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HomeMy WebLinkAbout215 MAGNOLIA ST - Building Permits f - CITY OF COSTA MESA Au sig. 9 BUILDING DIVISION F44„� ,)pS 77 FAIR DRIVE, COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us t• S FOR INSPECTIONS CALL: (714)754-5626 044 49 °°° ' PERMIT NUMBER: BC10-00019 PERMIT TYPE: B_COMBO STATUS: ISSUED Sub Type: RES_ALT DATE ISSUED: 06/09/2010 ISSUED BY: RMD JOB ADDRESS: 215 MAGNOLIA ST CM Suite/Unit: APN: 42540120 Zohing; - Vicinity: REAR OF HOUSE •. Primary Occ: Const Type: V-B SQ. FT: 387 - - Valuation: , $40,000.00 SCOPE OF WORK: ADD 387 SF TO A 1-STORY SFD. WORK TO INCLUDE THE EXPANSION OF FAMILY ROOM, NEW MASTER BEDROOM WITH NEW MASTER BATHROOM ATTACHING HOUSE TO AN EXISTING.DETACHED GARAGE. 1 ALTER/REPAIR HEAT/COOL, 1 VENT FAN, 14 LIGHT FIXTS, 10 OUTLETS, 10 SWITCHES, 1 SHOWER, 1,WASH BASIN, 1 WATER CLOSET. OWNER: KITTO,CATHY Address: 215 MAGNOLIA ST - Unit: Phone: 949-910-6236, . • City/State/Zip: COSTA MESA,CA - • APPLICANT: KITTO, CATHY - ' Address: - Unit: : Phone: 949-910-6236 , City/State/zZip: - . CONTRACTOR: OWNER-BUILDER License No. 000000 • Phone: Address:- Unit: Cell: City/State: ZipCode ARCHITECT: License No. PHONE: . ENGINEER: TIMOTHY D DAILEY License No.39489 PHONE:714-962-6903 COMBINATION PERMIT FEE SUMMARY Building Plan Check: - $353.11 Building Fees: $543.25 Electrical Fees: $60,90: _ Mechanical Fees: $44.45 Plumbing Fees: $62.70 SMIP Residential: - • $4.00, . SMIP Commercial: $0.00 Bldg Std Admin Fund $2.00 - . TOTAL FEES: $1,070.41 - ' • - . "Refer to fee receipts for all fees paid for project HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279 Monday thru Friday-7:00 am thru 7:00 pm. Saturdays-9:00 am thru 6:00 pm. Prohibited all hours-Sundays and the following Federal holidays: New Years Day,Memorial Day, Independence Day,Labor Day,Thanksgiving Day and Christmas Day • 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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: fn 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. CODER. INSPECTION TYPE DATE INTITIALS CODES INSPECTION TYPE DATE INTITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical A r1 q--q-/ -}2-(o I-f vin Ai- 1266 Pool Spa Final 208 Final Plumbing A ` -- ;-l6 PM 0-11' ' 200 Final Re-Roof 210 Final Electrical X 0/ -CI I"frn 00�` 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site y[ 204 Final Demolition 250 Final Building/Occupancy "I/,1 vck-1 o t,c— 11 RKEfZS'COMPENSATION DECLARATION: Owner ID verified by driver's license. 2Kles ❑ No i.e.-property tax'Dill or deed): 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a number are: 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 Carrier: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp (]his section neednot be completed J the permrt is valued al one hundred dollars(S100)or less) 2,Art 2Sec.341,Title B,California Administrative Code). PolisNumber: _ ❑ As owner-builder, I will not employ anyone to do work which would j =1,certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of —--- Applicant's Signature Date the Laborode,I hall f h • comply with these provisions. p (1 00 Division of Industrial Safety Permit Number: •• A• •.n1391gnature Y` HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILIRE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes ❑ No ($100,000), IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST. AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. 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 LICENSED CONTRACTORS DECLARATION: 500 pounds, or a volume of 55 gallons,or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license is in full force and effect. a registration form for acutely hazardous materials? ❑Yes ❑No Lic.# Class# (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 Contractors Signature Date 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 CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? ❑Yes 0 No (Section 25534 of the California Health and Safety Code provides that the Lender's Address: 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. Signature Date 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes ❑No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes ❑No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Government Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits). 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 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes ❑ No applicant for a permit subjects the applicant to a civil penalty of not more than (If'yes",the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). ❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Duality Management District or other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec. 7044,Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes 0 No 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 8. (If"yes", attach certificate of compliance from the appropriate air pollution sale. If, however, the building or improvement is.sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did no build or improve for purpose of sale.). information given above is correct. agree to comply with all state laws and rjtias owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. 'LICENSED CONTRACTORS to construct the project(Sec. 7044,Business and Professions Code: The contractors License Law does not apply to an owner of Signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that ❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: 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 thi p mit u fi inspection. (/ ii 197/6 9f 6055x/6 �� 6:.&grrdidr a al Owners Date /`Sfggpaire • I_".rOal 3057-46(3/07) And/or Authorized Applicant Date � City of Costa Mesa Building Division Costa77 Fair Drive, Costa Mesa, CA 92626 Mesa 714-754-5273 / Fax 714-754-4856 OWNER BUILDER VERIFICATION Permit # rC,1U-Q(X`�Br1 Disclosures & Forms for Owner- Builders Applying for Construction Permits IMPORTANT! NOTICE TO PROPERTY OWNER Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at a i S neVet nt, i A 6A. CaS+�. I'VLeSA , ( A 9Zl0Zn We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION DIRECTIONS:, Read and initial each statement below to signify you understand or verify this information. (i1Nt.:l;understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner- Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder andam aware of the limits of my insurance coverage for injuries to workers on my property. �// Ya�--2"I understand building permits are not required to be signed by property owners unless they are ��ressponsible for the construction and are not hiring a licensed Contractor to assume this responsibility. tlit=�3. I understand as an "Owner-Builder' I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his nnorher name instead of my own. ( . I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. :V=6 understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. 1 t j*understand under California Contractors' State License Law, an Owner-Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. 3148-30 CALBO Jan 1, 2009 OB Packet template 1 of 2 N• 0' `�`� f8-1-understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. Oji I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand at I am the party legally and financially responsible for proposed construction activity at the following address: .-1,agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. 6^ ' :I,agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature. nature.of-property owner � l`� Dates--rf'9 Note: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner-Builder. AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project(or Description of Work): -. Project Location or Address: Name of Authorized Agent: Tel No Address of Authorized Agent: I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note:A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: 3148-30 CALBO Jan 1, 2009 OB Packet template 2 of 2 -, • 4 0 * CITY OF COSTA MESA o a.•fl BUILDING DIVISION ^""a ' DEVELOPMENT SERVICES DEPARTMENT NI �' PERMIT PE IT NUMBER % B98-02032 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 • BUILDING PERMIT Job Address: 215 MAGNOLIA ST Status: ISSUED Suite: Applied: 11/09/1998 Vicinity: BACK SECTION OF RESIDENCE Issued: 11/09/1998 Parcel Nunmber: 42540120 Zoning: Applicant: MILLER, DALE Address: Phone: Zip: Owner: KITTO, CATHY Address 215 MAGNOLIA ST - Phone: "COSTA MESA,CA Zip: 92627 Contractor: , DALE'S ROOFING Address: 13781 NEWHOPE ST Phone: 714-534-6398 GARDEN GROVE CA Zip: 92703 • - License: 503508 Arch/Eng : Address: Phone: Zip: License: SCOPE OF PERMIT REROOF OVER EXIST 1 LAYER OF WOOD SHINGLES&1 LAYER OF COMP"EXIST.WOOD IS UNDER COMP."WITH 1 LAYER OF COMP. SHINGLES.BACK OF RESIDENCE. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $1,200.00 Permit: $40.25 Claim Valuation: 81,200.00 SMIP Res: ' $0.50 SMIP Corn: $0.00 Other: $0.00 - Inspection: $0:00 Total: $40.75' ' . PLANNING &ZONING • • SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right . .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 9 WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. . Lhave 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. cr, My workers'compensation Ins rants ca end policy number are: n CC / Cartier. 5 i fl / 'P 0,__ Policy Number: 79 $S—9 ,S-- /Y y Z. (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the wo1 for which thi permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compeniaf•• laws of Califo . ., . d agr' the ' I shou•)-.-come subject to the workers'compensation provisions of Section 3700 of the Labor Code, I shall forthwith • ,,. -. II t asst •visi0 / • r Applicant Signature: _ La_.i/ sate: — WARNING:FAIL : -•SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYERTO RIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED r-.• • •• ••E(S100,IXI11),IN ADDMON TO THE UAI OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES. LICENSE CONTRACTORS DECLARATION: ereby affirm that I am licensed underyT• sio sot Chapter 9(commencing with Section 7000)of Division 3 ofthe Business and •ro:-sions Code,and my license is in full force and effect.Lic.# S! ( Class# a_ Contractor's Signature: ��,. \ Date: • / —J W "/er— 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,CMI 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 properly,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.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: _ Owner ID verified by driver's license. ❑Yes ❑No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more 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? ❑Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons. or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the Califomia 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 a2ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control dlstnct or agency? LI Yes p 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 Alr Quality Management District or other air pollution control district or agency Is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: _ Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. • ature•A,— - • - ' / 9•- S . Date r iffir ,� n• r ,• ed Applicant Date CODE r INSPFCDONTYPF DAIS .mi. . CODE! IBSPECTION TYPE DATE DI➢DALS 1616 Fixed System Final Fire Proven ion 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 1n � 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 OWNER CRAWFORD,> .• SAM'-^. . •. JQNy O DATE 5-22-56 - - JOB ADDRESS 21 Ma•nolia Ave. BUILDING PERMIT NO. 3085 GENERAL CONTRACTOR Prank Bissell VALUE $ 6,500.00 A.P. 117-171-20 LOT BLOCK TRACT Add liv. room 4 Kit. Remove porch GROUP 1 TYPE V ZONE tu.l FIRE DISTRICT 3128 INSPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED � DATE NUMBER Footing Trench ��i} _ Foundation Forms and Gr aCgey�9 S a CsS Rough Framing �✓L 4,-/j .56. Plumbing,Rough to Slmpbl S O/C J4..- 2_6-- Plumbing, .S S Plumbing, Rough Complete ✓A(,f^(y,Q'.- � / _ r,�.( 0� 'y�iyn .8-p� 7_,z L�.�Y ,('C/ y�� -+•, Temporary Poled ,4 - Wiring, Rough / A C-/5 - ,44.-/,/--r sL 4,1,j ‘, - /C-f, .I,C' (eSL— Heating,Rough ® e Heating, Final .14,-, •;d Z7o4 6.-/.J -:r2, .t47.C-,47 .,-.-:-•--- - Sewer, House Sewer,St. Septic Tank or Cesspoo -t , _ . Lathing, InX #1 outx j�'{�- �j-1 ?,�J/ Plastering kc) LL p Plumbing,Final,Fixtures Complet 8///(4 Plumbing, Final Gas Test ((((ffff Wiring,Final JAN1 ' 1957 VCB Occupancy Jul 1 t 1957 VCB FORM 210 3M 10-35 3085 -Costa Mesa Building Department • /APPLICATION FOR PERMIT 1 P. O. Boz 3!7 ' _ 28 BUILDING 1 i. COSTA MESA, CALIFORNIA ‘;\.. FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY ��(y,� Receipt No. Permit No. BuilAddress x / .� //! i -t_.� CF�a•--, 30 �S� Costa Mesa, lifornta Received by Date Recd. Date Issued Nearest .Sit' 'c,2 -3— S— ' Cross Stnitli _ Buildin• + Address Owner • Costa Mesa, California Mail Address „fi.6„,,,.,t,Q` Nearest Tel. Cross St. City �,,1 No. Zone No.of Type Grout/ Architect or M '� �J7 LN. /1,1 I Plans y / Engineer No. Approved '�'� by � � rink 1 II 1 1�Date Address 1 ITO.tOttOIONsi 11 s • /CityLic. 44 f Contractor A , , 4. I - . No. 1 / i_l��---- Address j r,f J n / mac ,,..Q n`•/ 0 9 IgSAi • LegalLot Ir • Description I No. I BlockloOI Tract (Attach Metes and Bounds) qT. 17- 17/ 02p T�f II 11/4: ti taI�JI Size of Lot SO.44 SO2,5;-j Now oNo.of n Lott + 1 L� O Use ofNo.of No.of A Existing Bldg. 1 • Families Rooms,?U& . CITY OF COSTA MESA B Setback Line from ,, Rear Yard ZS ,11 PLANN,• G DEPT- i Center of Street v •'� Side Yard,1/2? �� �� s�� y DESCRIPTION OF WORK • r `, R '• pate-' J( y PLAN.TECH. New I I Alteration IX I Addition ` � _ Repair I I Moving I I Demolish I Building / . No.of I Size Rooms % .1 Stories �////1/ Exterior Wall � Roof ` L} `^"J� Covering .Y(�t� c e o I Covering oy APPROVALS CZY Use of New Foundation Location Inspector - Date ` Building Art-A, Forms,Materials, d' P _ Under-Pinning Frame: Fire Stops, Bracing,Bolts I hereby acknowledge that I have read this Application and state that the above is correct and agree to comply Lath. Int. with all City Ordinances and State Laws regulating building constr. 15 Lath. Ext. Signature of Permittee ♦ _ Plaster, Int Authorized Agt. Plaster,Ext. Valuation Permit Fee $ /49 Masonry Reinforced $ ((j�D Q• .0'L Tota Check$ X9 '— 1 Bond Beam Fee $ / — FINAL FORM 209 10.55 0.P. 3 5. C 0 6 J a a COSTA MAY 22-SGPDyESA 792 *'=**27.i1D i 3 4.Street t . j • .PLOT PLAN • F} Show location_ and distances from j • property line and between buildings.