HomeMy WebLinkAbout430 LENWOOD DR - Building Permits,
-, •
JobAddress: 430 LENWOOD DR
Suite:
Vicinity: ��
Primary Occ: R-3 Dwellings/ Cong Res <10
Parcel Number: 42514307 _
Applicant HARRIS, CHRISTINA
Address: 430 LENWOOD DR �
COSTA MESA, CA
Owner: HARRIS, MICHAEL D
Adtlress 430 LENWOOD DR
COSTA MESA, CA
Contractor:
Adqress:
Zip:
A1ch :
Address:
Zip:
/�d� " t� 77
ADD 765 SQ. FT. TO RESIDENCE -
CLOSET qND 197 SQ. FT FIRST FL
CREATE❑
OUT OF pREA WHERE KITCHEN�
Qther.
Inspection:
Total:
�1
79
$7
Front 20- 6
P
Front 0-0
Existin : 4
Phone:
Type of Construclion: V-N
Zoning:
�°"12ear 21-0
Rear 0- 0
Reouired: 4
Phone: 949-645-6993
Zip: 92627
Phone: 949-645-6993
Zip: 92627
Phone:
License:
Left 4- 8
LeR 0- 0
Pr000sed: 4
Status: ISSUED
Applied: 12I14I2001
Issued: 05/13/2002
ISSUED BY:
DR
CA
MASTER 2
KITCHEN
Calc Valuation:
Claim Valuation:
Right 5-0
Right 0- 0
-0440
BATN AND WALI
ROOM AREA WIL
$70,322.00
$o.00
N0710E: 7he work authonzed by this pe�mit shall comply with all aOPlicabla handreap access requ'mements under Calitomia sfatutes and relaled
regulalions. (Ord. Nb. 9228, § 1, 1241-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or ii work is suspended or abandoned
for a period of 180 tlays.
INSPECTIONS: In ortler for the work authorized under �his permit lo be consitlered legal, such work must comply with all applicable codes, and all
requlred Inapectlorys and Ilnal approvel musi be obtained. Failure to obtain Inspeclions and linal apptoval will resull in tha expiralion of ihis permit.
� FOR INSPECTIONQ CALL: (714) 754-5626
MMC �G'UO�
WOHKERS' COMPENSATION DECLARATION: �� �
I herooy aHirm untler penalty ol pequry one ol tne Idlowinq tleclara�ions: �
❑ I heve en0 will maiNain a cen�l¢ate at consent to sell-Insure lor workers' compensalion, as provitletl lor by section 3700 of the Lebor Cafe, lor l�e pertormance ol t�e
work for w�ich t�is permil is issued. .
❑ I nave anG will mamiain workers' componsalion insurence, as requiretl by sect�on 3700 0l lhe Lebor Code, far iho petlormance ot Ihe work lor whi[h ihis perrnil is issuaC.
My worMers' compensa�ion Insurance carrier antl pobcy num�er are:
Carrmr Policy Number:
(Tb�s :eclion neutl nof Oe complefed A fne Oermrt is ve/ued Bf one hun�red dollar5 (S 100f or /e55.J
❑ I cenAy Inal m Ihe petlormance ol t�e work tor w�ic� Ihis permil is issued, I shall not employ any parson in any manner so as lo become subjecl to ihe workers'
compensation laws ol Calitomia, antl egree �uai tl I shoultl become subjecl to Iha workars' COmpenSaiion pwvisions ol Seciion 3700 0l lhe LaDor Cotle, I shall lotlhwilh
comply witn inese provisians.
Apphcani Signalwe: Date:
W �HNmG- FAIt URE TO SECURE WOHKERS' GOMPENSAi�ON COVEPAGE IS UNUW FUL ANO SHALL SUfl1ECT AN EMPLOVER TO CRiMiN�1 PEN�LTIES AND dVIL FINES UP 1O ONE HUNDPED
iFqUSAND WLLARE (5100.U001, �rv �DDITION TO THE C(�T OF OOMPENS�TION, DRMAGES IS PROVIDED FOR IN SECtION 3"lD60F THE UBOR CODE, IMEREST,AIiDATTORNE�"5 FEES.
LICENSED CONTRACTORS DECLAFATION:
1 baraby afhrm I�a� I am licensetl untlar pwvisi0a5 0l C�apler 9(tommen[ing wil� Sa[tion 7000� ol Oivision 3 0l lhe Business
torce an� etleci. Uc /
Coniractur's Signawre:
CONSTPUCT�ON LENOMG AGENCV:
❑ I �en:by aninn �nat Ibero is a conStmcLon lentling agency lor ��e periormance ol �he work for
LenUer's Name: Lentler'S Atltlress:
Signawru: ��
OWNER-BUILDER DECL4RATIONS:
I nervoy atlirm t0at under penalry of perjury �hat I am E%EMPT PROM THE CONTRACT(
CWn: Any aiy or couniy which reQuues a permit lo tonstruct, aller, improve,.tlemolish, o�
�o hic a signetl 5te�nmeN ihel �o or she is licensatl pursuam �o t�e prwfsbnejoLlhe Con
Busine55 8ntl Prolesslans COGB) or Illai be Or 50B i5 e[emp� IherelfOR1 �e0d IhB bl5i5 �or
sub�ncls tna ap01¢ant to a civil penalty ol nol more Inan live huntlretl Cdllei� (5500)f�:
i �: e._xa: i :i ��n�..a
❑ I, as owner ot Ine propeny. or my employees wit� wages es iheir tde,c0lnpensalior
7Uaa. Businass antl Prolessions Coae: lhe Contracmrs Lkense tew;tloee rrot eOPI�
himsull or hersell or Ihmugh �is or �er own employaes(piovida0 tl�a� auth hnpmver
sold within ono year ol com0�etion, Ne owner-builtler will hev9,ihe burden ot�provin[
❑ I, as ownor nf I�e property, am E%CLUSIVELV
Ca7e: Tne conuanurs License Law.tloes not a�
I¢ense Pursuanl �o Ine CoNr&ctOhJ CkOnse La�
❑ I am o�ompl undBr seC. �� f�t�"'}T �
Signalure: .{'�?i��„^E'F:-'t';.; �
Ownor ID vOnlietl Dy tliivi
Venhwtion ol Ownetship
6ill or
DIVISIDN OF INDUSTRIAL SAFETY PERMIT CERTIFICATON:
k' *> •-� � F;.'-5.-r4:fA
� I nereby cenify thet no excavation five (5) or more ieel In tlepih into
oeimu, ano iha� iq WilAing simcture, scaHoltling�taleevioik, or tler
3a 1, l nle B, CalNortii2 Aommisiraove Code . 7'"
t ►'k->i a��'� ,
Class •
Date:
ucW�e; p[IOf,M ils issuance
e Le`w (Chepler 9 (commei
emF Uon`Any violation ol f
. /:'�;,�'�
IE,WORK; ena the slmcWr
��praperty�w�o huilds or im
nlefitleO;or ofleratl lur sala.
i tlid�nol buil0 or improva fo
n..�.r,�
R9 fo{constmcl Ine vmjnc�
i Meieon, and who [:onirac
reason _
_ Dato:
my bcense is in lull
31.5, Business anE Prof655ion5
3s �ne aOP�icam tor sucn permit
mlion 7000) ol Division 3 of Ihe
.5 Dy any applirant lor a permit
�detl or oHered tor sale (Sec.
on, antl who tloes such work
Ine building or improvnmem is
sala.).
8vsiness antl Protessions
�ojeci wii� a wmracmqs)
EspireS:
tlescantl, will De matle in tonnection with work aut�orizetl by iNs
will be more Nan tniey-six (36) leel high. (Cnap. 32, Grp 2, An 2, Sec.
� As owner-builtlar'liwill�nol employ anyone to tlo wali;wf�� waild�t8ryWr6 a permil"Irom Ihe Division ol Intlusvial Selety, es notetl a0ove, unless sur.h person hes e
permn to tlo su[ch work'irom Ihe tlrviswn.-� s x ?'� ��3,�d� tr
L,���':� �:•�1'•'� �je`_✓;1�3•'+��d`��s;:�
Sm��aiure: b: y� Date:
F3.F�^��#':�,A� r�.'��wh� i/ �[,r� l,;1,,�4 AM."1�%S-'.�%
Divisionotlntluslrial�SateryBermitNumbef:�7�'�+�i l�'���T+�M>'�%
�'
HAZARDOUS MATERIAL'SAND EMISSIONS CERTIFICATION:
, wx
i W ill Ihe aop���ani'oi present or hiture bu�Cing occupam nead lo lile entl cemfy a Business Plan lor emergency response to ralease or ��realenetl release oi a �ezerdous
.._. t.��r-�..h..
i5or.bon 255C5 0l t�o;Celifomie'Healih,and Salery Cotle requires, wnh some e.ceptions, that e Businass Plan be filetl with (he Cosla Mesa Fire Oepartment by evury
business whicn li2a al eoy one.time tluring a roponed year a quanUty ol nazaroous matenals aqual Io or grealer Ihan a weight of 500 pounas. or a voWme of 55 gallons,
nr 20U cuoic teel W iompressetl g2!'91 slantlartl temoerature and pressure).
....._........,. .... . ._ .............. .............. .. ........ . .............. . ....... . . . _._.. ......... ....... ........ .....
2 Dces or wnl inr, apDu[eN or presenl or lulure builtlmg occu0ant neetl lo lile a registralian lorm lor acutety �azartlous malarials? ❑ Ves ❑ No
e ,..,•;,. ..
ISechon 25533 nt Ine Celifomie�Healih antl Sa�ely Code. wim some e.ceptions, requires regisiration wnh Ine Cosla Mesa Fire Depanmenl by each Ousinoss whicb el eny
una ume has un nan4.elquantily ot aculely hazaiaous materrels equal to or greater than a weighi ol 5(� pountls. or a vulume ot 55 gallons, or 2U0 cubic teet of
comprasseo gas at slanaard temperaWre antl pressure�.
. _......._ .........................................._.._........................................;..........,....................................,_._......................................................................_............._......................................__.................................._........................._...............
3 Uoes or will Ihe apohcanl o� presenl or IUWre budtling occupant neeG to pre0are an RMPP (Risk Management antl Prevention Program lor aculely hazartlous materials)?
[] Ve:. ❑ Idu
i5uc�ion 255'sJ of the Caldomia Healln antl Salety Cotle provitles Ihat the Cosia Mesa Fire Departmanl may require Ihe preparatioq certifiwtion and filing with the Fire
I�upanmont ol an HMPP by Ousinesses which are reqwre0 b �egis�e� acuiely �alartlous matarials wilh Ihe Fre Deparimen�.
............ ........... .....,...... . ......... ...._. ...... ......... . .... . . ....... ............ . .. ........ ... . .... ... ................. . ........ . . ...
4 n an HMPP is presenUy requirea has Seaion 25534 of tne Cahtomia Heait� antl Satery Cotle been lully complieE wi1�7 ❑ Ves ❑ No
............. ........ ., .......... . . .. .. ......... .... .. .......,.. ........_ . ... .. ...... . ......... .. ....... .. .. __..... ....
5 Uons or witl Ine ap01i[an� or presen� or IUWre builtling occupaN requir0 fOr Ihe wOrk wp¢h is Ihe subleCi OI tAis a pliGdliOn a parm�l tor svcn cons�mr.Yon or mal iica�ion
Irom tho Somn Luasl Au Uuabiy Managemon� Disluc� or irom any ot�ar air polW�ion contml distnct or agency7 � Yes U No
ISection 65Pti02 nl Ine Calnornin Govemmem Code requires mai me requesma inlormanon be lurnis�ed on appliwtions lor non-residentiel Duiitling permits).
........... . ._ ........ . ...__........ ..... _...... .._._.. . . ......... . ......... .. ....___.. ... .............. . ........ . . . .. .._... . ... ..... .._. . . .......
b W��I any part ot ihe tacility m be con5ltucietl unde� ihis permit ba wiihin 1000 feet Irom Ibe nuier bountlanes oi a schoul? ❑ Yes ❑ No
pi'yos", ine iacilny musl meet ine requiremem of Seciions 25534 antl 42303 0l Ihe Califomia Healin and Satery Cotle�.
......................................................................._................._............................................._.......................................................................................__..........................._......_.._..............................................._...._............._..........._.._..._........
7 tl a pemii� trom Ine South Coasl Av �va01y Management District or other au OOIINion control tlistricl or egency is reqoiretl lor ihe work which is I�a sublect ol this
apu�iwuon, nevv all ol Ine tlisclosures prescribed by Calibrma Mealt� and Safery Cale Saction 42303 Oeen made? ❑ Ves ❑ No
............ ...._...................._................................................................_...._......_..__............_.._......................................__................................................................._......................._..................._._..._............_._........_..._..............._.............
P (If yes", auacn conibcale o1 com0lience I�om Inn appropriale air polWiion contwl oflicer).
CERTIFICA7E OF COMPLIANCE I cemry thai under penalry oi perjury the inlormaiion given above is'correcl. I agren to comO�Y w��h all slate laws itl cily orainanr.es
regartlmg Haxartlous Maiunals and Emissiuns.
SignaWre: ' Daio:
CERTiFICATE OF COMPLIANCE AND AllTT/ORIZ.AiION OF EHTRY: I CeNfy untler penalty ot Derjury thal I have read IhiS epplication antl s1a1e t�al Ine inbrmatinn given is
correu. I agrae lo comply wi�n all slate laws entl cny orainances relaiing �o builaing cons�mclion, antl au�horize re0resenlnlrves ol Ihe Gy ol Costa Mesa lo anlor upon Ihe
ebove4escntietl propeny !or inspeciion purposes. I agree not io occupy or allow occupancy ol any 6uiltling authorizetl by this permit umil linal inspeciion. ,
�Qf�� INS�ECTIOHTYPj
1676 FjaeG.SYSIem/.
Fire
203
2oa
9gnelure Of Legel Owneqs)
AnNOr AulOonzetl Appl¢anl
W all
QIjE I INTTI�lS
COOE� INSPECTIOHTYPE
21
21
Q/�T{ NI TR1,1L5
(714) 754-5273 • Fax (714) 754-4856 • www.cl.costa-mesa.caFyCUMBING PERMIT 77 FAIR DRIVE, COSTA MESA, CA g2E?6
Jqb Address: 43O LENWOOD DR
Suite No ,
VlciNry:
Parcpl Nunmber: 41514307
Applicant HARRIS, CHRIS
Address: 430 LENWOOD DR
COSTA MESA, CA
Owner: HARRIS, MICHAEL D
Address 430 LENWOOD DR
Contractor:
Address:
COSTA MESA, CA
ADD 765 SQ. FT.
MASTER BEDRC
WILL INCLUDE E
CREATED OU�
TOINCLUDE�RE
sr System $0.0 ' � '0�
ct Qce,Soda,etc) $0.0 0�
Units $0.0..� �0�
asher $9.8 �'" '1�
floor $0.0 " 0�
Rainwater 0.00 � 0;
Roof ' - - ., 0.00 �Q�.
ig Fountain $0.00 � 0�
sionTank ._ �,y'�,� $0.00 � 0
arthquake W �' �'. $0.00
-4 outlet ' � " �� $6.15 1
�ver 4 �tle�s) � t $0_00 0
��ip� ��� -�,- $0.00 0
e'r�iice���.. s�y : $0.00 0
m.�:.:.
7pto[� Gre35 Oil) $0.00 0
:ptors(S'a'nsj%Auto ) $0.00 0
Phone: 949-645-6993
Zip: 92627
Phone:
Zip: 92627
Phone:
Zip:
License:
P-Tra ;�b���`,�'''.,''.�
Pres re,Regu"�tor
�a-�x,..
Proc�ss;Pi�pmg,(per 70
Sg p�ctank� .
S`�vie�Cap;�or Demo
`$'e"�n�:o,�nect
S�wer Prwate Line
SJa�C, commercial
$ink, Floor
Sink, kitchen
Sink, service/mop
Spa (private)
Spa (public)
$0.00
$24.65
$9.80
$0.00
so.00
$0.00
$0.00
$0.00
$0.00
$0.00
QTY
1
0
0
0
0
0
0
0
0
1
1
0
0
0
0
0
0
0
Status: ISSUED
Applied: O6I17/2002
Issued: O6I17/2002
ISSUED BY:
iN�VJ�L WCLUDE A �
d�.,�FT+FIRST FLOOR A
MIIYY ROOM AREA W
�REF:601-01952.P
DRYTUBNJASHER,1
1 TOILET.
SumpPump
Swimming Pool
Trap Primer
Urinal
Vacuum Brkr Bkflow(1-0)
Vacuum Brkr Bkflow(5+)
Wash Basin
Wash Basin Set
Waste and Vent System
Water Closet (Toilet)
Water Heater / vent
Water Piping (Inst or Rep.)
Water Re-pipe
Water Service
Water Sokener
OTHER
VIOLATION
PLAN CHECK
REINSPECTION
AMT
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$9.80
$0,00
$9.80
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
so.00
TOTAL CALCULATED FEES: 5103.30
aTY
0
0
0
0
0
0
0
1
0
1
0
0
0
0
0
0
NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requiiements untler California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
E%PIRATION: This parmil shall automatically azpire and becoma void if work is no� commenced wilhin 180 days, or il work Is suspended or abandoned
for a period ol 1 BO days.
INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all
requiretl Ingpeetlona end flnal epprovel musl be obtained. Failure lo obtain inspections antl linal approval will result in the expiralion of this permit.
FOR INSPECTIONS CAIL: (714) 7545626
�eioo�
WORKERS' COMPENSATION DECLARATION: `� 7
1 �ero0y aHirm untler penalty ol pepury one ot Ne lollowing aeclaretions:
❑ I neve entl will mafniain a cenilicate ot tonsenl to sell-Insure br workers' compensalion, es Drovidetl br Dy sedion 3700 0l ihe LeOor Catle, lor Ihe perlormance of I�e
wo�k tor w�ic� t�is permn iSlssuetl. ,
� I nava and will maimain workers' compansalion insurance. as requve0 by secuon 3700 0l the Lebor Cotle, lar tne peAormance ol Ihe work lor w�ic� �his pennit is issued.
My worMers' compensaiion Insurance carrier antl pobcy num�er are:
Carnor: Pobcy Numbx[
(This secnnn nend nof Oe romp�eletl rt tbe permtl is ve/ued af one hunOred dolla�s (S �00) or IessJ �
❑ I cenily that in me Oatlo�mance ol the work lor which ihis permit is issuatl. I shall not employ eny Oerson in any manner so as lo Decoma subject to the workers'
compnnsauon laws of Cali�omia, ane agree Oiat d I snould become sublen to t�e workers' compensation provisions ol Sea�on 3700 0l the labor Cotle, i s�ail lon�wii�
comply with Ihese provislons.
ApPbcani Signalwe: Daie:
WAFNWG� f�rt URE TO SECURE YIORKERS' COMPENS/T�pJ CAVEPAGE IS UNIAWFUL ANp SMALL Sl1flIECT AN EMPLOVER TO CRIMINAL PEN6LTIE5 AND CIVI� FINES UP l0 ONE HUNDREO
THOUSN�D IXJIIAFE �5100. WOL �N �DDITION TO TNE COST OF GOMPENS�TION, DAM4GES AS PPOVI�ED FOP W SECTION J]D60F TME LABOR CODE, IMEREST. M1p A770RNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I heroby atlirm I�at I am hcensetl unaar pmvisions ol COapler 9(tommencing wilh Setlion 7000) of Divisfon 3 of lhe Business
force ana etlecl. Lm. • pass a
Coniraaor's Signawre: Date: .+�':
CUNSTRUCTION LENDING AGENCY: '
❑ I hcreby aHum Inat Ihere is a constmcLon lentling agency lor Ihe peAormance of Iha work for
L[rnUer'S Name: Lentlei 5 Atldress:
Signaiuru: �
OWNER-BUILDER DECLARATIONS:
I neruoy anirm Ihat untler penauy ot periury Ihat I am EXEMPT FROM TME
Coda: Any ciry or counry which requires a permit m consimct, alter, impmvi
to hlc a vgnetl slatnment inal ho or ane is Iicensetl pursuant Io Ihe prpNSlo
Busin055 antl Pfotessions COtlB) or Ihai AB Or 5h6 i5 eaBmpi �here1f0111�90f
suo�ects Ina a00Lcant to a civil penatly ol nol more Ihan liva huntlreC �dollera
Al..r.."r K-:�.
❑ I, as owner of Ihe O�oDeny. or my employees wilh wages Gs Ilielr bda
7U44. Busines5 an0 Pwte55ion5 Cotle: l he ConlraClorS.Ckense Lew.
himsult or herselt or Ihmugh his or �er own employees!�pruvideE.thaC�.
sold within one year ol rorti0letion, I�e owner-builtler irill AevO,ttia.bur
c � r-nro.�. r
� I, as ownar ol t�e pmpeny, am E%CWSIVELV CONTRACTING WITI
Cotle: Tne ronuactors License Law.tloes not apply l0 90 4wner ol pw
I¢ense Fmsuanl to Ihe ConlydctOraiLkOnse Laws.)� ��
❑ i am e.emo� untler sec. •�4��'°f'ir-�`'� {7.;��{_f�Business ai
SignaNre: %'r�yaLi�'^„ ` i'c� �f?`✓:,+�w�
ry..nr�+.a: " T y'..(
Ownor ID von�iotl Oy tliivei 91ken504� �QjVBs� D.Nor�yy
/,C�':E�P�_ �va:�9. B�f:Y,'Y•�E
Venhcation o� Ownership py.(lype d doCumeni, Le. - pfoperlY J8x bill or tlee
DIVISION OF INDUSTqIAL SIFETY PERMIT GEHTIFlCATION:
i:i�.0 '!� j'!.lsh��it{•{
❑ I horaby cenity tf18t no excavation live (5) or more.IBBI'.41 tlepth inlo
oermii, ano ihat ro huiltlino slmaure, scafloltling�,f819BwOtk, Or tlen
341, Title B. Caldoini2 Adminislrabve Cotle). ��� ��„{
or repetr4any stmcW 4e; p[iof,M i�s issuence
imradora Llcense Law,(Cfiepler 9 (commer
�r tlie'e119peB eaemptiwi:SAn'y violation ol £
�.�
���vt�s3r.� ,kF,+�i`.:;�
on, WILL DO�TMEjWORK;�entl me slmcWrv
�ly to,en',oWne(,'oY,ptapefty,;who huiltls or im
BI11fiI1I38lB�f1011I1[BlICBd O! OHBfBtl Wf SdIB.
ig tYet ne�of� e Aid �Id buila or imDrove to
) COHfRACTOHS to conslmcl t�e pmjett
�iltls0l:ItlipiGVBB tlleieon, an0 w�o conlracl
�1��''-'� a3,�Y�i
ns C§o'Oo fori��is reesan:
k=����a� Udio:
my license is in lull
.5, Business and Professions
tne apphcam lor sucn permit
lion 7000� ol Division 3 ot i�e
by any apPlicant lo� a permit
idetl or otlered tor sale (Sec.
�on, antl who tic�es su[h work
. IOe builtlmg or improvnmenl is
sale.).
Business antl f'rotessions
rojecl wiih a toNraQor�s)
ERpires:
tlescentl, will 6e matle in conneclion with work eut�orizeC Cy Ihis
will be more ihan ihirty-six (36) lee� high. (C�ap, 32, Grp 2, Art 2, Sec.
❑ As owner-bui�Cer4 will nol employ anyone Io do Work�rrfuc� wouM fequlie a permit9mm the Division of Intlustrial Satety, as noletl above, unless such person �es e
oermil lo tlo suCO wOfk irom I�e tlrvisioa �`�;;�C��'.,1.";���„�rq n.iN�
,�;�.,� .. ck'Vjy,�r�'d"{�,{ "n Jl
eionamre: �--d.-J'�.: � � f •Ar'i.GnGA�'ti"xCw,j Dete:
-p•.�wi: 1' JV
�i:.� r".:; �'S:�rr'3;� �` ;r t��`� �
Divis�onollntlusVial�SelaryPermitNumbet:+'.'."- �'... ?:�`�r
.� t ,'
HAZARDOUS MAlEfl1AL'S AND EMISSIONS CERTIFICATION:
rcr
I W ill ihe appllwnt or;D�esem oyh!iure butlding occupant naed Io lile en0 tenity a Business Plan lor emergency response to release or Ihreatened release ot e hezerdous
iSar.non 25505 o1,i�e Celifanie Healtfi�and Safety Coae requiras, wilh some e.ceptions, �hal a Business Plan 6e lilotl with !he Cosla Mesa Fire Department Dy evury
bu5ine55 whiCh liae el en � onB tlme Ourin a re ortetl eal a uantii of haZartlous matenal5 e ual lo Or reaie� I�an a wei hl ol 500 oun05, or a volume oi 55 allons,
_,.,.,._._._'__'_'____Y�___"____'_'9'_P'___Y_' Q..'__Y_ a 9 9 P 9
UOCS o� wtll �hC dpD�ken{ IX�p�BSBi fo� lutute builtlinJ OCCuOd�� neetl to lile a regisvation form lor acmeiy Oaiartlous maierials? ❑ YES ❑ No
y•
ISection 25553 ot Ine Celitwnie Heallh and Salely Cotle, wiln some ertepiions, requires registration wiih Ihe Cosla Mesa Fire Depanment by eac� �uslnnss whicn at eny
unn ume has un nanC;a.queinny of acutely hazaiaous matenals equal to or greater than a weignl ol 500 pountls, or a volume ol 55 gallons, or 200 cubic Inet ol
compinsseo gas at siantlam temperature antl pressure).
................................................................................._............_........................_.........._........_......._........_......._......................._..............................................._...................................._...__........_...................._.........._.............................
Doos or will Rie a0olican� o� presenl or fulure buiitling occupant neetl to prepare an RMPP (Risk Managemenl antl Prevention Pmgram lor eculety �azartlous materials)7
❑ Vet ❑ hlu
i5ection 2553a ol ihe Cahlomfa Healih antl Satety Cale provitles i�ai ihe Costa Mesa Fire Department may require Ihe preparation, certilication an0 filing with t�e Fire
1�enAnmem oi an HMPP Uy businesses which are raqwretl Io register aculely hazartlous materials wnh Ine Fve DepaNnen�.
........ ........._ . . ...... ... . ........,.. . ......... _ ..._....... . ......_... .............. . ......... _,._...... ....... ... . ......_..... ._.
u an H�APP is presently require0, has Sachon 2553a ol ihe Calilomia Health and Sa�ery Cotle Deen lully complieC with7 ❑ Ves ❑ No
...... . ......... . . ._...... . .. ._......... , ,. . . ......_... . ......._... . ... .... .._ .. ......... .. ........ ............ ..,. ........ . .....
I�ons ur wdl me aOP�icant or present or IuWre builtlmg occupant reqwre lor Ihe work w�ich i51h0 Subje[t ol I�is �ap pl¢ation a ermn for suc� consvur.tinn or mafiliwtion
irom Ihe Sou�n G�asi Au Uualiry Managemom Disv¢I or �rom any o�her av pollution control Cistrict or agency7 u Ves � No
ISecunn 65PS02 nl Ine Calitomin Govemmenl Cotle reqwres Ibat ihe requestatl inlormation be fumisnetl on ap0�icalion5lor nomresitlentiel OuilEing permitsj.
.... . . ........... .........,.... ...._.. ...... ..._,........... . ....... .... .. . . . ................ ...._..... . .. . _.. . ..... ..... , .._.... . . ...... . . ... .....
. . . ..... ....
W ill uny pen oi inn lacibry m �e cons�mclad untler Nis Dermit be wiihin 10001ee1 Irom Ihe outer bountlaries ol d School � ❑ Ves ❑ No
111'yes', �he iar.ihty musl meei �he reQuvement ol Seciions 25534 antl 42303 0l Ihe Calibmia Haalth antl Satety Cotle). '
.. .. . . . .. .... . .. . ........ ......._.. . ..._... .. .. .....;... . ............ ._......... ,. .... ..... ... ......
.. ........ ............
il a pe mi trum I�n Soulh Coasi Alr Oualiry Management Disinci or olher ai� polWbon rontrol disincl or egency is requiretl for Ihe work which is Ihx subjecl of Ihis
bppbcauon neve all of ine E�sGosuras 0'escribea by Calilomia Healih antl Salery Gode Section <2303 �een matle? [] Yes ❑ No
. ......... ........................................................._...._....._.............,.............._.._......._............_....._.__......._........_......._..._.............................._........_................_....... .._......................,........._....................._....._....................._............,.....
III yes", atlacb corvficale UI compliance Imm Ihn appropnaie air pollulion conlrol oHiceQ.
CEH7IPICNT[ OF COMPLIANCE I cetlity tha� unoer penaity of perjury Ihe inlormation given above is correcl. I aqreo to comply with all state laws iA ciry ominanr.os
regartling Hazartlous Matuiials anJ Emisswns.
Signaluret Uala:
CERTFICATE OF COMVLIANCE AND AUT/10RIZA710N OF ENTAY: 1 cenity untler penalry of Derjury tha� I have read Ihis epplical�on antl s�ale Inat tne intorma�ion given is
correct. I agree lo comply wiln all s�ata laws entl cny ortlinances relalmg Io building consimclion, and authorize represematrves o� I�e Gty ol Gosla Mesa to enler u0on Ihe
abovu4escnbetl Oropony for inspeciion Durposes. I agree not io occupy or allow occupancy ol any 6uiltling authorizatl by this permit umil linal inspeclion.
G4➢F� INSP€SJ14h.*woF
NS_€
1676 Fixefl'�Sntem.
Fire
?03
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Signeture Of Legel Owneqs)
/lntl/Ot AulOor¢Btl ADpliGdnl
Wall
o�re i iNTTI�LS
COOE � IHSYECTION TYPE
21
21
2AIE INiRULS
OWNER x. w. xnT,T, enu.cm �rn TNC �
IOB ADDRESS
BLIILDING PERMIT NO.
GENERAL CONTRACTOR ,� VALI[E $ 13 � 000. (10
AP. No. LOT 7 TRACT �� �7 FIRE ZONE DESCRIPTION OF WORK Res, v;�a{;t �ar.
.GROIIP I& J TYPE p ZONE RI1 PLAN NO. 5256
.INSPECTIONS I DATE I SUBCONTRACTOR I DATE PERMITSNUM ER
a
, Costa Mesa Snilding Department APPLICATION FOR PERMIT
.� '� • 111 EAST 20th STREET 5286 B tD I L D l N G '
s... IJ COSTA MESA, CALIFORNIA
FOR OF'FICE USE ONLY
� FOR APPLICANT TO FIY�Y� YN Receipt No. Permit No.
e°''d'^9 5253
Address 430 Lentrood Drive
Costa Mesa, California Recefved by Date Rec'd. Dah Issued
CrossSt. �UStlri
owne� S, id. Fioll Construction Co„
Mail
nda�ess ?gz6 Nei.r�ort Blbd.,
Tel.
city Pieimort_ Beac'r_. Cal. No. HA 52
Arohitector�rT��Z LiC.
Engineer 1�� ld@ �: T. Oy3. No.
Address 2025 bTet�rnort Avenue, Costa
CiSy Lic.
Contrector �41rieT' No.
Metesand Bounds)
a 60 a 100.5 �
Bldg.
Line from
f Street 51 � 6°
DESCRIP�'ION
IX I Alteration
Use of New
No. of Bldgs.
Nowon Lot I`rOrit�7
No.of I No.of
Rooms
I Roof
Addition I
Demolish I
Stories �-
I hYreby aclrnowledge that I have mad this Application
and state that the above is correct and agree to cromply
with all Clty Ordinances and State Laws regulating
building rnnstruction.
Signatureof d
Permittee / /%� .+ __\ / %/ .
Valuation I PermitFee
$ �3OOO _ � PlanCheck
; I, To��
Fee
AM 204 S-BP 2M 6-53
�,.�� 6 —s —s7 �ui�
Building �
Address
Costa Mesa, California
Nearest
Cross SS.
Zone � � No. of � Type �/
APPR�VL�Y,S
rundation Location Inspector
Forms, Materials,
Under-Pinning
�ame: Fire Stops,
� � Plaste�, ExL
3p � Masonry Reinforced
� S � Bond Beam
i�'S '� FINAL
Date
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Show location and distances from
property Ilne and between buildinga
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