HomeMy WebLinkAbout224 KNOX ST - Building Permits .. - CITY OF COSTA MESA
.04to ruts
o ,� ' BUILDING DIVISION
it vfitut,a'I[g 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
1004FOR INSPECTIONS CALL:(714)754-5626
PERMIT NUMBER: E10-00077
PERMIT TYPE ELEC STATUS: ISSUED
APN: 42533308 DATE ISSUED: 05/04/2010
ISSUED BY: RMD
JOB ADDRESS: 224 KNOX ST CM Suite/Unit: . ,
Vicinity:
SCOPE OF WORK: ELECTRICAL PERMIT FOR TEMP POWER POLE IN CONJUNCTION WITH NEW DUPLEX. REF#: BC10-00049
OWNER: CEFALIA JIM AND SARAH • Address: 221 CABRILLO Unit:UNIT B
PHONE: 949-697-3993- City/State/Zip: COSTA MESA, CA
APPLICANT: CEFALIA JIM • Address: 221 CABRILLO Unit:UNIT B
PHONE: 949-697-3993 City/State/zZip: COSTA MESA,CA
CONTRACTOR: OWNER-BUILDER License No. 000000 •
Address: Unit: PHONE:
City/State: ZipCode: CELL:
•
•
ELECTRICAL PERMIT FEES •
•
Electrical Plan Check Fee: $0.00
Electrical Permit Fee: $47.00
Reinspection Fee $0.00
TOTAL FEES $47.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No.92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
CODE#. IN$PECTIO&TYPE DATE INTITIAEs COOED -INSPECTION TYPE DATE INTITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing T-
200 Final Re-Roof 210 Final Electrical Z y l o C.�^•✓I
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
WORKERS'COMPENSATION DECLARATION: Owner ID verified by drivers license. Yes 0 No
I hereby affirm under penally of perjury one of the following declarations: Drivers License No. Expires: ‘410 ,(J
O I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document.i.e.-property tax bill 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
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 ❑ 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,scaffdding,falsework,or demolition
Carrier: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
(This sedan need not be completed the permit is valued atone hundred dollars(3100)or less.)
2,Art 2,Sec.341,Title 8,California Administrative Code).
Poli Number:
0 As owner-builder, I will not employ anyone to do work which would
('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 su.'•: • • workers' compensation provisions of Section 3700 of Applicant's Signature Dare
the fo. 4 h comply wit ese provisiq/ns.
5 r [/ I0/ Division of Industrial Safety Permit Number:
,n cQ7'!re are HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
W•• G: FAILURE 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 li e. - is'' fu force and effect. a registration form for acutely hazardous materials? ❑Yes ❑ No
' rir:Cfass#. (Section 25533 of the Califomia Health and Safety Code, with some
exceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one time has on hand a quantity of acutely
�nlmda•ssignature _CSq. . 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 ElNo
(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 0 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 0 No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the Califomia Govemment Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be fumished 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 0 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 Quality 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 Califomia
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 No
thereon,and who does such work himself or herself or through his or her own
8. (If"yes",attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for
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 not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
O I, as 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 Dale
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
Elam 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 by this permit until final inspection.
allOr ' of-ea- r.wnerls) /pyte
� signature Datee S( �0
•'= 'b(3/07) / Q.-•Tor'fid Applicant_. ..
`Ova 6 CITY OF COSTA MESA
•
4 BUILDING DIVISION •
> %J I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
F r1i/i + PERMIT B07-00315
4.1{�,lr"�11,�{
•
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.eiMLL"ma rcRMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 224 KNOX ST Status: ISSUED
Suite: Applied: 03/16/2007
Vicinity: Issued: 03/16/2007
Primary Occ: R3 Type of Construction: V-N
Parcel Number: 42533308 Zoning:
Applicant: ROSS SAVAGE
Address:
Phone: 949-290-6500
.. -"Zi _ _ ISSUED BY:
- - % �- - Th
Owner JAMES STERN"2- "
-
Address 224KNOXST, •� -
- : , ,��
t . ` ', Phone 714-742-7961' „ •
� �-1�
CM,CA/ " J =Zip 92662(.,- C > ti J{�J-
Contractor .OWNER BUILDER - 3
Address..// - tiA
Q _v v,A: A
r i Phone. �- �\
;/ Zip: License: 000000 �_,1V, �,
Arch : Eng: A �\,
Address: • Address: \.
'�'•• Phone. - - -� -Phone: ,
..# ..
Zip: - / License _• _ Licensed \\ti
- _ - L\
It �.
�v ' ' - - SCOPE OF PERMIT .. . -`'� v ^ "+.•
'DEMOLISH EXISTINGSFD AND DETACHED GARAGE. \ :'
" --FEE SUMMARY- • - - - -
Plan Check: r ' $72.31 1. .' , -''77 '1/7`,'=/' /'r`--r H �" ' Calc Valuation: ' _' `-$4:100.00
• - Permit: $111.25 - -�" _ "' ' ' '�'• "` -/Claim Valuation: ' $4,1'00.00
SMIP-Res: . $0.50 \ •
SMIP Com'- $0.00j;) 11!
N . Other:`. • $0.00 - - v'-_ _ // , - •;, l ' J!;
• Inspection. $0.00 :-. ?/ �. v - /
/` y r , /,'
Total: $184.06 , 7` 'z. }i; /
PLANNING & ZONING .
SETBACKS' ,N: --,-12-':t;' %�� ` "
MAIN STRUCTURE Front, ',0-0 Rear 0-0 '• ,Left 0‘.70c'7..,_ Right ' 0-0;i ,, i,
ACCESSORY Front 0-0N,: Rear 0 0 , , Left 0 0 - , - Right,,0-0 'N 71, '
�N/ / \ /1.J
/ ,
PARKING � Existinq:%` 0 Required �
0 . >. Prouosed.` '0 �• � � � �/ / ,
_ I\\ /C) i �,
4
, 7/
.r.`
• 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 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
244646(&00)
DECLARATIONS ° "" 4- ,
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.
❑ 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: 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 performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions.
Applicant Signature: Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.p Class#
Contractor's Signature: Date:
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: 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 toe 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)
lice e pursuan •the Contracto License Laws.).
•• =m. eider s--." Business and Professions Code for this reason:
(_tae: 3' ►G-0"7
` o. -Etta:
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 WIII the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the 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? ❑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 appplicant 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 Califomia Health and Safety Code been fully complied with? 0 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 a ermit for such construction or modification
1
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 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 Califomia 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 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.
Signatur Owner(s) Date
— —07
And/ d Applicant to
CODE II RISPECTION TYPE Qat. IKEEIBtS RODE! INSPECTION TYPE QaIL immeks
•
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 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
•da-MKT tl3:2hr FrarArchrtxe-smith "-stat,.ens; 04 ROB 1494 T t
-08. P.Gg5Po0.r
F-62>'
FFtc CM :CITY OF COSTA MESA ,g N3, :7:4 754 436, Mar. 2007 03:44Fri P3
DECLARATION OF AUTHORITY Bldg.Permit
FOR AGENTS OF PROPERTY OWNER This Permit d
TO APPLY FOR PERMITS
Street Address: a 4 15,Y i OiC 7--COs ma a__ AP Number. • -
t. I(we), �e3 cil + o declare that I em the Owner of tide of the above
referencedrealproperty.-and that I iwe)hereby authorize: /
Name: QOSS Sf3S1 1L-{/!�- c r / . Telephone Number: 91e-e290-kSO-
Street`Atteress: �Q L4 J4CJt4- M1K..y.4t4-.4-e, _
Cly: /Y ecog o± e_ae-li Slate:e a Zip:co?. 6 ��
to obtain pe units in my behalf,as ownerlbuilder,for . Oe n-, t1
at the above referenced property-
2. Should any person become an employee engaged in the improvement of the properly,I(we)shall immediately provide Workers
Compensation Insurance coverage and cause a certificate of that coverage to be tiled with the Sliding Division of the City of Costa
Mersa,as required by Slate of California laws,
3. As ownerlbuilder In fact. I understand and accept that air responsibilities do not transfer to any other person, company or
corporation,
4. I agree 10 Indemnify and held the City of Costa Mote end its employees of otfiters harmless from any caim resulting in damage er
Personal injury to myself or any other parties as a resort of work auU»rized by Me permits from me Cy of Costa Mesa.
I declare under the penalty of perjury that the forego.ng Is MB and COtrect.
Executed fhla day of 20 ,al - .California.
Print Name: 1 '4�S ST. !'�( (7-----...\\) •
Signature: .. r
Gate: lc.)-
-
Now: This aulhorization does not grafi auCwtiatlan In perform the wok as owner,
0 solely provides for lyttked power N attorney In sxaim Nt permit in any behalr
enyae n�Arcot
,
`,� '6 .)
CITY OF COSTA MESA
BUILDING DIVISION
tastr DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
-w.-....-./.1 • PERMIT • P07-00163
Seep; 046
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.BLddMBING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 224 KNOX ST Status: ISSUED
Suite No Applied: 03/16/2007
.�(1 Issued: 03/16/2007
Vicinity: _ .fit v1
60
Parcel Nunmber: 42533308 Y 4, ,� /1
Applicant: ROSS SAVAGE DAA
Address: - - ISSUED BY:
�, ; ,,i7- - Phone:- 949-290=6500',-f =
�
_ -
",/ ,
AOwner:ddress/ JOHNSTON, OSCAR LEROY •- C1 \ 1 ` \\N\
Zip: 92662
' , N / • ,/,--',,,,- i',A` •
- z)A*.,‘,
/ /. j3 ' '‘i•-•,'v'`r, Vr.- \
Contractor: OWNER=BUILDER `; \
,Address: 'ii":% ,g` �����,\ - \ \''-‘ �
/'" Phone:
/ Zip . . 1v \.. ` \H �
'�''. - ;- •License"•000000. °' ) ,,\
i, - - -- ' _ -
�' s- v: SCOPE OF PERMIT - /' - -
1 SEWER CAP FOR THE DEMOLITION OF SFD.REF B07-00315 -/� ��- \,' = i�;• t
\� i
FEE SUMMARY. . A `
AMT QTY -- r - ,,,,,,\ _ _ P n r. -.AMT QTY T: .A . AMT 1 OTY
ISSUE FEE $23.50 . Laundry,Tub/Washer-` _ i_$0 00 .:_0 1 �) `-Sump Pump r y i : $0.00 ,,0
Backflow irrigation $0.00 0 -. .... Landscape-Irrigation-- - $0.00--- 0 . - ---Swimming Pool '' , .-$0.00 ,r0
• Backflow Preventer. '_ , $0.00 0\ P-Trap $0.00 'lit? /Trap Primer ' • $0.00 -0
• i
Bathtub $0.00 0 Pressure_Regulator $0;00 /0 f Urinal 1•X ; $0.00 i 0
Clarifier System $0.00 0 - . - Process;Piping{per-10R)"• $0.00` /0 ,r-- v, Vacuum Brkr Bkflow(.1-4) ; $0.00 i 0'
Connect(Ice,Soda,etc) $0.00 0 ---- - Receptors- ' --$0.00/L,'0 - - `, Vacuum Brkr Bkflow(5+) l., $0.00 i,‘,0
Dental Units $0.00 0 - - Septic Tank'- --,-' r�_.-_$0.00 /1 0--- - .I Wash Basin '7//I / $0.00; .i 0
Dishwasher , $0.00 0 Sewer Cap for Demo $9!80 f 1 Wash Basin Set>;, / - `$0.00 ,0
Drain-Floor " $0.00 0 . Sewer Connect '$0.00 0 ` Waste and VentSystem-`1$0.00 )0
Drain,,Rainwater -, , $0.00 0 Sewer Private Line _-$000---.0 Water Closet(Toilet) /N- .-_$0.001 / 0
Drain,Roof , $0.00 0 Shower $0.00 - 0 Water Heater/.vent $0.00 r 0
Drinking.Fountain- r .$0.00 0 , Sink,bar ,‘,,.-;'- $0.00 0 Water Piping:(Inst or Rep:) ' $0.00' 0
Expansion,Tank `•$000 0 , Sink,commercial,,. ` `ry,4$0.00 0 Water Re�pipe �- / $000 0
commercial, r
Gas Earthquake Valve., $0.00 0 Sink,Floor $0:00; 0 Water Service /$0 00 0
Gas(1-4 outlets) $0.00 ,. 0 Sink;kitchen o ' $0b0 -PO - ., Water Softener' 1, ,/,'$0.00 0
Gas(Over 4 outlets) $0.00 ‘ 0 ) -.,' Sink,service/mop $0.00- 0•-'..K:, "-?.''OTHER _ $0.00
Gas Repipe $0.00 ' 0i. - Spa(private)", $0.00 0 M VIOLATION, 7 /$0.00
Gas Service '$0.00 '0 `Spa(public) " 'U $0 00 '0 `i PLAN CHECK- 1' / $0.00
Interceptors(Grease;Oip�"$000' ' 0 ''- -\ r '; - ' , - . �"'REINSPECTION� , $0.00 0
Interceptors(Sand'Auto), $0.00;'.,0 A_. , _% I" _'-- ci. !- _ r�V�-\,v' ,
TOTAL CALCULATED FEES: $33.30
, - � - - _ _ - _ VVv /- , j, -/
i,COMMENTS/SPECIAL.CONOITIONS - -,:y
i>
/:i.2',(--:----
.
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 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
2446-46(6/00)
DECLARATIONS siTh Cr.
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.
❑ 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: Policy Number:
(This section need not be completed ii the permit is valued at one hundred dollars($100)or less.)
❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions.
Applicant Signature: Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOUARE(3103.030),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lie.$1 Class#
Contractors Signature: Date:
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)
'cense pursuant to the Contractors License Laws.).
❑ —T'''empt u er ec. Business and Professions Code for this reason:
a•re: �
/€)co'r'es: 7-�' 0
V: tuition of Ownership by(type of docume i.e.-property tax bill or ed: l J
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:
I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑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 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? ❑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_aPermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U 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? ❑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 penally of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signal e.. •-:n: - Date
/�1 - .-
•-..•/A..!'-' T•.plicant Da
CODE I INSPFCRONTYPE g&IE INTRIAI& CODE! INSPECTION TYPE DAIF IMALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1286 Pool Spa Final 208 Final Plumbing S---/S-09 4$14))
200 Final Re-Roof 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
ADDRESS a BUILDING 224 KNOX ST Whet CITY OF COSTA MESA - BUILDING PERMIT �2 -00,03i
OWNERSNAMEIF ST KNOWNKENLINE LLOYD M TR
ADDREEE: 224 KNOX PERM NO: B 086446
COSTA MESA, CA 92627 PERMIT NO: B 086446 PLAN CHECK NO: N GOVT: N SUPP : N
APPL• AWNSADDRES& CONSTRUCTION TYPE: V-N PERMIT, TYPE: STR • PURPOSE: OTH
ARCHITECT OREJIWNEER: UC NO.: JOB DESCRIPTION : T/OFF S REROOF COMP . SQ FT : 1 , 800 .
ARCH.OR ENG.'S ADDRESS: WIT:
CLAIM VALUE: 1 , 800 . 00 CALC-VALUE: 1 , 800 . 00 GROUP OCC: R-3 /
c«+mACTarSNAMEMCFARLAND CONSTRUCTION ( 714 ) 548-1753 '
CONTRACTORS MAILING 247 E 18TH ST COMMENTS : X
• ADDRESS:CMCA UC. 663682 ********4******************************************************************************4**********************************************************************
92626 WMT: B _ Z ONI NG REQUIREMENTS
UCENSED CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury that I ant licensed under provisions of Chapter 9 $ E TB ACK S
(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force end effect. .
0 UC.NO.: UC.CLASS: B 66368 • MAIN BUILDING •
ACCESSORY BUILDING
Dale: //7/96 / Contract FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNS BUILDER DECLARATION:I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the
ng reason(Section 7031.5 Business and Professions Code:Any city a county which requires a permit to consuud,alter.improve, PARKING REQ: P ROV: PARCEL: 42533308 Z N E: REF NO:
smoltsh,or repair any structure,prior to Ns issuance,also requires Ihe applicant for such permit to file a signed statement that he or ahe ;s�+
a provisionslicensed pursuant to the of the Contractors License Law!Chapter 9(commencing with Section 7000)of Division 3 of the PLANNING NOTES>. "i
Business and Professions Code]or that he or the is exempt therefrom and the basis for the alleged exemption.My violation of Section >,, - ,•r
7031.5 by any applicant laepermn subjects the applicant mecinl penalty of ltd moredollars j$
than fee hundred 500]). •
*******************************************************************************
❑ I,mown*rdthegopeMor mi.employees with wages as their sole°repression,will do the work.and the structure is not intended D E V E 'L_ O P MEN T S E R V I C E S R E U I R E M E N TI' S
or offered for sate(Section 7044.Business end Professions Code:The Contractors license Law does not apply to an Owner of propertyta, Q
who builds or improves thereon,end 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.I,however,the building or improvement is sold within one year of completion,the ZONING APPROVED` B Y DATE:, ''�
owner-builder will have the burden d proving he or she did not build or improve for the purpose of sale). •
❑ I,as owner of the property.am exclusively contracting with licensed contractors fo construct the prated(Section 7044,Business and
Professions Code:The Contractors License Lew does not apply to en owner of property who builds Of improves thereon and who BUILDING APPROVED BY : DATE:
contracts for such projects with a contractor(s)licensed pursuant to the Contractors License Law). w
w
❑ Iamexempt under Secn: B.AP.C..for this reason: APPLICATION ISSUED BY: DATE:
***************-************************** ************************** * * ****
Date: OwnerLEGALIZATION:N F E E SUMMARY STRUCTURAL EGMENT:Y
I do hereby certify that 1 am aware of and understand the requirements of California Health and Safety Code Sections 25505.25533,and
25534,and that I or any future building occupant will/will not(circle one)need to comply with said stale codes and the requirements for
a permit for construction or modification from the AirtiSv anagenentDdrd.Resieentialconstrudnnapplcaliaaareexemptfmmthese BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
provisions. PERMIT 56 . 75 . 50
•
Date: Applicant SM I P/NON-RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the following declarations: IS
oIhave and wiamaintanacerticateoconsent toself-insure ler wan kecompensation,as provided for by Section 3700 of the Labor BUS UE FEE
Code.forthepedamanceoW*worktorwhichthispermnisissued. BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
❑ Iheeand wit malnan
ntawoers'compensatoninsuae, requiedbySeabof
3700NCode,for TOTALS > 57 , 25 0 . 00 0 , 00 57, 25 57 . 25 00
work for which this permit is issued.My workers'compensation insurance cancer and policy number are:
•
Carder: REVENUE DIVISION TOTALS--> COLLECTED : 57. 25 OVER/SHORT: . 00
Policy Number: - BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
(This section need not be completed I the perk is for one hundred dollars(stool or less) 56 . 75 . 50
I candy that in the performance of the work Ler which this perm is issued.I shall not employ any•: ..• any manner o as to
become subject to the workers compensation bws d C.. ..: that HI should .... . to the w ricehs' *******************************************************************************
comPen ssbd
n3 of Sean 3700 of the Labor C.. I shall f. comply th.- r...gat/ I N D I V I D U A L F E E B R E A K D O W N
1C-:)m.
Failuretosecure workers' coverage unlawful,and shell subject an employer to criminal penalties and TYPE QTY D E $ , C R I P T I 0 N UNIT COST TOTAL COST
civil linos Ws to one hundred thousand dollars(EI04000).In add/tion to the cost of compensation,damage as provided for In
Section 370dolthe Labor Code,Interest,and aromey'sfoes SFR 1800 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 1 , 800 . 00
CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of perjury that there is a construction lending agency for the END OF FEES
performance of the work for which the penult is issued(Section 3097,Civ.C).
LENDER'S NAME:
LENDER'S ADDRESS:
I certify that I have read this application end state that the above information is correct.I agree to campy with all city and county ordinances
and state laws relating to building construction and hereby authorize representatives ofthis city l0 enter upon the above-mentioned properly
for inspection purposes Y _ _ : •LAND
01-o7-19981e1:43 "viVi57.25
�_ r: / /7149PERMITyi086446
fa/ Date: /
Signature of a .d 1:enUAppkcant/Cont
(5151,46.W P) White-Building A Safety;Green-Fla:Canvey-Appk w*Pink-Revenue;Goldenrod-Assessor A
• CONSTRUCTION AND PLANNING POt,� & SPA
APPROVALS Permit # . • Date Inspector APPROVALS Permit# _ Date Inspector
_s
1. Temporary Electrical Service or Pole . 52. Pool & Equipment Location • - _
,2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement •
-
3.-Electrical Conduit Utility-Undrgrnd. '. ' 54. Forms •
• •4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
• 5, Steel Reinforcement 56. Rough Plumbing & Pressure Test
.6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE - .
• _7. Footings 58. Electrical Conduit-Uridrgrnd.
c8. Foundation - .n 59. Gas Pipe, 0 Undrgrnd., Test'
:9. Water Pipe-Undrgrnd. 2, ! _, 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK-
4 11. Property Sewer Line'& House,Connection62. Backwash & Receptor-Final
12. Sewer Cap _ ' ' 63: Heater& Vent-Final / - - •
•
13. Roof Drains - • -• -64. Plumbing System - Final r, •
14. Rough Plumbing i, • 65. Electrical-Final -
15. Rough Electrical,Conduit , -66. Solar System-Final ' '
16. Rough Electric Wiring7-1 '
67. Fencing & Access Approval "
17. Rough Wiring Sign •
• . - - 68. APPROVED-FOR PLASTERING
, 18. Rough Electrical-T Bar Ceiling r . 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning - •y --• T. FtRE DEPT.:REQUIREMENT -1
20. Rough Factory Fireplace ='' - " -II." APPROVALS' Pe-Emit# .` •
21. Ducts, in-Structure. - - 70. Underground Hydro • .
22. Ducts, Ventilating - ? _ • ' 71- Product'Piping 0Gas ❑Oil
23. Gas Pipe,Rough&.Test - -• - - r. 72. Underground Fluth-
24. Roof Framing ,• -' > „ -J`, 73: Undergrnd.Sto g`e;Tan1.0 Gas ❑Oil
25. Roof..Sheathing l4-e i A4y41_, 74;-'Overhead Hydro
-
26. T-Bar•Ceiling (Structural) & Monocoat •' -? Q (�_ -' 75.-Dry Chemical • _ - . •
27. "Frame and Flashing 76. Dry Standpipe•- ;. • - i
- 28. Lathing&Siding • . -.) " 771 FIXED SYSTEM-FINAL ' '
• . 29. Insulation .: -- .� - 4. _- 78. FIRE PREY, FINAL
30. Drywall Nailing r - ;t HEALTH DEPT. REQUIREMENT
. 31. Plaster Brown.Coat - ; 79. FINAL INSPECTION '
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED '
' - - _
- 33. Final:Electric . ' ..f •" .7- • `b.- Notes: - -
,• 34. Final Heating& Air Conditioning - , Ix t - -
35. -Final Gas Pipe=Test - ) '" '
36. .Hood or Canopy ^c,
-1
37. Final Factory Fireplace, ' _ . s ij -
38. Final Plumbing ., - :,
-.. - . _ ,
39. Water Service-Final . .' " -
-
40. Gas Service-Final s. ' - - " •
- 41. Solar Domestic•Final - - - - -
42. Backflow Preventer . - --1
43. Backflow Irrigation - 4 •
44. Landscape Irrigation,System_ c_ -- r ;• 4 S • .: v r)-z.' ,
45. Sound Attenuation- ' •• -. T -
46. Handicap•Regtilations I - - -
47. FINAL STRUCTURE & BUILDING
48. E;INAL PLANNING , -- _
• 49. Elects•ic Release to Edison
50. Gas Release to Southern California;Gas Co .
51. CERTIFICATE OF OCCUPANCY
No. Date
J