HomeMy WebLinkAbout2181 STATE AVE - Building Permits .� , 1, CITY OF COSTA MESA _ j
• BUILDING DIVISION
4:
DECLARATIONS (. ) n
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penally 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 01 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:
Carrier: 1. Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.) /---'
I certify that in the pe.. ' ce.1 the 'rk for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation la.- of.a 3.mi a - ee that If I should become subject to the workers'compensation provisions of Section 370 of the Labor Code,I shall forthwith
comply with the pro si•r s. r / � / .�Date: 3 h 3 /
Applicant Signature: , / r4(/ (/
WARNING:FAILURE TO SECURE WORKERS COMPENSATION COVERAGE IS UNLAWFUL NO SHALL SUBJECT AN EMPLOYER TO CRI NAL PE TIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(5100.000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
1 hereby affirm that I am licens �r�rgfysipn • ./..er• 'ommencing with Section 1800)of Division 3 of the Business and P o ssions Code,and my license is In full
force and effect.Lic.# "•/ 1 f y/i Class# C� /314
,`
Contractors Signature: ' ' Date: �j 3 63 /----
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: 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 Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes ❑No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑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 Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes D 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 ❑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:
CERT1FICA •'ICOMP •• CE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
corre -g : t: co ith all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
ab c b.. '. ;r r' spection purposes.I agree not to occupy or allow occupancy of any building authorized by t _permit ntil final inspection.
_ 0 03
mrimum ignature Of Legal Owner(s) / 30 0, ate
And/Or Authorized Applicant Date e'
CODE I INSPECTIONTYPE PATE 1NTRIALS CODE( )NSPECDON TYPE PAIL EMU
1616 Fixed System Final Fire Prevention 206 Final Mechanical
•
1266 Pool Spa Final {� 208 Final Plumbing
200 Final Re-Roof G-[/�"V 3 � 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
PRWECT AODRESSi 2181 STATE AV -- UNIT: - " -- , - -• CITY OF COSTA MESA. - BUILDING- PERMIT - - PERM NO: B 046860- •
-
OWNER'SNAME: DEBORAN -J. COLLINS . • ' - ' - . . 'r. 4 - • ';, t
a00REss: 2181 STATE AV. - •
PERMIT NO: 'B :046860 •
PLAN •CHECK NO: N • - ' GOVT: N -SUPP:' N
COSTA MESA •• •• - -
CA-92627 • •
CONSTRUCTION TYPE:, 5-N .PERMIT TYP,E: ' STR PURPOSE: 0TH
• (7.1'4 )722-7734 , '
• ARCH/ENGINEER: REG.NO.:• - • JOB DESCRIPTION : WINDOW CHANGE OUT , -• SQ FT: 1 , 300
ADDRESS - = ' ' UNIT: CLAIM VALUE:' - • 1 , 300 ,00 CALL-VALUE 1, 300, 00 ' GROUP OCC: R-3- /'
PERMITTEE: DEBORAN -J.• COLLINS (714 ) 722-7734 - • • • .• ' •
ADDRESS: 2181 STATE AV COMMENTS: SMOKE DETECTORS) RE�UIRED IN HOME,
COSTA MESA f - CA 92627 •- - + ******+E****EL**�ESe�r************ Ee**+r+E*****�L�Lririt�r***************x•�k*�t***+t*+F+t*if EE**�F •
°
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONIN G; R E Q UIREMENTS .
• 7000)of.Division 3 of the-Business and Professions Code,and my license is in full force and effect 1 a _SETBACK 'S . -
•
CITY uc.: . . STATE UC.: CLASS:• MAINS BUILDING - ACCESSORY BUILDING,. ' •
Date: Signature: • , ' FRNT: . FT ••IN' REAR: - FT IN FRNT: FT IN REAR: FT • IN. .
WORKERS'COMPENSATION DECLARATION: I herebyaffirm that I have a certificate of consent in self-insure or a certificate of Workers ' LEFT: FT IN RGHT: ' FT IN, , LEFT: : FT. • IN RGHT: ' FT IN.•
Compensation Insurance,or a certified copy thereof(Section 3800,Lab.C). , . .• • -
y ucYNo.: EXP.DATE: PARKING REQ: PROV: PARCEL: 42242104 ZNE: • REF NO: •
-?• $PANY: •
• 'WCenirea coPLANNING NOTES> ' " -
pyt is hereby furnished. ❑ Certified copy is filed with the city Building Division. >
Date: Applicant - r'
EFT: FT IN ', SERVICESS R E Q U I R E M E N T S
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION• : (This section need not be completed if the permit is for one hundred($100)or less). , ""{ 't•;
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 ZONING APPROVED IBY' - • , DATE: +..• '
subject to the Workers'Compensation Laws of California. - _ ,
•
Date: ' ' -- Signature: - BUILDING APPROVED BY : • - - - - DATE: '
NOTICE:If,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor -
Code,you must forthwith comply with such provisions or this permit_shall be deemed revoked. •
APPLICATION ISSUE , BY •
DATE: 7/y
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for ************************ **** * #iF�k****************** **/flF *
D ** •
which this permit is issued(Section 3097,Civ.C). •
**************************** ************ *************************jf**********
ADDRESS: •
- LEGALIZATION:N - e `F 'E E - SUMMARY STRUCTURAL .SEGMENT.:Y -.-
OWNER BUILDER DECLARATION: hereby affirm th•at I am exempt from the Contractors'State License Law for the following reason•
HLDU ?MT PLUMP ING - ELECTRIC MECHANIC FIRE SM I P/RES ,, GRADING
(Section 7031.5 Business and Professional Code:--Any city of county which requires•a permit to construct,alter,improve,demolish,or' PERMIT 31 ,00 S U
repair any structure,prior to its issuance,also requires the applicant for such permit to tile a signed statement that he/she is licensed - - SHIP/NON—RES
$ pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business : PLAN . - . .. • '
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of.Section 7031.5 by ISSUE FEE • •
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500): ` t •
BUILDING •' PERMIT •• ISSUE - PLAN-CHECK TOTAL - PAID DUE
I, as owner of the property or•my employees with wages as:their sole compensation, wit do the work, and the I TOTALS----> • ' - 31 . 50 - '0 . 00 • 0 . 00, 31 . 50 11 . 50 ' .0.0
'•❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law '.
tloes not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through - -
• his or her own employees,provided that such improvements are not intended or offered for sale. If.however the building or . REVENUE DIVISION TOTALS--> COLLECTED; 31 50- OVER/SHOAT: 00
improvement is sold within one year.of completion,the owner.will have the burden of proving he/she did not build or improve :BLDG PMT PLUMB ING ELECTRIC MECHANIC FIRE -SMIP/TOT GRAD ING PLAN-CHECK
. far the purpose of sale). . • ' 31 :00 . c .50 •
-
I,'as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business ;
' •
•
❑ 'and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon ,***.**.*'**********.**************.***-************************.*•**..$E**r*****'***********
and.who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware
' y that proof of their Worker's Compensation insurance should be provided'to me. . ,I N D I V 'I D U A L F E E B R E A K D O' WN '
L"] ' Iam exempt under Section: B P 7 0 4 4 B. K P.C. H • '
for this reason: NO EMPLOYEES - - ;-TYPE QTY D E S C° R •I P T'-I 0 N UNIT COST TOTAL COST
Date: . ^ :-- P o r` it SFR 1300 ALTER BY. VALUE RESIDENTIAL NOZONE 1 .00 1• , 300.00
I do hereby certify that Iam aware of and understa�ments, 'we'd .n Safety Code Sections 25505,25533,and END OF FEES
•
-25534 and that I or any future building occupant will/will not(circle on o comp) 'it'said state codes and the requirements for a . ' - . -. • • ,
permit for construction or,modification from the Air Quality Mangey' District A..denbal construction applications are exempl'fram -
these provisions. . , : l ' ' •
Date: y' U t��// r_ I • , • • ,
I hereby certify that I have read this application and state[ oq�h�i.' s co act.I agree to comply with all city and county ' •
ordinances and state laws relating to building construction. • Feb.authorize re' 'septa'es of this city to enter upon the above-mentioned . - - . — • D i. 00053085-00058086 •
TOT. e
property for inspection purposes. - '
ef—f re) /��' DATE: 04/09/90 TIt9E: 08:18 31, D
Dale: S. .tire: r.7/'
• 'Driver's License or Social Security •. - r ` • .
1641♦6 White—Building:Green—Cotle Enforce�ary—Applicant:Pink—Revenue:Goldenrod—Assessor >f •
• a
•
CONSTRUCTION AND PLANNING ' - PC S SPA K . •
• APPROVALS - Permit# • Date Inspector APPROVALS Permit# 'Date -Inspector
1. Temporary Electrical Service or Pole • - 52. Pool & Equipment Location '
1111 Pipe-Undtgrndl - 53. Steel Reinforcement y
,,2� ';
n,v -� 4,✓. -7.r. - ,
.=3abecV!caI Cortttuiy Jtility-Undrgrnd. 54. Forms S ;1'
'"t3 O2EE MF2triiical Coras3lt`TJndrgrnd. • 55. Electrical Bonding • - rnn7 v.
'' ;S);PaeLtteinforce• t - 56. Rough Plumbing & Pressure TeN - co.
J 'Cu - - o!
6".•EleCtrical UFEWGind. 57. APPROVAL TO COVER-GUNLTE . , ' 4•;
„ Qt7 Foot ngs 0,C 58. Electrical Conduit-Undrgrnd. m . / • i i , co /
. , -> r •..,
8. Foundation 59. Gas Pipe, 0-Undrgrnd.,Test _
�9. Water Pipe-Ugdrgrnd. - 60. Backwash Lines, P-Trap, 0 Undrgrnd. ,7- r '
10. Structural Floor System 61. APPROVAL TO DECK s.'
11. Property Sewer Lie & House Connection 62. Backwash &'Receptor-Final
12. Sewer Cap co ,63. Heater & Vent-Final . :, -
.. t
13. Roof Drains _. o 64. Plumbing System - Final. .- 1• !
14. Rough Plumbing - 65. Electrical-Final • . -
15. REugh Electrical-Conduit 66. Solar System-Final I 1 f
16. Rdugh Electr c Wiring 67. Fencing &Access Approval I
si
17. Rough Wiring-Sign - - 68."APPROVED FOR PLASTERING ' - .
L
18. Rough ElectrLca l-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT REQUIREMENT R
rn f n n ! m-, Trn t Vl T hdt4 ^ a THa=.
! tzm rC`a * c . IPx x Ir gl V M * T co
2ffl RJ ghactryeplace ! S� �� * S rn* * r APPDVL1 LS�r P��r mit #
21� Dtxts,gh StEucture ! •• •• ,S * S cJ "1( * 70.1-Uncle-q i Igdro *
c-, T mrrg C.-. * n w flit * ,--1
2 D ts,f a lat ! cl x p ¢ E•x x ;. 71. prod u6t ipmg as Oil
23. Gra; Pipe-ROugh &Test ! 615 * m e" 4 O t * i- 72. Underground Ffilgpi-i F u
M w -., - r ,x- , c* r r _.•• •' * -5., n
�!
2RofLamiAgx ! r'-• .•mi * > >. �x * g � . .
7 Under r d.Stoia an ❑Gas O-Oil
25. Rr.f ..a• L .., , .•1 ..., ,. .: - ,.,r„ .w
po dseathing1 C vvX �_ O Cu* * 7T1.Overhead Hydro *
2% T'-Sar Ceiling (cqpctural) X1�l ocoat * O >H33 0* * 7(i,.cpry Chemical r,•;1 * I-1 V
J * T F * a tvw U2- * J .Y C-'
27oFreme, nnd.6laspg 7-11X PM tr rL* * 76. DryStarlt7pipe-' t * m
:l s- .--..71-r: * >..>r 't . <�-. w r, ns r-•
1 ' 28. LAhigq& $k'idir8)x rn Oa g r- o beg: 77- FIXEDP:ST IN '4",! n m
29. Insula);aon . --* 0 •• I , 4 * 781 FIRE PREY. FINAL * > Q
41 O 71:1' S 0 ' S •
i
t 30. DrywallN5iing`* w � 1x
C.r-Uty7!!,E�AL1 CDEI REQUI MENTF S!
I 1.-721* ' .o w * v tr ,�
1 31. Plaste63rocn e S ; ;nm "no 3r44T 79. FINAL Ii+1SPECT:LON * m
34Electrical P'werPf5leter¢inil• r Pi .<'-:* : tr 8Ei1 FOOD CERTIF}LATE rr�SUED
1, o;i 1 c• xm I 7* * d �l rr * t;
3 Ftryal EJectvc m* n 6 * I . - * fUotes: r -WI - 7 O NM
1 J 34) FWal Heatr g & Air ConditiooiiKg f x r ,tyF * h < i-i * = C7.S7
• Z -t H* ti m # > ,.';tr x !t I En< * Crl
$17 `- X CD `7 * t !/I* x 1 , l 1 .1:.1 * :l. >V
. Finial Gas Rpe-Yeito •• r .-; 1!//! * .ti0 171-i * ,,m ,
• 36. Hood or Cano * = 4
t ! elm . * n '1/-5 ,i*:5 z no ¢
0' Z* n ! mm :A ,KI •.I* m mo * en r
r) TI* I SR' ='1 * m ' /(p* * 2 t I x ,.,
• 37.. Fill Factory FirQpiaie ! ;.f- a k 1 ari, x -: ;v
^ - =t 'V <, .,- t-
38. Filial Plumbing * `CU i `" * I I l ` S .* ''a O
c. .-. x M ! O k I 1 `It* * CC w CC * r�
11 * I a i r* X :l cam;i * % V
39. ter Service-Find£ ! Q y, * >.-
ti x S
40. Gas ServiceFinal.* m 7Nt" S . m I * * Q•�-, os * a
41. Solar Dom stic-F*na� n •• O`' I I x c•n' r" re
41. Backflow Preventer its k I I I* * Q >(-. • s :Li - -
n xn.1 rli,i w r. .; - * * m 0QPc) * F
t rxSS - * 4 * •n F0 * o -r
43. Backflow Y7igati4n >, k ix * * it - * n
., * =. 5. - K1. : r '_
n 1 44. Landsr pe;trripatton Syst 1W1O X * t i 0 r- O* * M S 0 2a t S KJ F a
n r ,"-!cc F 'r' * £ F-' f, :y* t C 1-I -i o-1 -
45, SouncLAttenuat' n * toi-a *
.y •• n ( i* M _ 01 r` • FO :r,
4`c< Handicap Regulations !-+ O * •r ! * * x cc •S (Do n *
I 4P'. FgrALSYTUCTCJRE& Bf&ILDING # 6 I NOS *
4b; F(D1AL•PLANNING i :•-•F t 1 r* * T n K * F -1
* * I I Iryr * [ Q co 5 * rC •
t �1 * F S ! K -7 w
' 49' E1i�ctr Release t*i Edison i * x tr - ,r * O
I .s tress C7 J.::
C • 50: Gas Release to Sou• thern California Gas Cox I I .rx * i- 4 n • c X O -
t, r : C•C g - * * • S no (i * Eli O
I, 51. CERTIFICATE OF OCCUPANCY * * 4 > C) MO .. * F o
No. Date _ .
PROJECT ADDRESS: .. --" L .*. UNR: -• -- . .Mr - -- ' - ,
OWNER'S NAME: 2181 STATE AV -CITY OF COSTA MESA. - BUILDING PERMIT PERM •
NO: G . 044844 • '
_. 'S.NAME: R. JANELLE. 7ANUARY
• • SAME PERMIT NO:. 044844 PLAN •CHECK NO: N GOVT: N SUPP•: N• '.
. a : - - .. •
•
CONSTRUCTION TYPE: • PERMIT TYPE: ELE MEC PLU STR PURPOSE: ALT •
.
ARCNJENGINEER: 1 I i 'REG.NO.: JOB DESCRIPTION : RENEW PERMIT *43036 • SQFT a 11 O '-
AODRESB: '. UNIT: f.
' -CAM VALUE: 17, 00 . 00. , ALC-VALUE: 1 ,870 ,00 'GROUP OC :, R-3 / :
•PERMmEE: JANELLE JANUARY ' ' ( 714')650-4160 - •
ADDRESS 218E STATE' AV - COMMENTS: 'CONV, CARPORT- TO GAR, /REMODEL"'KIT',
CM CA 92627 ' er**+r*EE*****EE*�a�E*�r*erer******Erer�riE+e+rEEerityE+rSrxiE*�B*****�Eet******+ESr*'***** *4*�EiE� *4*****EE** •
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing With Section rZ 0 N I N G R `E Q U I R E M E N T S' . '
7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. S E T. B A C• KS •
CITY UC.: , STATE OC.: CLASS: i - ..
Date: signature: • MAIN BUILDING ACCESSORY 'BUILDING
i_, r; NERS'COMPENSATION DECLARATION: hereby affirm that have a certificate of consent to self-insure or a certificate of Workers'
FRNT: • 25 FT IN REAR: 42 FT IN • FRNT: FT IN REAR: FT . IN-
•
ipensation Insurance,or a certified copy thereof(Section 3800, Lab.C). -LEFT: 5 FTI . IN RGHT a • FT IN : LEFT: FT IN RGHT: ' FT ' INI,
ICY NO.: EXP.DATE: • . .
•
COMPANY: PARKING REQUIRED: . 1 PARKING PROVIDED: 1 PARCEL: 42242104 ZONE:
❑ Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. . ' PLANNING •NOTES> RENEWAL OF A BLDG PERMIT TO ALLOW THE CONICOF A CARPORT TO
." - > A GARAGE- GARAGE ATT- TO RES' ON RT; •KITCIIEN -REMODEL ALSO, -
' Date: Applicant: •
************************************** **'**************************************
• EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred(5100)or less). D •E .V EL O P M. E N T S E R V .I C E S -', R E Q U I' R :E M E N' T S • '
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 t e�'orkers'Campens tion Laws of Calitomia. ZONING, APPROVED BY lei '4 ���. - t ' 'DATE \ t" Olfj•
'Date: / '- Signature: Ont.•P /�p•� . . -
NOTICE:If,after making this declaration,you should be s lett to the Workers Comp tion provisions of the or BUILDING .APPROVED BY DATE:
Code,you must forthwith comply with such provisions or thi ermit shall be deemed revo ' I .
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY; . \ :fa- _ _ �--� ., 1 ' DATE:. 1 �I E
which this permit is issued(Section 3097,Civ.C). *.*.{a.*.***.*.*-.**-*.*.***.*.*****. . —= ***.**.**.N.,N.* FN iF F .^ F*
LENDER: •
. . **************************************** ************************************** '
' -'ADDRESS: • - LEGALIZATION;N • "' F' E 'E ' S M M A'" R Y STRUCTURAL SEGMENT:V
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELEC.TRIa MECHANIC . FIRE SMIP/RES i GRADING
(Section 7031.5 Business and Professional Code: My city of county which requires a permit to construct,alter,improve,demolish,or PERMIT • - - 43.'00 ' 8 , 00 ' 10,50 ' 4 , 50 .,5,0,
repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed ' - ' - 2 5$ '5 0$ 2 5$ SM I P/NON-RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of•Division 3 of the'Business •
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption:Any violation of Section 7031.5 by .PLAN - �••
• • - , : '
•
•k,',applicant for a permit subjects the applicant to a,civil penally of not more than live hundred dollars(8500). = ISSUE FEE •• -3 , 0 0 1 5 .0 0 1 5 , 0 0 .=y -"S • . . . .
I, as owner of the property or my. employees with wages as.their sole compensation, will do the work,rind the BUILDING=DIV-> PERMIT ' ! • ISSUE PLAN-CHECK TOTAL 'PATIO •I DUE
4 , structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS:----> 66 . 50 ' -` 3 3 , 0 0 • , 0 .00 • . ..99 . 50 ' `9 9t 5 0 I . . 00
does not apply to an owner.of a property who builds or,improves thereon,and who does such work himself/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 will have the burden of proving he/she did not build or improve REVENUE DIVISION' TOTALS--> COLLECTED: 99 .50: OVER/SHOR'.T: :a 00 ' , •
for the purpose of sale). . • BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING'- PLAN=CHECK
• I,as owner.of the property,am exclusively contracting with licensed contractors to construct the project(Section'7044.Business • - - 43. 00 11 , 00 - ' '25 . 50 I 19 . 50 ,, 5 0 % 4 ,,j '
• ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon {,'
and'who contracts for such projects with a contractor(s)license pursuant to the Contractors State License Law). l am aware ,*********************************{E******************************:',{e-*.a .aE,**9t********
that proof of their Workers Compensation insurance should be provided to me. - •r
❑ am exempt under Section: : B.8 P.C. ' I N D I V - . D U A' L F E E B R E A K D W N • t
•
or hisreas/on n0 TYPE QTY' D E S C R I P T I O N : UNIT .. OST ' (; TOTAL COST
Date: /1 E ' /�J owne .L/J^�`/ �'�`e •
SFR , 110_ RES GARAGES TYPE �j 17:'00 •
1. , 870. 00
I do hereby certify that I am aware of and understand the requirements of California alth and Safety Code 3eEtons 25505.25533,as dd ELE 1 FIXTURES, LIGHTING 1 S T X PIR K s . 7 5 .. . •
7 5
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a ELE . - 9 ' RECEP T/OUTLET - 1 T 50�.y •
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt fromgg I@te Il • . 75 6 7 5
these provisions. ELE 4 • RECEPT/SWITCH 1 5 EA. • . 75 - 3. 00
MEC 1 VENTILATION FAN CONN TO SINGLE D �4 50 - 4 . 50
nate: Applicant: ' PLU ' • 1 DISHWASHER • - �"'� ' 2. 00 2 . 00
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county PLU ff 1 ' LAUNDRY TUB OR WASH Berth . - 2 . 0 i 2 . 0 0 ••
•
ordinances and state laws relating to building construction and hereby authorize representatives of this c' to enter upon the above-mentioned PLU • N �1 SINK-, KITCHEN ' ' ' 2 .10 - ' 2 . 00
property for inspection purposes. PLU {�' 1 WATER ,HEATER AND/O VENT ' ' •
2 .. �0
4 y (244"4.24---
2 rn���
0.--ii-4-4027 Ly) E�]D OF FEES
Date: 117 Signature: Q L�/"•' — •
E
Driver's License or Social Security a: •\
•
-----'_'-`-=.••,rnirvc C,.een=Code Enforcement;Cenery—Applicant;Pink—Revenue;Goldenrod—Assessor •
dr
`!' "-' .... - I�
CONSTRUCTION AND PLANNL.., - _ - . • - 530L& SPA .
Date Inspector - • Date Ihspector
•
APPROVALS Permit# APPROVALS Permit# �•
1. Temporary Electrical Service or Pole ' _ 52. Pool &-Equipment Location ; r
t2.r_Soil Pipe-Undrgrnd,� - 53. Steel Reinforcement - 'ill
• 811
3.Electrical Conduit:15tility-Undrgrnd. 54. Forms - - -it
i '
- 4. Electrical ConduitUndrgrnd. • _ _ 55. Electrical Bonding - :! rLl•
- 'S. Steel Reinforcement • - 56. Rough Plumbing & Pressure Test
.:'-6-. Electrical UFEi'VtGrnd. 57. APPROVAL TO COVER.GUNITE
•
.".J;. Footings a;c; 58. Electrical Conduit-Undrgrnd.
8. Foundation " 59. Gas Pipe, 0 Undrgrnd., Test
9.- Water Pipe-Undrgrnd. - I'� -
60. Backwash Lines, P-Trap, 0 Undrgrnd.
' v-r''
10. Structural Floor System 61. APPROVAL TO DECK /K;, •
11. Property Sewer Lirie & House Connection 62. Backwash & Receptor-Final i
12. Sewer Cap c., -; - - 63. Heater & Vent-Final � .-�
L4 .
13. Roof Drains i>" 64. Plumbing System_- •Final -1
14. Rough Plumbing 65. Electrical-Final
•J
15. Rough Electrical-Conduit 66.- Solar System-Final - ••Y
.16. Rough Electric.Wiring • ' 67. Fencing & Access Approval ' , • ;!. '
17. Rough Wiring Sign - 68:APPROVED FOR PLASTERING 7
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL /Li--'
19._Rough Heating &.Air Conditioning-__ ; G _ _,FI RE_DEPT. REQUIREMENT - r..Jr._•
• _ n: ^mom
20 Roiigh Factory Fireplace Sim ,-;*:: 4. ,J ;;:;1; « -APPROVALS, . -Permit# - _ -r:Ci �..' .
21.-Ducts, in Structu[e'" " " -' O I-‘i; -- -,c- -i
_* =:r-• .7 _ ;It x ,:70. Underground Hydro
•
22._Ducts, Ventilating.* _i ..C) is '; 0 -.a: < 1:71. Product-Piping OGas DOil _. , `
23. Gas,-Pipe_Rou`gh &,Test ,�� rr` "4h A j 1' .i T72, Undergro un FliTsh't -" -
24.'•Roof Framing 2 -7.e---• ;,• , j .a: •;.•
i
_ _ :: z: ••73-Undergrnd.Storctge TankO Gas ❑Oil
25. Roof Sheathing •-" '_" ' - ° Jy y? 74?Overhead Hydros_^
26.-T-Bar Ceiling (Str,u&tural) &'Monocoat j . p r, b.i x 75r Dry Chemical -. 5. +: - r„= =:,7r,;= .c:
27,€-Frame arid Flashin • 'r- ;11_ :'+e 0• E-'i: :r: a= x - - " c-• 'Iv --_::ti
9 ..-,r, _ 1•r •r,- : 76. DryStanda • ��. . ,. r. .;3 - --��.
28. Lathing;& Siding-,r, p .•'r' I 77r FIXED SYSTEM FINALc :r l :t -;•o
t.
29. Insulation `•9' •� O .x: _. I }�I ~-..t.: 78zEIREPREV. FINE $ '• • - "T
y 9 :^ �: `- :+ r •t�; `;•p- Sot o HEALTH:DEPT: REQUIREMENT- `}rj�'
X30. Dr wall;Nailin _
-'31. Plaster Brown Coate = -_ ^_t ':.x %rT I p' "79. FINAL INSPECTION• * - = c;
t,,, ` , `"c:l-.g "t I I . '80F FOOD CERTIFICATE ISSUED, '•'-_ � '
4,32.;Electrical Poviter Meter Final'
t33SFinal Electric * i^ ' _ ^: I '� 't; Noies• -I. -IF m '-: Ci°�0" • __
(-Ir."e. . • T! I 14 I: -- o n,..0,-, ,!:: 1 _
• 34_Fi al Heating&Air:Conditioning t: 1 - `^ ''-' n=" t- - -,_ _ ›'='
35.-Final Gas PiPe.Tests ,1 - ,- :n -- (• •; is - C.r+2' is - r::_.;,. -'71
. .... ."~r•a it V to`. ...'1 r• 4 -, c_.•_r r-t .
-436._Hootl or Canopy_,'±, •:. i4 r• •-.1 i L%fi ± r. n :�o ` } r-
-37.'Final Factory Fireplace • ;r-. -`Ci:e ." .it ' `; .: - .- w .>{ �' - f ni
rr. ., .. •-1••.• :.t 1 L` r d:c e� r^ X. 'Y 0 _ 7
V38. Final Plumbing r, t'IN n> //.l/b .0? : , 7.7.•.)P., * t.::
� I
X39. Water Service-Finalw ,^_ •.�' r I j r:. s ,- _ _ x rr,� '-;, 4
�' , . v 'Mt_ '4' I r< -c c- i
•"4- 0. Gas:Service-Final r% a•''_-' -Cr.::: i" '
� 'It: * =i r�cr.: ,:;-
_41. Solar Domestic-Final' 7, ;-.1 C,: :l; ". ' ) r,': jc rn -=c G= r.) v' - 1
42 Backflow Preventee` , -•I 'S;:-; '` * .>":::::-
r-'• ' x C• i- I
is i, - . ,. _ . _.. .
43. Backflow Irggatiom - - N;p':;�: h ...< .1... `"�','!•-
;"44. Landscape Ir-rigatidn System ata t.`' j•* =". G "r.t` " - �� t' al ;.` :.�c �'�u�;•
•
-45.E--)Sound ••Attenuation �•::'.. ort,ix ` i-i P:' f.-., :; . Incomplete Inspections
'46."Handicap Regulations ;i x I * rume i'........::
�/'�' _'__--
i.
,47.-F1NAL STRUCTURE& BUILDIN&r$ . : : F ,- .: - ' c-LL p:
48 FINAL PLANNING ; HE. -'F ''* r_ -Et": ? -. s; t
^ C7 iti Y: :wit.
49 :Electric-Release to Edison
w
''50::Gas?elease to Southern California Gas Co 'C! ' -! ?' . !VI '^
51. CERTIFICATE OF OCCUPANCY 4. ''' ^ ..
No. Date
Costa Mesa Building Department !J(�� APPLICATION FOR PERMIT
• 111 'EAST 20th STREETCOSTA MESA. CALIFORNIA %. /6�7/L! _ -. . .� BUILDING 1
Ninine
FOR APPLICANT TO FILL IN r FOR OFFICE j Receipt--No.No. Permit�No. 1
ONLY I
•
!
Building I i u 3yb
Address 21B1—St _
Receivedlby, Date Rec'd. Date Issued f
Costa Mesa, California i s y r x
Nearest
Cross st. Governor St. Building i :
Address j i
Owner creek Homes Inc. Costa Mesa, California i I
Mail •
Address 9363 Wilshire Cross St. I :
Tel. I
City Beverly Hill a No. CB 54361 Zone No.of Type I Group
Architect or Lic. i ! I Plans I I j
Engineer Cain—McKerracherto. Approved j Date i '
Address2110 F_Walniit-Pasadena I CORRECTIONS ••
City Lie. '
ContractorBalbOa Vista No. 143231 . . ; I
I
Address 9363 Wilshire-Beverly Hilly' • I
Legal Lot I - r i
Description I No. 166 I Block I Tract 187, I 3
I
(Attach Metes and Bounds) I I
No.of Bldgs.
Size of Lot 70 x 105 I Now on Lot 0 -- _-- ..------_- ___-_ o
Use of I No.of I No.of i /us A
Existing Bldg. Families Rooms ,n
Setback Line from Rear Yard y.41 -- - -. - ----- -•--- -" ----- -
Center of Street 501 Side Yardl 11 6-1 0 D
DESCRIPTION OF WORK A . EH. rr fr` , ' r
New I x I Alteration I I Addition
Repair I I Moving I Demolish
_
Building No.of
_Size 1034 s-q_ .Pt Rooms 5 Stories 1 —
Exterior Wall I Roof Compo
17QQ0 Covering Shi nEl a -- APPROVALS ..
Use of New Foundation Location Inspector Date
Building Residence-att.Carport Forms,Materials,
Under-Pinning
Frame: Fire Stops,
• Bracing,Bolts
Lath. Int.
II hereby acknowledge that I have read this Application
and state that the above is correct and agree to comply Lath. Ext.
with all City Ordinances and State Laws regulating
' building construction.
Plaster, Int.
Signature of
Permittee _131bne Vi rata Cn Plaster,Ext.
ARAuthorized A r Masonry Reinforced
Valuatlorl183C.oC PPlan Check $ Bond Beam
$ Total
Fee $ FINAL
Form 204 G-H 1M 12-53
OWNER CREEK HOMES INC . , / DATE 6/4/54
JOB ADDRESS 2181 STATE ST. BUILDING PERMIT NO.• 326
GENERAL CONTRACTOR BALBOA VISTA CO VALUE $ 5,000.00
LOT 166 BLOCK - TRACT P 1872
GROUP I TYPE V ZONE R4. FIRE DISTRICT 292
PERMITS ISSUED •
INSPECTIONS DATE SUBCONTRACTOR DATE NUMBER
Footing Trench eg -- - a-�-
Foundation Forms and Grade to ppGarrarag�ee
Rough Framing &St Y-4-s4
Plumbing,Rough to Slab Ii -4 7 S' _
Plumbing,Rough Complete f14- - -t• YSCAS'.., 4._!--6/ -/f/‘ - -
Temporary Pole S-4---ii
r 'r /� •
Wiring,Rough G- 6-ii 7 -21-174 ,farm ...A.� A -f/f ,22 fO
i
Heating,Rough g rr �
Heating,Final £ r-4 /- -S //
Sewer Ai/ ,..&1 A.LAV) r. //-• C-.5 9 'rf
Septic Tank or Cesspool
Lathing - 4- ! (4O :t 1,
Plastering s--. 3,7- ,-
Plumbing,Final,Fixtures Complete ,t 4 - -
Plumbing,Final Gas Tes a -". _ //-2 ___ •
Wiring,Final ,. . //-341 - _
Occupancy
Form 210 G-H 1M 12-53
43036
. ':rn,i lea-7r,%'=�'OR s87:� ,�,rr:a'Lica.5tl
-COSTA MESA-BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
ADPL ION FOR-STRUCTURAL PERMIT
For Applicant to Fill in Completely — Use Ink Only
BUILDING• `/ - w/` RECEI DBV DATE RECEIVED D/�If E�SSUp
ADDRESS / .S7.-"7,7—z_--- S� l/_ p - PE/'� I.JL NA7
// A.P. NO. /Air 3 /i0 3 -
OWNER - 4 c -Li i♦ .
•
MAIL
BUILDING
—ADDRESS -t 74 TE A
lee
. ADDRESS / pi Jc7rz
TEL. TRACT 73dit Loll"' CITY Cg�/ i-tES9 NO.
BLOCK
CONSTRUCTION NEW ADD ALTER REPAIR MOVING DEMOLISH
. LENDER •
BRANCH ` .— g04/1 TAM,i/ARY
OWNER 04'ADDRESS b /� /• UE nilARCHITECT TEL. USE f _la- �i r- _ UO
OR ENGINEER NC) - '
FIRE
ADDRESS • • - ZONE T PE -jr— GROUP
• •APPROVED
' CONTRACTOR aLi 0,r C AN S BY A DATE — ' '
' ADDRESS „V.'? C HAO Are y - �e'
...� TEL.5 ,�$L Zoy NO.OF USE OF NEW •
CITY "AttieC tip././ NO. S: 606 A,- /� �� PLANS BUILDING �}���(/
YARDS APPROVED YARDS APPROVED
LIC. O..a_/—;f/2 ,c: LIC. NO. MAIN BUILDING • ACCESSORY BUILDING
IQ SIZE ' j NO.OF BLDGS. (FROM C/L STREET) Co -i"
.�
0. OF LOT I NOW ON LOT / FRONT FT. FT.
aUSE OF • /^
• ,N.,
EXISTING BLDG. O /-1 /� L/ J. R,SIDE FT. J FT.
c&
E—. Separate permits are required for L.SIDE FT. Ili- Qc<FT. fa
electric,plumbing and heating work. 1/
C REAR FT. • FT.
F., USE OF���zzzz BUILDING O WORKATORE PERFORMED DISTANCE BET. BET.MAIN& z
Qn /y7% (4�4t/," / a MAIN BLDGS. ACCESS. BLDhtS,
'illeG ! 3 rig C U.P.# APPROVED
a a '7�l r/�. rc C'� la �T ' VAR ((get
•
•
t/ / / APPROVED II---is--z4
> / f (� ,BY DATE
w
II4Gr,� -1L/ x-r,7�/9,/,44
.Q , I hereby acknowledge that I.have read this application and state • - . -
N
h.
CC that the above Information is correct and agree to comply with '
m
0. all laws regulating building construction, and I shall not employ
Z any person in violation of the workmen's compensation laws of e
the State of California.
2 -
��SO. FT. m
3 I hereby certify that I am properly licensed as a contractor under _ N
the State of California Business and Professions Coda,-Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that such licenses are in full force and effect,or I THE PURP06E OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the provisi ns of the State of California Business i s
VALUATION PERMIT FEE $ a '
• and Professions Code, Div n 3,Chapter 9. -
m
Signature of PLAN CHECK $ /dn
Permittee $ O ' TAX $ ��,� //// �J Cl
Authorized nt ' TOTAL PAID $ 9�✓� '