti%)USAND DOl1ARE (5100,000), IN ADDITIIXJ TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 31060F THE LABOR CODE, ItJrEREST, AND ATTOPNEI^5 FEES.
LICENSED CONTRACTORS DECLAPATION:
I hereby attirm that I am licensed untler provisions of Chap�er 9(commencing with Section 7000) of Division 3 ot the Business�3j�d Professions Code, and my license Is In full
torce antl eHecL Lia k 7 77 Class a i5
ConlractorsSigneWre: �Q/ Date: /0 �i0^O �t
CONSTRUCTION LENDING AGENCY:
❑ I hereby aMirtn that there is a consiruction lentling agency For the pertormance of the work to� whic� this permit is issued. (Sac. 3097, Civil Code).
Lender's Name: Lender's Adtlress:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby aHirtn thet under penalry of pe7ury that I am EXEMPT FROM TME CON7RACTORS IICENSE LAW tor Ihe following reeson (Sec. 7031.5, Business antl Professlons
Code: Any ciry or counry which requires a permit to construct, alter, improve, demolish, or repair eny shucture, pnor to its issuance, also requires the epplicant for such permit
b file e signetl statement thet he or she is licensetl pursuent ro Iha provisions of Ihe Conirectors License Lew (C�epter 9(commencing with Sectlon 7000) of Divislon 3 of ihe
Business and Professions Cotle) or ihat he or she is eaempt iherefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by eny epplicant for e pertnit
su6jecls tha applicant to a civil penalry oi not more than tive hundred tlollars ($500).):
❑ I, es owner of the properry, or my employees with weges es Iheir sole compensatlon, WILL DO THE WORK, antl the structura is not intended or otteretl for sale (Sec.
7044, Business and Professions Code: The Coniractors License Law does not apply to an owner ot property who builtls or Improves ihereon, antl who tloes such work
himself or herself or through his or her own employees, provided that such improvemenis era not intended or oHaretl for sele. N, howevar, t�e huilding or improvement is
sold within one year of completion, the owner-builder will have ihe burden of proving that ha or she tlitl not build or improve for purpose of sale.). •
❑ I, as owner of the property, am EXCLUSIVELV CONTRACTNG WITH LICENSED CONTRACTORS to constmct the project (Sec. 7044, Business and Professions
Cotla: The coniractors Ucense Lew does not apply to en owner of propeny who builtls or Improves Ihereon, antl who coniracis for such projed with a contractor(s)
license pursuant to the Contractors License Wws.).
� I em e:empt under se. c. _
Siqnature: ���rl/��
Owner ID vanfietl by tlnver's license.
❑ No
Business and Professions Cotle for this reason:
Date: (Yi —2�/ —03
Dnvers License Na. � Expires: � 2.�s� aS
Venficatlon oi Ownership by (rype ot tlwumem, i.e. - property tae bill or tleed):
DIVISION OF INDUSTRIAL SAFETV VERMIT CERTIFICATION:
❑ I hereby certity Ihat no exwvetion tive (5) or more faet in depih into w�ich e person is required to descend, will be matle in connection wit� work authonzatl by �his
permit, antl that no building structure, scattoltling, falsework, or demolition or dismantling ihereof, will be mora then thirty-six (36) leet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title e, Califomie Adminisiretive Code).
❑ As owner-builder, I will not employ enyone to do work which woultl require a pertnit from the Division of Intlus�nal Safery, es noted above, unless such person hes e
permit to do such work from ihe division.
SignaWre: �ale:
Division at Industnel Safery Permit Number: _
CERTIFlCATE OF COMPLIANCE AND AUTHORIZATON OF ENTAY: I certity under penalry of perjury that I have reatl this application and state thet the information given is
correct I egree to comply wlth all stete laws entl ciry ordinences relating ro building conswction, entl authodze representatives of ihe City of Costa Mesa to enter upon ihe
ebove-tlescnbed properry for Inspection purposes. I agree not to occupy or allow occupancy of any Duilding euthorized by this permit until final inspection.
iy� /J ' re OI Legal Owner(s) 6 20-6 �1e
/ .O/G/ % �
S��� And/Or Authonzed Appl�cant Date
I CO�E 1, INSPECTIONTYPE
i676 Fl:ed System FinalFire Pravention
1266 Pool Spa Finel
200 Finel Re-Root
201 Final Block/Retaining Wall
202
203
204
Final FaCtory Fire Place
Final Sign
Final Demolition
pA7E I[�9L9
40UE� INSPECTIONTYPE
206 Final Machanical
208 Final Plumbing
210 Final Elecincal
212 Final Fire Preventlon
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
Q9IE It�lL$
ll-ao-n3 �S �
(714) 754-5273 • Fax (714) 754-4856 • ewiw.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job Address:
Suite:
Vicinity:
992 SPRINGFIELD ST
HOUSE & ATTACHED GARAGE
Parcel Number: 14172411
Applicant: GURNEA, SEAN
Address: 1013 E WALNUT ST
Owner:
Addres
i �
Contractor
Address
� "_
i-`_ _
SANTA ANA, CA - - ' �
NILI; ROBBIN A. � � '
s 992 SPRINGFIELD ST� . _-
' �COSTA MESA, CA'� �� ; ` � �
7/VEATHERLINE ROOFING INC
1013 E WALNUT ST
Zoning: R1 R1
Phone: (714) 731-3425
� Zip: 92701
Phone:
Zip: 92626
Phone: (774) 7313425
Status: ISSUED
Appiied: 12l17/2001
Issued: 12/17/2001
ISSUED BY:
- SANTA ANA,CA , � ' '
Zip:.: 92701� License: 729560 - . - � � �
Arch.: ��' . . , Eng: - _ . ,
Address: ��` ` ; Addiess:�. .� . .
� Phone:
Zip:
License:
� � � � Phone: , '
\ .
, � License: �
a�.�r� �r rcrtnu i �
-' REROOF EXISTING SINGLE-FAMILY RESIDENCE & ATTACHED�GARAGE (24 SQ). TEAR OFF EXISTING ROOFING &� , �
RESHEATH WITH il2" OSB. INSTALL 15# FELT UNDERLAYMENT�& REROOf WITH 30 YEAR ELK COMPOSITION � � ��
SHWGLES. ' -. , ' �
; � � _ _ � FEE SUMMARY%, �L �� � ��,. , r ` ,
� �� Plan Check: $0.00 � � � � Calc Valuation: �' a , � Ss;000.00�
Permit: $11t25 Claim Valuation: � $s,000.00
SMIP Res: $0.50
SMIP Com: $0.00
Othec $0.00
In`spection: � $0.00 _ � � -' - �
> _� �,.��
���Total: �5111.75,,� ' , ' �, '_ `_ - 'l
, , ,
SETBACKS '
MAINSTRUCTURE Front 0-0 ' Rear 0-0
ACCESSORY Front 0-0 � Rear 0-0
PARKWG Existin : 0 . �Requiretl: o
NOTES:
Lefl 0- 0
Lek 0- 0
Proposed: 0
�.� �� ;� .
� ` ' i
��
Right � �0-0 " "
Right , 0�0 �
�
NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-27-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under ihis permit to ba considered legal, such work must comply with all applicable codes, and all
requlred inepectlons and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
zawa �eroo�
WORKERS'COMPENSAnON DECLARAnON:
I hereby aHirm under penalry of parjury one oi the tollowing declaratlons: �
❑ I heve end will maintain e certiticate ot consent to selt-Insure for workers' wmpensation, es provided for by section 3700 of the Lebor Code, for the pertormance oi the
work tOr which ihispertnil is issuetl.
� I have antl will maintain workers' compensalion insurflnce, as required by section 3700 of the Lebor Code, for the peAortnance oi tha work for which this pertni[ is Issued.
_ My workers' ompe�tlon Ins ance cerriar antl policy number ere: �/� S q� �-�/.
Carrier." �-�4. Policy Number. �� �
(This secNon need nof be compleretl il the permit is velued ef one hundred dollars ($ f 00) or less.) �"-
❑ I certity that in the orman ot ihe work for which this pertnit is issueq I shall not employ any person in any manner so es to becoma sublect ro the workers'
compensatlon I s of Calllor ia, antl egrae i I should become sub�ect to t�e workers' compensatlon provisi tion 3700 of th Labo Code, I shall torihwith
complywiththe rovisio . �—' _
Applicant Signature: - _ � Date: � � � 6 '
WAqNING: FAILLIFIETQSF RKE PENSATION CAVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER ENALTI 5 AND 0 �IL FINES UP TO ONE HUNDRED
THOUSANOOOLLARE($100,000),INADDITIONTOTHECOSTOFfAMPENSATION,OAMAGESASPROVIDEDFORINSECTIQY31 ELABORCODE,INTEREST,ANDATTORNEV'SFEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aHirm ihat I am licensed under provisions ot Chapter 9(commencing with Section 7000) of Division 3 of ihe Business and Professions Code, and my license Is In full
torce and etted. Gc. M 3 Class p—� ��%
Co�ractofs Signafure: �� _ _../ i � Date:— _ �� - � 1—� �
CONSTRUCTION LENDING AGENCV:
❑ I hereby attirtn that there is a consiruction lentling agency for the peAormance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lendefs Name: Lentler's Atltlress:
Signature:
Da[e:
OWNER•BUILDER DECLARATIONS:
I hereby aMirtn Ihat untler penalry oi parjury that I em E%EMPT FROM THE CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business and Protesslons
Code: Any city or counry which requires a permit to consirucL alter, improve, demolish, or repair eny siructure, pnor lo its issuance, elso raquires iha applicant for such permit
to file a signetl statement Ihat he or she is Ilcensed pursuent to the provisions of the Contractors License Lew (Chepter 9(commencing with Saction 7000) of Division 3 oi the
Business end Protessions Code) or Ihat ha or she is ezempt fherefrom end the basis for the allegetl exemption. Any violation of Section 7031.5 by eny epplicant for e pertnit
subjecls Ihe appliwnt to a civil penelry of not more ihan five hundred tlollars ($500).):
❑ I, as owner of the property, or my employees with wages as iheir sole compensation, WILL DO THE WORK, and ihe structura is not intentletl or offeratl tor sale (Sec.
7044, Business and Pmfessions Cotle: The Coniractoro License Law dces not apply to an owner of property who builds or improves iheraon, antl who does such work
himself or herselt or ihrough his or her own employees, provitletl that such improvements are not intended or oHeretl for sale. If, however, the 6uiltling or improvement is
sold within one year oF completion, the owner-builder will have ihe burden ot proving thai he or she did not build or improve (or purpose ot sele.).
❑ I, 05 owner of the property, am E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consiruct Ihe project (Sec. 704d, Business and Professions
Cotle: The coniraqors License Law does not apply to an owner ol property who builtls or Improves thereon, and who wntwcts for such project with a contractor(s)
license pursuant to the Contrectors License Laws.).
❑ I am exempi under sec. Busine5s and Proteuions Code tor �his reason:
SignaWre: Da�e:
Owner ID veritied by dnvers licen58. ❑ VBS ❑ No Driver's LicenSe No.
Verificetlon of Ownership by (type of document, I.e. - property tax bill or deed):
DIVISION OF INDUS7pIAL SAFETY PERMR CERTIFICATION:
Expires:
❑ I hereby certily ihet no excevation five (5) or more feet in deplh into which e person is required to descend, will be made in connection with work euthadzed by this
permit, and ihat no building strucWre, sceMolding, falsework, or demolition or tlismantlinq thereof, will 6e more Ihan thirty-six (38) feet high. (Chap. 32, Gry 2, Art 2, Sec.
341, Title 8, Calitomia Atlministrative Code).
❑ A5 owner-Duilder, I will not employ anyone lo do work which would require e pertnit from the Division of Indusirial Safety, es notetl ebove, unless such person hes e
permit to d0 SUCh work trom Ihe diWsion.
Signature: Date:
Division ot Industnal Sefery Permit Number:
CERTIFlCATE OF AND AUTFiORIZATON OF ENfAY: I certify untler penalry oi perjury that I have read ihis application antl state that the inlortnetion given is
correct. I egr o comply with I s;ate laws end ciry ordinances relating to building construction, end authonze representatives ot ihe Ciry oi Costa Mese to enter upon Ihe
above-describe erty, nsDection purposes. I agree not to occupy or allow occupancy oi eny building euthorized by this permit until finel inspection.
COpE I, IMSPECTONTYPE pSjE INf1iIpL5
�%
1616 Fixed System FinalFire Preventlon
�1266 Pool Spa Final �t
200 Final Re-Rool %� ���V �
201 Final BIocWReiaining Well
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition
cooe� ixsvecnoxTvve
206 Final Mechanical
208 Final Plumbing
210 Final Elec�ncal
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 . FinalBuilding/Occupancy
GAg It�llLfl
276Q5
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 7200 COSTA MESA, CALIFORNIA 9T6RE
For Appl7canf ro F711 In Complataly _,
MAIL
iK�����,
a, s. Henryok „o�'j46-56
'� L1ard Place, Costa Mesa
�exris R, Schmid
sE� 25-���;�,h,00 1or , ,, °,: 10:;.5Ck
� ApPLICATION FOR PERMR
���; � BUILDINO .
�For Off(ce Use Only
ZONING
no.av _ uacorH�w
NO.
N0T6: NOGV60V[RXAN68HALLOHLE88TNAN
TH4 54ao96o 90' TO 8ID[ O RBAR P. L
N
— ee awvea
„oo;o�„tDOs. O ALLOWBD <U.B.G..REOUIR6MEN[1
YARDHAPPROVHD YARDSMPROVHD
MAIN BUILDINO ACCE850RY BUILDINO
LIX[ IROtl
�r srrticT 0� RBAR Y D lO �
RD I LHFT I� RIOlTT 7�
DE3CRIPTION OF WORK
). OR
�MH
ROOP
L V � Jv � [�:ora—� YN" ^ L
! HCrtCeY wG!(NOWL¢O06 TNAT 1 XAVB pHAD TH18 APPLICATION
AND BTI1T6 TXAT THC ABOV6 IY CORR[Gi AND AORB[ TO COM.
PLY WITX ALL CITY OPDINANC�/ AND iTl1T6 LI1WY R[OYUTIHO
BOILOINOCONBTRYCTION. N � J � "
AUTHORIZiD A6lNT
v,w. #
nwre
- J r � • • a
w
�
����y�.�. o�' �
0
TM8 I�MOUNT BMOW UNC6R VAIUI�TON t0 !OR TH6 �
•YPP06H OP [BTABLIBXINO A PlPMIi PE8 ONLY.
VALUATION �
� PERMITFEE G ��
s,;2/ 03P- 3 S� ,5 a w
TOTAL FEE " D�= �