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Home My WebLink About213 KNOX ST - Building Permits • i,,----7 "S- CITY OF COSTA MESA . BUILDING DIVISION F - , DEVELOPMENT SERVICES DEPARTMENT PER NUMBER 4. �aI PERMIT IP 03-00848 (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 213 KNOX ST Status: ISSUED Suite: Applied: 05/21/2003 Vicinity: Issued: 05/21/2003 Parcel Number 42533221 Zoning: ��e/ Applicant: ROBERT ZERGMAN ISSUED BY: —fi �ek Address: 17092 VAN DYKE LN - - , -% Phone: (714)542-5397 - ' - HUNTINGTON BEACH,,CA- - Zip: 92647 ' -2, Owner CARRFREEMAN, BARBARA K • - - _ - Address /1418 SANTIAGO DR , - . _ . / .2,/, `'V A _ — - Phone: '' -,, v. ,'-- '' NEWPORT BEACH CA : • Zip: 926604946 ` Contractor: 'ROB'S ROOFING /Address: 17092 VAN DYKE LN - - �. i Phone:t (714)542-5397 < HUNTINGTON BEACH,CA - Zip: ' 92647. . License:. 532516 - Arch : - - Eng: - - ' / Address: -- - _ _Address: ' " - . Phone: Phone: 'Zip: - --License: `� 'License: - - -, SCOPE OF PERMIT-_ - ' TEAR OFF EXISTING ROOF. INSTALL OSB_15/32 BOARD;15#FELT, 30 YEAR COMPOSITION SHINGLES.800 S.F. , ' FEE SUMMARY Plan Check: $0.00 _ , 7�., . 7 •. - Calc Valuation: $3,900.00' Permit: $97.25 Claim Valuation: $3;900.00 ' ' '-SMIP'Res:, . $0.50 2 " ;SMTP Com: , ',_ , $0.00 , i, Other \t $0.00 • _ •, Inspection: ;,$0.00 \ \\Total: $97:75 ,. 1 . "PLANNING &ZONING SETBACKS\ 'Y MAIN STRUCTURE_Front , 0=0 Rear'- 0-0 Left 0-0 . - Right 0-0 ACCESSORY Frent`.0-0': ,,l r', :Rear. _ 0-0 Left 0-0 Right 0-0 ; // PARKING Existing:, 02 Required:- ''0 Proposed: 6 ' . - 2 NOTES: : , , NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections end final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS (^ WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: Y 1 ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compo satlon Insuranc¢caweer and poliicyy number are: t1 �! Carrier: c7�' T� 1 ' Policy Number: / 0? `•( 6 (This section n ed not be completed if the p unit valued-$tone hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation law- • - '•rn .,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with then Applicant Signature: Date: S-Z 1" D WARNING:FAILURE TO SECURE WORKERS'CCMPEN TI COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINE UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisiens of Chapter 9(commencing with Section 7000)of Division 3 of the Busines d Professions Code,and my license is in full •force end effect.Lic.# j i `LS` Class# C " Contractor's Signature: i L ` Date: sr^'7J—0'3 CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: 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 properly who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have.the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ 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 Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application akEermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE 11140 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. ure Of Legal Owner(s) ate A r Authorized Applicant Date CODE I INSPECTION TYPE PATE INTITIAL$ CODE( INSPECTION TYPE DATE MALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical • 1266 Pool Spa Final C �� 208 Final Plumbing 200 Final Re-Roof Y'7'03 � bs4 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 bo-10-7-1,1 L-'- 'Lt's 7 C-erc e� cLc c-t- dile/ a-4+S AbKAZvL OWNER WUNDER, NICK DATE 9-24-59 JOB ADDRESS 213 Knox St. BUILDING PERMIT NO. 10430 GENERAL CONTRACTOR Owner-Builder VALUE $ 1,000.00 AP. No. 117=142-15 LOT TRACT FIRE ZONE DESCRIPTION OF WORK Covered Porch INSPECTIONS DATE I GROUP I TYPE V ZONE R J1 Underground Soil U.G. Water PERMITS ISSUED Underground Gas — SUBCONTRACTOR DATE NUMBER Overhead Water and Gas Rough Heating Rough Plumbing Miscellaneous Prop. Swr, Line House Con. St. Swr. Sprinkling System Heating, Final Plumbing Fixtures Final Gas Test _ Construction Pole Underground Power Rough Wiring / 3-tiii« i v -i</-✓i //a9e - Trenches/7l.W Forms/0V Steel Floor System Steel Reinforce Chimney Re-Rod Bond Beam Sheathing 8o9p i2-16-57 Frame and Flashing Lathing, In Out Plaster, brown coat _ Plumbing Fixtures, Final Electric Fixtures, Final ,l/�j • Building, Final/ r "r/ OCCUPANCY _ Form 210-3M-4.5? 10430 104.30 COSTA MESA BUILDING-SAFETY DEPARTMENT f EE RECEt'J ED P.0.BOX 317 COSTA MESA. CALIFORNIA • FOR APPLICANT TO TILL IN COMPLETELY APPLICATIOTty OFcPERbra M. s. TYPE OR PRINT - BI$iUDINo AD '' i : : f/ ,r`/' ADDDRESSRESS COSTA MESA• . CALIFORNIA foe OFFICE USE ONLY' OWNER , A Awn RECEIPT NO. I PERM T NO. • MAIL • Rc,,E.�I[)VED BY P TE RECEIVED.) I DATEDATE ISSUE ADDRESS �e a7 I 11 u- . �W`i. O/61�r y -0,---64C57 CITY CVS 61774- .I/ g SA- TEL. NO. `. ADDRESS ARCHITECT LIC. COSTA MESA, CALIFORNIA :' OR ENGINEER NO. - ADDRESS L FIRE `� ': ZONE TYPE GROUP !J( STATE f1- APPROVED �J CONTRACTOR (J'9�1`!LQ/V LIC.NO. :' BY DATE/"Z-7/ J '. ADDRESS ZONING //�f�� ' ZONE NO.OF UHE OF NEVA-./ I. LEGAL LOT (s DESCRIPTION I NO. �f I BLOCK _ TRA / j PLANS BUILDING %. APPROVE�1J '� A.P.NO. —./ _a ` :. BY (Af DIAD/ATE 9--a it-5 - - SIZE OF LOT -i---6 /3J,6. i NOW ON LOTS. I YARDSEQIALLO W • REQUIRED ALLOWED USE OF . (CENTER LINE ST.) n �, v 'V,EXISTING BLDG. ../ FRONT _ IN. . SETBACK LINE FROM % �� j -I �Y" / L • CENTER OF STREET 6 O 4• REAR YARD ' R.SIDE / FT. 7 IN. I SIDE YARD (LEFT 61 (RIGHT 02/,9 •f L.SIDE . FT. W-J-4' i IN. DESCRIPTION OF WORK �/ REAR (SO FT. CO IN. NEW 1 It ALTERATION I II ADDITION I - • REPAIR 1 11 MOVING II DEMOLISH II �, BUILDING 9''Oj/T-ROOMS NO.OF / STORIES / , SIZE .1 EXTERIOR WALL . ROOF COVERING WoccL (COVERING 96 M/Nt Mol II USE OF BUILDING AND WORK TO BE PERFORMED Sy-r I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. BUILDING CONSTRUCTION. /f ////qq • �. VALUATION (: SIGNATURE OF 7i A e /V�At D� f�I PERMIT FEE '$ ' `• I. PERMITTEE 71i-de `�l�/� fiy 'Jlnt bk<^" $ / \ PLAN CHECK $ : AUTHORIZED AGENT F. 6 TOTAL FEE $ 1o338 FEE, RECEIVEDIl COSTA MESA BUILDING-SAFETY DEPARTMENT NAN�/DEPT? P.O.BOX 317 COSTA MESA. CALIFORNIAFt FOR APPLICANT TO fill IN COMPLETELY APPLICATION�ITY FORF EORMAI MESA TYPE OR PRINT BUILDING BUILDING( 3 R _ �'No X .- ADDRESS COSTA MESA, CALIFORNIA^'/y//pe . foR.officE USE ONLY' . OWNER Awn Wit Y u /Y W r I .RECEIPT NO.' -.%ERM NO. _.i /.(/v_ - _ , �A/ RECEIVED BY gDATE RECEIVED �9ATTEE'ISSUEED ADDRESS c2I3 /�'W 5 - .._/-L' / "" /c-S7I 1-17-77 LL / TEL. BUILDING CITY £,1....& rn,Q.j�L_ NO. ADDRESS ARCHITECT LIC. COSTA MESA, CALIFORNIA OR ENGINEER NO. FIRE ADDRESS / - G ZONE TYPE // GROUP i, . • ///�� Q //p STATE CONTRACTORB,16_{Oi jJQA4f01LQ C No.16196 q BY DATE DATE ADDRESS/,20.'1// Wesf7N i N Sfeh Ave S.f}, ZONING LEGAL LOT ZONE/if' NO.OF USE OF NEW Iy^J DESCRIPTION //NJO.+' /I BLOCK 1 I TRACT a I PLANS BUILDING -I BUILDING y747/,--, Y/�/C U A.P.NO. l/' /y/�y� >/N '� /� BYPROV APPROVED J" :DATE ✓'//'/ /I OF LOT;J(/ /i �/� g I NO.OF NOW ON LOTB / YARDS REQUIRED EVES ALLOWED // 7 USE OF o n t (CENTER LINE ST.) ,.EXISTING BLDG. CJI de 1Y d g FRONT ,� n SFT. IN. • SETBACK LINE FROM ssie i _ CENTER OF STREET REAR YLA�RD 070 R.SIDE FT. IN. _ SIDE YARD I LEFT 3 I RIGHT / ' EL.SIDE '1 /�� FT. IN. DESCRIPTION� OF WORK REv-,--. R .� 0 /1FT/_2,,., ' I IN. NEW I 1"...#'......-ALTERATION I II ADDITION /� j< c ( t�fra /Q-J REPAIR I MOVING 3I DEMOLISH Y _ -/l SIZBUE DING]/yo114181.44. NO.OF 1 ROOMS STORIES' I EXTERIOR NNG'Z O (ROOF COVERING COVERING USE/OF BU DING ANDWORI(y0 BE ERFOR D /aoi�_ a' - 02s2: " ..e-, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. BUILDING CONSTTRR U ION. ///� VALUATION SIGNATURE OF Y.. �A_c..C'd PERMIT FEE $ 30-- ' PERMITTEE f/ l� �, , / S PLAN CHECK $ /s $ /Of (p AUTHORIZED AGENT TOTAL FEE'S (e S