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Home My WebLink About284 23RD ST - Building Permits O CITY OF COSTA MESA t, BUILDING,DIVISION >:j 1. DEVELOPMENT SERVICES DEPARTMENT P MIT NUMBER 1. 1 w _�... I 4PERMIT B02-02012 grrtwoomIsa� (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa. IIrdsLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 • Job Address: 284 23RD ST Status: ISSUED Suite: Applied: 12/11/2002 Vicinity: Issued: 03/17/2003 Parcel Number: 11913325 Zoning: Applicant: LALONDE, RACHNA ISSUED BY: Address: 284 23RD ST Phone: 949-574-5204 COSTA MESA,CA Zip: 92627 Owner: LALONDE, JOHN AND RACHNA Address 284 E 23RD ST Phone: 949-574-5204 COSTA MESA,CA Zip: 92627 Contractor: Address: Phone: Zip: License: Arch : RUDY JUREACK Eng: Address: 20351 IRVINE AV Address: STE 5 Phone: 714-545-2263 Phone: NEWPORT BEACH,CA Zip: 92707 License: C24021 License: SCOPE OF PERMIT ADDITION AND REMODEL TO EXISTING SFR.ADD 1221 SQ. FT.FIRST FLOOR AND ADD 1,890 SQ.FT. NEW SECOND FLOOR.ALSO ADD 175 SF BALCONY.EXTENSIVE REMODEL OF 1349SF EXISTING HOUSE. EXISTING 3 BEDROOM HOUSE WILL BECOME A 4 BEDROOM HOME. RESIDENCE CURRENTLY HAS 2 BATHROOMS.AFTER REMODEL AND ADDITION THE RESIDENCE WILL HAVE 4 BATHROOMS.CHANGE DRIVEWAY APPROACH AND RELOCATE GARAGE DOOR TO FRONT OF GARAGE INSTEAD OF SIDE.REROOF EXISTING HOUSE WITH COMP SHINGLES. PLNG.-ZA-02-67 FEE SUMMARY Plan Check: $1,705.18 Calc Valuation: $390,170.48 Permit: $2,623.35 Claim Valuation: $0.00 SMIP Res: $39.02 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $4,367.55 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 20-0 Rear 63-9 Lett 5-0 Right 5-0 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. LFOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) • • , 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'compenhation ins'ra ce,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. My workers'compensation Ins;r:n•, a vier: d•: -umber are: I Carder: / < S Policy Number: /NI0 This s lion need not be completed if the permit is .rued 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 pf C •omia,and agree that if I o Id come subject to the workers'compensation provisions of Secti n 3700 of the Labor Code,I shall forthwith comply with these prow ns �� 17 I A� Applicant Signature: �S1YfiTfCs /lam-fL'k 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(5100.000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF 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.a Class a 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). 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 property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If.however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ . I am exem.`R der :c Bu ess and Professions Code for this reason: ,211111--Gs Signature: :._%' , i _4 � -x r5 _. ' / Expires: z —I 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 Wit 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? 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 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 ermit for such construction or modification from the South Coast Mr(Duality Management District or from any other air pollution control district or agency? Li Yes lLI No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 8 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 penalty of perjury that I have read this application and state that the information given is correct agree to empty with all -ate la,s and city ordinances relating to building construction,and authorize represe tatives of the City of Costa Mesa to enter upon the above scri ed 'warty for in,.ct o, •u roses.I:gree not to occupy or allow occupancy of any building authorized by his permit lu/i�inspection. -rt ,/ /1 j � •i•-a -Of Legal Owner(s) Date And/Or Authorized Applicant Date CODE t INSPECTION TYPE PATE Ucrmau CODE r INSPECTION TYPE - pg.E RITUALS 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 _ r 203 Final Sign 222 Final Site .1 / �yT� / 204 Final Demolition 250 Final Building/Occupancy ,R-a7-07 Y/ K I . . • NEWPORT-MESA UNIFIED SCHOOL DISTRICT N° 4230 CERTIFICATE OF COMPLIANCE OF DEVELOPMENT FEES PURSUANT TO AB 1600 AND AB 181 To: ( t4y of Costa Mesa District Receipt No 12`f //� 219 ( ) City of Newport Beach , ( ) County of Orange Plan Check NoVO� 020 t;e Applicant ZAZ/k tvc_..' /v A-LG h�e Z S cp c ll-OC. 3—. Address: '� Telephone Number: (Fa - 6/! if - i 0 Tract/Parcel and Lot Number(s): �Xy/ /� Location of Project: 2- 1 13(L k te.54--- , Number of Square Feet of Residential Space 3 I 1 I x 81.84 Total 5 74; T • a 4 Commercial and Industrial Space x $ .30 Total Commercial/Industrial Project is: (Check One) Warehouse Motel Preschool R 8 D _ Bank _ Auto Repair Movie Theater Neighborhood Shops _ Hospital Mini-storage _ RacquetMealth _ Large Office Heavy Industrial _____ Hotel _ Office Bldg. Regional Shops _ Medical Office _ Restaurant Light Industrial _ Office Park _ Fast Food This project is exempt because This certifies that the above-named Developer/Applicant has paid school facility fees in compliance with Government Code sections 53080 and 65995. The Building Permits for this square footage in this proposed development may now be issued by your jurisdiction. Checks are to be made payable to Newport-Mesa Unified School District. B a iAa S �_ .: .rfzed Re. . -tive The above representation as to square footage is true. Applicant agrees that if it is later determined that such representations are not true,then this certificate shall automatically terminate and thea.. opriate City/County • . ha-- - 480803/11:03 MIA5724.24 I / RCPT4:01-8110467 124223 Date: -)I ri I Cat ataisti. - di i L._t • Applicant I - - • • INSULATION CERTIFICATE IC-1 284 23RD ST. COSTA MESA STREET ADDRESS CITY ORANGE COUNTY TRACT LOT Description of Installation 1 ROOF Material Brand Name Thickness(inches) Thermal Resistance(R-Value) 2 CEILING AREA Batt or Blanket Type BATT Brand Name OWENS CORNING Thickness(inches) 6 1/4" Thermal Resistance(R-Value) R-19 Loose Fill Type Brand Contractors min installed weight square ft lb Minimum thickness inches Manufacturer's installed weight per square foot to achieve Thermal Resistance(R-Value) 3 EXTERIOR WALLS Frame Type A. Cavity Insulation Material BATE Brand Name OWENS CORNING Thickness(inches) 3 1/2 Thermal Resistance(R-Value) R-13 B. Exterior Foam Sheathing Material Brand Name Thickness(inches) Thermal Resistance(R-Value) 4 FLOOR OVER GARAGE AREA Material BATT Brand Name OWENS CORNING Thickness(inches) 6 1/4" Thermal Resistance(R-Value) R-19 5 SLAB Material . Brand Name Thickness(inches) Thermal Resistance(R-Value) 6 FOUNDATION WALL Material Brand Name Thickness(inches) Thermal Resistance(R-Value) Declaration hereby certify that the above insulation was installed in the building and the above location in conformance with the current Energy Efficiency Standards for residential buildings(Title 24, part 6, California Code of Regulations)as indicated on the Certificate of Compliance,where applicable. WL61A et,.Q,12,4, 11/17/2003 PARAGON SCHMID BUILDING PRODUCTS Item Us ignature, Date Installing Subcontractor(Co. Name)OR General Contract(Co. Name)OR Owner Item tis Signature, Date Installing Subcontractor(Co. Name)OR General Contract(Co. Name)OR Owner Item Us Signature, Date Installing Subcontractor(Co. Name)OR General Contract(Co. Name)OR Owner From:Danita Clark-Office Manager (626)432-1717 To:PETE TENACE Date:2/27/2004 Time:4:08:58 PM Page 2 of 2 �_ g fQSOECitO American International Inspections,Rd. 118 Palriclal l Way, Pa;a gena,04 91105.1024 (626)795-0770 office(626)431-1717 lax February 27, 2004 To: Building Official. City of Costa Mesa Department of Building& Safety Re: Final report for 284.11' St., Costa Mesa 23Ro Permit #: B02-02012 Contractor: Advanced Masonry All of the special inspections for epoxy for this project are now complete. Final inspector's report per 1701.3 uniform building code. Work requiring special in pecti'nu, Was to the best of my knowledge, in conformance to the approved plans and specifications and the applicable workmanship provisions of the code. Sincerely, .r4Kenneth L. Baleom Deputy Inspect or SUBCONTRACTOR LIST .. City of Costa Mesa - Planning Div13lon P. JO. Box 1200, Costa Mesa, CA 92628-1200 / ote �/i � �' Phone l Lt3) J `au /Builder (50Il1�� 11� �tAddress Job Site 7L( I O( °>'h (V- ', 91427 Date. II I j )0 2j Permit # t 0 2- 02012— Valuation TRADE SUBCONTRACTOR ADDRESS PHONE STATE LIC. NUMBER ASPHALT CABINETS ( j4- I' llIIIS I/h otonfoVic--.314m- 013 //3 CARPETS Ift/e. QI'(Ciic FIN?-5 () -CARPENTRY tY _ ��.r.• `ICO'PA O14f jl�t�� CEMENT CONT. CEMENT TRANSIT CLASSIFIED SPEC. CLEANUP/HAULING \o .;WO401/1/11 a ItgAty DOORS (GARAGE) 1:vv '•2.)t,1QG1zf `rii�6644 { I51LOWU1'ri.1U) Iig7.72),-/%u -DRAPERIES �,�� c� %,1/3A �y /� DRY WALL r1 as I-Yl -. Yom' lecpr tc -qic� % 1 S ELECTRICAL V -Orhard. L ELEVATOR ��" qy `�7 EXCAVATION 17(A/�/-e, I-6 Qi i I W-r-GSL��(� ��Z1J!f �1#�?�,i'��D Lf)0. ) FENCING NUv�"' (BYL 1-1 MA;-06 FIRE EXTINGUISHER FLOORING/DECKING Wm( 00.121 i3ALta: �)�Ct tl A11k',ldL 1A2'-3iI25 1 tH 3 3 5- FORMICA FORMICA FOUNDATIONS `N &fl (- i.n �rn� Um/aid (ibtalt GLAZING /' (� HEATING £ taioe'D I.lea.1. J. ill p -INSULATIONU/lZta Dl1 S hl l l� ?2015, Ale 9 51.4* "4' '1114�..atltki LANDSCAPING / jn I'� // LATHING J1-4 0116/12.4 \'Wii9 Ue97L 111)( -67Cf_7 3 / 1/01/6-; C,LEUM/ASPIIALT CSM L4?7 � TILE ,UNITE }1'111)) C/1()l�!' 'ci14, MASONRY /til&--('upeig_ S PAINTING 11 ag: `4 -0147:Af ei5es PLASTERING �I PLUMBING I -V V� � T) rC. TS-71 POOL / REFRIGERATION - // ROOFING 7e.V4 Di'I IL/�[�7�kI` y Veck(mdea, PatitAv f44a Gv $04 j7S y3 SANDBLASTING Uv SEWER SHEET METAL ?fkl poth\ �f" c-gv e, SHOWER DOOR sitnivv Pi SOLAR SPRINKLERS Ro 3 c STEEL REINFORC. _STEELSTRUCT. OC • r �� STUCCO 0A/1/1d cc\ W./� 414-UStq "7 3 -731/p9C-3 TRUSSES/GLU-LAMS TV ANTENNAS WALL COVERINGS d WEATHER STRIPPING VaAti l,6 n S � 14 ZZ-c� S. kit S� ' $6n� 'h'li�5l4 iq 7 OTHER SPECIALTY J CMF 0701-30.rev. 10/85 • • • CITY OF COSTA MESA DEVELOPMENT SERVICES DEPARTMENT PLANNING DIVISION OWNER BUILDER CERTIFICATE OF EXEMPTION I am fully aware of the responsibilities as owner builder. The persons named below are my employees and I agree to withhold the following required deductions: Federal and State Income 'faxes, Social Security payments, and Workmen's Compensation Insurance Premiums. My employer's number is Further, I hold no objection to a copy of this certificate being forwarded to any governmental agency upon their request for same. Employee's Name Address Social Security No. • • • • Under penalty of perjury, I declare that the above statement is true and correct to the best of my knowledge and belief. Signature Date • Address �yTA CITY OF COSTA MESA 4499 BUILDING DIVISION F• ,,, l11•911.1ri. MI DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER • PERMIT 'ka.P„ o P03-00202 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 284 23RD ST Status: ISSUED Suite No Applied: 03/28/2003 Issued: 03/28/2003 Vicinity: Parcel Nunmber: 11913325 ISSUED BY: Applicant: LALONDE, RACHNA Address: 284 E 23RD ST Phone: 949-574-5204 COSTA MESA, CA Zip: 92627 Owner: LALONDE, JOHN AND RACHNA Address 284 E 23RD ST Phone: 949-574-5204 COSTA MESA,CA Zip: 92627 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 000000 Arch / Eng: Address: Phone: Zip: License: SCOPE OF PERMIT ADDITION AND REMODEL TO EXISTING SFR.ADD 1221 SQ. FT. FIRST FLOOR AND ADD 1,890 SQ. FT. NEW SECOND FLOOR.ALSO ADD 175 SF BALCONY.EXTENSIVE REMODEL OF 1349SF EXISTING HOUSE.EXISTING 3 BEDROOM HOUSE WILL BECOME A 4 BEDROOM HOME. RESIDENCE CURRENTLY HAS 2 BATHROOMS.AFTER REMODEL AND ADDITION THE RESIDENCE WILL HAVE 4 BATHROOMS. CHANGE DRIVEWAY APPROACH AND RELOCATE GARAGE DOOR TO FRONT OF GARAGE INSTEAD OF SIDE REMOVE EXIST. FOOTONG AT THE EXTERIOR OF THE GARAGE AND RECONSTRUCT AS PER CITY STANDARD.REROOF EXISTING HOUSE WITH COMP SHINGLES. PLUMBING TO INCLUDE:3 BATHTUBS, 1 DISWASHER, 1 FLOOR DRAIN,6 GAS(OVER 4 OUTLETS), 1 LAUNDRY TUB/WASHER, 1 SEWER CONNECTION, 1 SEWER PRIVATE LINE,4 SHOWERS, 1 BAR SINK, 1 KITCHEN SINK,6 WASH BASINS, 1 WASTE&VENT SYSTEM,4 WATER CLOSETS, 1 WATER HEATER, 1 WATER PIPING AND 1 WATER SERVICE. REF.:B02-02012 FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $9.80 1 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 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 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. 0 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.) L�{-� 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 -alifornia, :nd agree that if I ou ecome subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with the • sions) ///� II �7 /] Applicant Signature: • % e �Ll Date: J I LT) (o 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($108000),IN ADDITION TO THE COST 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 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.# Class II 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). 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 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.). • Ig 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 exem ',,)n',,•der�eecn 4 _i B 'i,s and Professions Code for this reason: r� (� Signature: e' — Ijt,H - S a Expires: 02l c(/e):5 - Verification of Ownership by(type of docunt,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PE MIT 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 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 0 No (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 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? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit 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? ❑Yes ❑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? ❑Yes ❑No ....If. .... t.. i. . . ... .. fro . ... .. i.t...i.. 8 (If yes",attach certificate of compliance fromthe appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under p tty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardot1s�Aaterial and Emissions. /� Signature: V -1_4(A..- . Qi/B�D Date: �'C�;T](a 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. 1 agree to comply with all state laws anlar y o •' ances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-de n d property f inspection purp•; '•re not to opcu y or allow occupancy of any building authorizeby phis permit uptll final inspection. I / Signatu ' • age Q ner(s) �.JI/�j /Date And/Or Authorized Applicant Date CODE I. INSPECTION TYPE DATE INTmALS CODE/ INSPECTION TYPE • Rd%1 I$T1ALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical �1 22 1266 Pool Spa Final _ 208 Final Plumbing ' 1 ' 1P- QJ .b n/ 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 CITY OF COSTA MESA i ►° BUILDING DIVISION s• �..� DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER t>. apeik PERMIT E03-00229 (714)754-5273 • Fax(714)754-4856 • www.cicosta-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 284 23RD ST Status: ISSUED Suite No Applied: 03/28/2003 Vicinity: Issued: 03/28/2003 Parcel Nunmber: 11913325 c[/y ^ ' Applicant: LALONDE, RACHNA ISSUED BY: 2��yy'`/'- Address: 284 E 23RD ST Phone: 949-574-5204 COSTA MESA,CA Zip: 92627 Owner: LALONDE, JOHN AND RACHNA Address 284 E 23RD ST Phone: 949-574-5204 COSTA MESA,CA Zip: 92627 Contractor: Address: Phone: Zip: License: SCOPE OF PERMIT ELECTRICAL TO INCLUDE:TEMPORARY POWER POLE. REF.:B02-02012 AND E03-00228 FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $12.30 1 Temp service test $0.00 Busway/100 ft $0.00 0 Res.a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0 Lighting Fixts $0.00 0 up to 50 kva/kw $0.00 0 Recept Outlets $0.00 0 up to 100 kva/kw $0.00 0 Switches $0.00 0 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 0 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1 hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 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: 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 WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: O I have end 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. O 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($700)or less.) 0 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 allfomla,a0d agree ma I sh••d become subject to the workers'compensation provisions of Sec Ion 3700 of the Labor Code,I shall forthwith comply th thpnv.i C. .. -5?";')/C& P,f0 ^ Applicant Signature: C. �La.s r4 44 'Lr, Date: Y� WARNING:FAILURE TO SE• RE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMI PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLARE($100,030),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37C6 OF THE LABOR CODE,INTEREST.AND ATTORNEYS 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.# 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 previsions of the Contractors license Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business end 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 .l1 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.). CJ V 1,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 nder se,f 4. Business a •Professions Code for this reason: Signature: A_ .a [a. /.�41=i •. _� /�� Expires: 2.4(0 Cr 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,talsework,or demolition or dismantling thereof,will be more than thirty-six(36)feel high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 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 0 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? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this Replication 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 DI No (Section 65850.2 of the California Govemment Code requires that the requested information be fumished 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). _ AirQuality Management ___._ _ _ _.. 7 Ifa a p tion from the South Coast rcri ed Healtheal;Oilier airpollution control district3been or agencyeis required for the work which is the subject of this application.have all of the disclosures prescribed by Californiaia and Safety Code Section 42303 made? 0 Yes 0 No B (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 agre: • comply with all state laws and .' • •I :5 relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-descri•:d .rope or' pection purpose..I a. :: 0 occupy or 1 w occupancy of any building authorized by this a it until fine inspection. it Signatur egal• ner(s) to And/Or Authorized Applicant Date CODE# INSPECTION TYPE OAIE PITB1ALS CQDFt INFECTIONTYPE • PATE MALI 1616 Fixed System Final Fire Prevention 206 Final Mechanical 2008 Pool Spa Final 2081Final Plumbing + p. 200 Final Re-Root 210 Final Electrical 2'bTo / it 1 Y 201 Final Slock/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 os40111.4 1 $ CITY OF COSTA MESA 7 4 k ° BUILDING DIVISION >•4,,,,,.' DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F t r..tasa 1 PERMIT E04-00555 444,Poiano 41' (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 284 23RD ST Status: ISSUED Suite No Applied: 05/12/2004 Vicinity: REAR SFD Issued: 05/12/2004 Parcel Nunmber: 11913325 Applicant: PATRICK GALLIGAR ISSUED BY: Address: 22343 LA PALMA SUITE 104 Phone: 714-692-1132 YORBA LINDA,CA Zip: 92887 Owner: LALONDE, JOHN AND RACHNA Address 284 E 23RD ST Phone: 949-574-5204 COSTA MESA,CA Zip: 92627 Contractor: MASTERPIECE POOLS AND SPAS INC Address: 22343 LA PALMA SUITE 104 Phone: 714-692-1132 YORBA LINDA,CA Zip: 92887 License: 804110 SCOPE OF PERMIT . INSTALL 38 S.F.GUNITE SPA AND 362 S.F.GUNITE POOL.REF.:804-00879 ELECTRICAL TO INCLUDE: 1 POOL/SPA,2 OUTLETS,AND 1 SUB-PANEL. FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 . Busway/100 ft $0.00 0 Res.a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $49.50 1 up to 10 kva/kw $0.00 0 Lighting Fixts $0.00 0 up to 50 kva/kw $0.00 0 Recept Outlets $2.20 2 up to 100 kva/kw $0.00 0 Switches $0.00 0 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 0 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $30.50 1 Plan Check Fee $0.00 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: 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 to - D 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 Cade,for the performance of the work for which this permit Is Issued. My worke ' m 'on Insurance carrier and policy number are: Carrier: 'AaL 3 L Policy Number: � L (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 shyuId become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pre ion . L Applicant Signature: Date: -•�—`- L1 WARNING:FAILURE TO SECURE WORKERS COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR ODDE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am lice n rpr1vI lorb Chapter 9(commencing with Section 7000)of Division 3 of the Business and Profgsklonsf.,ndggnd my license Is in full force and effect.Lic.# ` L h orb Class# ( Contractor's Signature: Date: C Ca. 0 --e 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: 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 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.It,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 Driver's License No. Expires: Verification of Ownership by(type of docum t,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation live(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,felsework,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 _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 en RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 II an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No .__tu.r._..._.. e..._.._ _.........._.....rmit such c 5 Does or will the tcAir orQualpresentity a a emen building occupant at requirer for the work which is the subject this application a srtnit for such construction or modification tram the South Coast Air Oualiry 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? []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 Ouarty 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 COMPUANCE 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. Signeturre Of Legal Owner(s) Date A r Authorized Applicant Date CODE# INSPECTION TYPE PATE gO1nAL6 CODE IN2PECT10N TYPE CITE QAL,S 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final mbing r 200 Final Re-Roof in ectrical r 201 Final Block/Retaining Well et Fire Prev: •.111 202 Final Factory Fire Place 220 Final Planni proval 203 Final Sign 222 Final Site _ 204 Final Demolition 250 Final Building/Occupancy 4`,STp 9 CITY OF COSTA MESA -' - BUILDING DIVISION :4 _ ,r DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 1.4714f. 1 ��..� i PERMIT �• • E04-00555 (714)754-5273 • Fax(714)754-4856 • wynv.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 284 23RD ST Status: ISSUED Suite No Applied: 05/12/2004 Vicinity: REAR SFD Issued: 05/12/2004 Parcel Nunmber: 11913325 Applicant: PATRICK GALLIGAR ISSUED BY: . Address: 22343 LA PALMA SUITE 104 Phone: 714-692-1132 YORBA LINDA,CA Zip: 92887 Owner: LALONDE, JOHN AND RACHNA Address 284 E 23RD ST Phone: 949-574-5204 COSTA MESA,CA Zip: 92627 Contractor: MASTERPIECE POOLS AND SPAS INC Address: 22343 LA PALMA SUITE 104 Phone: 714-692-1132 YORBA LINDA,CA Zip: 92887 License: 804110 SCOPE OF PERMIT INSTALL 38 S.F.GUNITE SPA AND 362 S.F.GUNITE POOL.REF.:B04-00879 ELECTRICAL TO INCLUDE: 1 POOL/SPA,2 OUTLETS,AND 1 SUB-PANEL. • 6/18/04:SUPPLEMENTAL ACTIVITY TO ADD 1 CONDUIT, 1 MOTOR TO 1 HP(FOR SUMP PUMP)FOR FUTURE BATHHOUSE PER PENDING PLANNING APPROVAL.MAY REQUIRE ADDITIONAL PERMIT PER 1ST INSPECTION. FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res.a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $49.50 1 up to 10 kva/kw $0.00 0 Lighting Fixts $0.00 0 up to 50 kva/kw $0.00 0 Recept Outlets $2.20 2 up to 100 kva/kw $0.00 0 Switches $0.00 0 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 0 Misc.Conduit $18.20 1 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1 hp $4.75 1 Circus(mech ride or lights) $0.00 0 Motors to 10hp 50.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $7.50 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(WOO) DECLARATIONSfe - • - e WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ eve 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. Er 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'tom enation Insurance carrier and policy number are; 11 ��--�-7 Carrier: ,. CI-A442 Policy Number: 1�// (—E 7 (This section need not be completed if the permit Is valued at one hundred dollars($100)or less.) O I certify that In the performance of the ork 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 .•omia,a-'ree that II.I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these p vi Applicant Signature: Date: —� —ofd WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DCC-ARE(5101,000),IN ADDFI1ON TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am IIconsngeCprqylslogs�L hapter 9(commencing with Section 7000)of Division 3 of the Business and Prof¢ Code,and my license Is in full force and effect.Lic.a 0//``'11.. 11.,ll Class It CL. `"� Contractor's Signature: ' Date: . ci'7,,— 041 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: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I em 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 fore permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): O I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044.Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 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). O As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 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 filo 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 end 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 II an RMPP is presently required,has Section 25534 of the California Health and Safely Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of thisapplication akermit 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 U No (Section 65850.2 of the Califomia 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). .._hich i...__.. ._a of th _.. 7 If a permit from the South Coast res Descry ed Management DistrictHeor other airpollution control district3 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 cattily 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 MD 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. _.�Signature Of legal Owner(s) 0. y Oe t- AnNOr Authorized Applicant DSle CODE P IISPECTION TYPE DAIE' INTTAtS CODE I INSPECTION TYPE PAM INTf61e 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 174"04 201 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 on MF .` - " ' CITY OF COSTA MESA 444G c BUILDING DIVISION >:j«,k .. II DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER WANII. ��.�..��,"-�� t PERMIT qPoitatiO B04-00879 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,ffCOSTA MESA,CA 92626 BUILDING PERMIT Job Address: 284 23RD ST Status: ISSUED Suite: Applied: 05/12/2004 Vicinity: REAR OF PROPERTY Issued: 05/12/2004 Parcel Number: 11913325 Zoning: Applicant: PATRICK GALLIGAR ISSUED BY: Address: 22343 LA PALMA SUITE 104 Phone: 714-692-1132 YORBA LINDA,CA Zip: 92887 Owner LALONDE, JOHN AND RACHNA Address 284 E 23RD ST Phone: 949-574-5204 COSTA MESA,CA Zip: 92627 Contractor MASTERPIECE POOLS AND SPAS INC Address: 22343 LA PALMA SUITE 104 Phone: 714-692-1132 YORBA LINDA,CA Zip: 92887 License: 804110 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT INSTALL 38 S.F. GUNITE SPA AND 362 S.F.GUNITE POOL AT THE REAR OF AN EXISTING SFD.. FEE SUMMARY Plan Check: $208.81 Calc Valuation: $20,000.00 Permit: $321.25 Claim Valuation: $20,000.00 SMIP Res: $2.00 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 • Total: $532.06 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: 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)754-5620 2446-46(5/00) WORKERS'COMPENSATION DECLARATJON: 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 ,.5 willwork for which this permit is Issued. \ I have and 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 workerscem eennsatlon Insurancerer and policy number are: e r �^ Carrier: --�`"`�-� �`'"'� Policy Number: L L t (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,a 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 si ns. Applicant Signature: Date: S— � -c*L WARNING:FAILURE TO 5 RE 0 ERS'COMPENSATION COVERAGE IS UNLAWFUL AND SWILL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES MC CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000).IN ADDION TO THE COST 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 livens -p(aNslbnstole Byer 9(commencing with Section 7000)of Division 3 of the Business and Profe ns C d my license is in full force and effect.Lk.4 J K• Class a Contractors Signature: a Date:utr CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation.WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I.as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. Yes ❑No Driver's License No. Expires: Verification of Ownership by(type of docum t,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 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 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 a$ermit for such construction or modification from the South Coast Alr Quality Management District or from any other air pollution control district or agency? U 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 ❑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 ❑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 end 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. - Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date CODE N INSPECTION TYPE PAIL HMO CODET Pd$PECTI0N TYPE RAIZ IHIIIIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 6?'`/'O1 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 CITY OF COSTA MESA (.7 O.uY P P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628.1200 ''t .. DEVELOPMENT SERVICES DEPARTMENT November 4, 2004 Rachna LaLonde 284 23rd Street Costa Mesa, CA 92627 RE: MINOR CONDITIONAL USE PERMIT ZA-04-84 284 23RD STREET, COSTA MESA Dear Ms. LaLonde: Review of the zoning application for the above-referenced property has been completed. Based on the following project description and findings, the application has been approved, subject to the conditions set forth below. PROJECT DESCRIPTION The subject property is presently improved with a one-story, single-family residence, an • attached two-car garage, a swimming pool, and a spa. A minor conditional use permit is required to construct a new, 40 square-foot, free- standing bathroom adjacent to the spa in the rear yard. The proposed accessory structure (bathroom) contains a toilet, sink, and shower. The applicant would like to have the fixtures installed for the convenience of those using the swimming pool and spa. A land use restriction is not necessary for the proposed structure since it is too small to be converted into a living area. Consequently, the potential to convert the structure to a dwelling unit is unlikely. FINDINGS A. The information presented complies with Costa Mesa Municipal Code Section 13-29(g)(2) in that the proposed improvement is compatible with developments in the same general area. Granting the minor conditional use permit will not be detrimental to the health, safety, and general welfare of the public or other properties or improvements within the immediate vicinity. Specifically, the proposed bathroom is only 40 sq. ft., enough area to accommodate only a toilet, sink, and shower. Consequently, the potential to convert the structure to a dwelling unit is unlikely. Granting the minor conditional use permit will not allow a use, density, or intensity that is not in accordance with the general plan designation for the property. Building Division(714)754-5273 • Code Enforcement(714)754-5623 • Planning Division(714)754-5245 FAX(714)754.4E56 • TOD(714)754-5244 • wvoiv ci costa-mesa.ca.us ZA-04-84 • November 11, 2004 Page 2 B. The project has been reviewed for compliance with the California Environmental Quality Act (CEQA), the CEQA Guidelines, and the City environmental procedures, and has been found to be exempt from CEQA. C. The project is exempt from Chapter XII, Article 3, Transportation System Management, of Title 13 of the Costa Mesa Municipal Code. CONDITIONS OF APPROVAL Ping. 1. The detached accessory structure (bathroom) shall be served from the same utility meters (electric, gas, and water) as the main dwelling unit on the property. 2. Construction, grading, material delivery, equipment operation, or other noise- generating activity shall be limited to between the hours of 7 a.m. and 8 p.m., Monday through Friday, and between the hours of 8 a.m. and 6 p.m. on Saturday. Noise-generating activity shall not be allowed on Sunday or Federal holidays. Exceptions may be made for activities that will not generate noise audible from off site, such as painting and other quiet interior work. 3. The applicant shall contact the Planning Division to arrange for an inspection of the site prior to the release of utilities. This inspection is to confirm that the conditions of approval and code requirements have been satisfied. 4. The minor conditional use permit herein approved shall be valid until revoked. The minor conditional use permit may be referred to the Zoning Administrator for modification or revocation at any time if the conditions of approval have not been complied with, if the use is being operated in violation of applicable laws or ordinances, or if, in the opinion of the development services director or.his designee, any of the findings upon which the approval was based are no longer applicable. 5. The conditions of approval and ordinance or code provisions and special district requirements of Minor Design Review ZA-04-84 shall be blueprinted on the face of the site plan. Eng. 6. Maintain the public right-of-way in a "wet-down" condition to prevent excessive dust and remove any spillage from the public right-of-way by sweeping or sprinkling. CODE REQUIREMENTS The following list of federal, state and local laws applicable to the project has been compiled by staff for the applicant's reference. Any reference to "City" pertains to the City of Costa Mesa. Ping. 1 . Approval of the zoning action is valid for one (1) year and will expire at the end of that period unless building permits are obtained and construction commences, or the applicant applies for and is granted an extension of time. A written request for an extension of time must be received by Planning staff prior to the expiration of the zoning action. ZA-04-84 November 11, 2004 Page 3 2. All contractors and subcontractors must have valid business licenses to do business in the City of Costa Mesa. Final inspections, final occupancy and utility releases will not be granted until all such licenses have been obtained. Bldg. 3. Comply with the requirements of the California Code of Regulations, Title 24, also known as the California Building Standards Code, as amended by the City of Costa Mesa. Eng. 4. A site access permit and deposit of $500.00 for street sweeping will be required by the Engineering Division prior to the start of any on- or off-site work. SPECIAL DISTRICT REQUIREMENTS The requirements of the following special district are hereby forwarded to the applicant: Sani. 1. Applicant shall submit a plan showing sewer improvements that meets with the District Engineer's approval to the Building Division as a part of the plans submitted for plan check. 2. Applicant shall pay all applicable sanitary district fixture fee charges (714) 754-5307. Upon receipt of this letter, your project has been approved, subject to the above-listed conditions. A copy of the approved conceptual plans are enclosed. The decision will become final at 5 p.m. on November 11, 2004, unless appealed by an affected party (including filing of the necessary application and payment of the appropriate fee) or by a member of the Planning Commission or City Council. If you have any questions regarding this letter, please feel free to contact the project planner, Hanh Tran, at (714) 754-5640 between 8 a.m. and 12 noon, Monday through Friday. Sincerely, /JJ P RRNeff7VALANTINE v Zoning Administrator Enclosure: Approved conceptual plans cc: Engineering Fire Protection Analyst Water District Building Division ,_ Busy 2. JVorton k Special Inspection Services eLz n 6232 Kiowa Road •Westminster, CA 92683 A(/ ® Joint Certified CI 1 Ph 7895-I344 ICBG Reinforced Concrete Tv Op '? a&' 14-899-5684 ACI Concrete Field Tech BVI CO nnnb�'Ie 714-309-7304 License#052863 �� V KZ verizon.net Insured REGISTERED INSPECTOR'S DAILY REPORT Job1lAO �� DaW g TYPE OF 0 Reinforced concrete 0 Structural Steel Assembly / 0 Quality Control INSPECTION ❑ Post Tensioned Concrete /Gun ie 0 Epoxy REQUIRED 0 Reinforced Masonry 0 Shot crete ❑ Other Jab AddressCity a8y 51- Cais 71741 cps Job Name Permit No Issued By ZA ,tau ,4 ay.i-ozis79' eddy Type of Structure.... Architect f1_ ///I Material Description(type,grade,sou e),— Engineer 1/0071. l 44 C.AOX S ./Age' Contractor �i1 f /-%S Alr A.s„gw/ 3f/s Ail 5Arck , �/l�Ps7 rinr �o�s Inspector(s)Name / Subcontractor r�i �9 Ahyt roar. t!� G TESTS PERFORMED TYPE OF SAMPLE SLUMP QUANTITY IN SET ADDITIONAL REMARKS ON SAMPLES er /.,e ,,...A.- -s—' 3/en :5,4- T kav AT 1,75- ,014/ 4ad /n ,flseity< INSPECTION SUMMARY-LOCATIONS OF WORK INSPECTED,TEST SAMPLES TAKEN,WORK REJECTED,JOB PROBLEMS,PROGRESS,REMARKS,ETC. INCLUDES INFORMATION ABOUT-AMOUNTS OF MATERIAL PLACED OR WORK PERFORMED,NUMBER,TYPE&!DENT.NO'S /�OF TEST SAMPLES TAKEN:STRUCT, CONNECTIONS(WELD MADE H.T. BOLTS TORQUED)CHECKED;ETC./ n M+S//.Y--,'Y iCcn l,71ir ,(J�l ra i...>, LL o. .-' o0/a s,t r t - S}eeeri P//Jn/rs /lr�r.4:'f(/- .a..,„a— AD/L ri,,41 ,4-A.)/err on/ •S -/ Acre/22+»// re) rCat..7yZ% /- 7(1AI A17 Ai.. Ss U2,Q Aeoz0„.”, ,¢7' r S / // /J J S n /.' 351,4 /.c'i.vishccP '/.his/,n / y 9 4 kA.ersS ,a,,iia-c--/I Zing neivS • /an/ i.4r`i.OA /L-1--Al A .4f, mart el -JAZ 7/ CONTINUED ON NEXT PAGE 0 PAGE / OF / TIME IN TIME OUT REG.HOURS O.T.HOURS SAMPLES /.R.'2o Sur— 8. . ' All inspections based on a minimum of 4 hours and over 4 hours-8 hour minimum. SIGNATURE OF R ISTERED INSPECTOR ra 5'o'eiy �/71/ V'-V/ 7-c2c9-/la G� Approved by S'Ep TY NO AGENCY P dntentlenl WHITE-CITY'S COPY,CANARY-ACCOUNTING COPY,PINK-INSPECTOR'S COPY 4`ag1p MF 9 CITY OF COSTA MESA BUILDING DIVISION ).•: �_�/�; DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER FI PERMIT 'pro Mnd_nn2gi (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 284 23RD ST - Status: ISSUED Suite No Applied: 05/12/2004 Issued: 05/12/2004 Vicinity: REAR SFD Parcel Number 11913325 ISSUED BY: Applicant: PATRICK GALLIGAR Address: 22343 LA PALMA SUITE 104 Phone: 714-692-1132 YORBA LINDA,CA Zip: 92887 Owner LALONDE, JOHN AND RACHNA Address: 284 E 23RD ST Phone: 949-574-5204 COSTA MESA,CA Zip: 92627 Contractor: MASTERPIECE POOLS AND SPAS INC Address: 22343 LA PALMA SUITE 104 Phone: 714-692-1132 YORBA LINDA,CA Zip: 92887 License:804110 SCOPE OF PERMIT INSTALL 38 S.F.GUNITE SPA AND 362 S.F.GUNITE POOL.REF.:B04-00879 MECHANICAL TO INCLUDE: 1 INST FAU> 100K BTU FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 - Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $0.00 0 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $18.20 1 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0 Inst/Rep.Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 - Compressors/Absorption Systems Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Fumace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 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: 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 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 th o for whiclaal5 ermitis Issued. My worker 'corn ens Ion Insur carder and policy number are: _ Carrier: Policy Number: (This section need not be completed it 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 a ree that if I shouldbecome subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shell forthwith comply with these•rap .. Applicant Signature: ♦. Date: ` yL —act. 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 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am license er sins fh.. 9(commencing with Section 7000)of Division 3 of the Business and P 9ssio Cat and my license is in full force and effect.Lic.a ' Class A l i Contractor's Signature: n `— S :•‘-* Date: S...rkr.c7 • 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: 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 end Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of do ment,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet In depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 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 en 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 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification from the South Coast Air Duality Management District or from any other air pollution control district or agency? LI Yes 8 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 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. C? nature Of Legal Owner(s) 2 t. _Dat�� nd/Or Authorized Applicant �L Date PODEI INSPECTION rot DATE INTRIALS CODE I INSPECTION TYPt 1616 Fixed System Final Fire Prevention 206 Final Mechanical I Z jt 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 TA MF1 CITY OF COSTA MESA X •r, bt BUILDING DIVISION . >•; DECLARATIONS y WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: O 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 rk 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'co pens Insurance rri and olicy 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, d agree that if L€hould become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with thesa�pmwf ns. Applicant Signature: Y Le.,_ 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 DOLLARS($100,000),IN ADDITION TO THE COST 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 license• •,:r• ovjst1s,of`ha9er 9(commencing with Section 7000)of Division 3 of the Business and ProfV6 'ons d my license is in full force and effect.Lic.a ull,, CCII Class B �L,i Contractor's Signature: Date: 2 — oc--t 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: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty Df 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).): O I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). O I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 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: O I hereby certify that no excavation five(5)of 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 Pile and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes ❑No (Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be tiled 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 en RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 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 ❑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 ❑No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify Mat 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. Signature Of Legal Owner(s) alate And/Or Authorized Applicant Date CODE I INSPECTION TYPF DATE I11IDALS CODE INSPECTION TYPE gAg MSS 1616 Fixed System Final Fire Prevention _ 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing I rgreiLl/ 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Well 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 CITY OF COSTA MESA ! • 4 ►D r BUILDING DIVISION .A�• DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER lo 1 PERMIT 4. arra %/inl rys!,°c PO4-00333 (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 284 23RD ST Status: ISSUED Suite No Applied: 05/12/2004 Issued: 05/12/200 Vicinity: REAR SFD ISSUED BY: Parcel Nunmber: 11913325 ✓ Applicant: PATRICK GALLIGAR Address: 22343 LA PALMA SUITE 104 Phone: 714-692-1132 YORBA LINDA,CA Zip: 92887 Owner: LALONDE, JOHN AND RACHNA Address 284 E 23RD ST Phone: 949-574-5204 COSTA MESA,CA Zip: 92627 Contractor: MASTERPIECE POOLS AND SPAS INC Address: 22343 LA PALMA SUITE 104 Phone: 714-692-1132 YORBA LINDA,CA Zip: 92887 License: 804110 • Arch I Eng: Address: • Phone: Zip: - - License: SCOPE OF PERMIT INSTALL 38 S.F.GUNITE SPA AND 362 S.F.GUNITE POOL.REF.: B04-00879 PLUMBING TO INCLUDE: 1 GAS(1-4)OUTLETS, 1 POOL AND 1 SPA. FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $60.75 1 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo- $0.00 0 Wash Basin Set $0.00 0 Drain, Floor 50.00 0 Sewer Connect $0:00 0 Waste and Vent System $0.00 0 Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0 Drain,Roof $0.00 0 Shower - $0.00 0 Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 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 i\ 2446-46(6/00) DECLARATIONS ° - - r , WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: O I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Cede,for the performance of the work for which this permit Is issued.- L 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 policy number are: Carrier: Policy Number: (This section need not be completed it 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 shell forthwith comply with these pr�s. ( / ( Applicant Signature: `4 / �� Date: ' S_ a..-- 0(4_ 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 OOLLARE($100,000).IN ADDfON TO THE COST 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 ••: •roviSio0s of`heater 9(commencing with Section 7000)of Division 3 of the Business and Pro(e5;ioidyp`nd my license is in full force and effect.Lic.q_ .. 1, C� Class If _�JJ Contractor's Signature: • Date: �� L�r�•--/-1 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: 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,end 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.). O 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. -mettYes 0 No Driver's License No. Expires: Verification of Ownership by(type of docu ,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 t0 do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 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 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 en RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No Does Or will the applicant or present or future building occupant require for the work which Is the subject of this a plication a ermit for such construction or modification from the South Coast Air(Duality 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? ❑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 penally 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. Ignature Of Segal Owner(s) S l -8a�te J / ate nd/ r Authorized Applicant Date ;ODE f gISPECTION TYPE PATE iNTITIALE CODE INSPECTION TYPE PATE INTITIALE 1616 Fixed System Final Fire Prevention 206 Final Mechanical •./ 1i 1266 Pool Spa Final 20' - ' • • 7/// 200 Final Re-Root / / bb'i Ed 201 Final BIocldRetalning Wall / 212 Final Fire Preventlo' 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition _ 250 Final Building/Occupancy April 3, 2003 To whom it concerns, I had the unusual opportunity to visit the 284 23rd Street construction site on 04/02/2003 in the AM. I reviewed all pre-dug footings along with pipe column template and re-bar placements. The above mentioned work was completed to the specifications indicated in the original plan and/or revisions created by my engineer and myself and stamped and approved by the City of Costa Mesa's plan check department. _ Sincerely, RUDOLPH i JUREACK 47 Rudy J e= sire � NO.C 24021 'JREN.9.30.0 �Q � lFOf CAUL° • 0 r i B ,tel . v, } P -7. -t-44 • ,o f ' - ' 'mo-• '°\.r ,cn + . r� �ir� . + ��f i .lr :�, r,r3 ,jfx.rl - #-- -4 .lifissi . - • 1 • ♦e„00,>>0. • ? - }• .. : ate • C4� \�,Q s._ti .,.v - /fir.✓+ 1 .��p7:j'.• .4 -tef r t 281 z$'40 sr • • 1. '2 O . ` y IL.,..} cy F ei ��, x t • o.tea: A,--(4;:'t-i-7 - /,t�( ( � i � '�^ ..„., 1 Y�\ f 1 ,�,, s 6,! { i -1 =. 1 1 f///r ` s. : . - 4jy Mvtt z.` A . l l 1 d 28 4 4egr D Y+ £ iTT > V� owe c irtri ti _ 1 ' dr r H. 2 o C si n - a _ ° 4n ap43.9 oii I Ave . � '�•., IS Q� G�/ i� -� 4 n b M ,lam+ U l IT 0 " l YS 4z 1 r. ida'kr✓ i ' w, 250 2, #' S I f ----......5,__-t...-,... .„--.....,-". 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Orr O-� .:: a fit' . 7k as r , ittakk ;sq 23 'ems 5i lI Z/3 \-...) y ti r C * •\ •�, n . , J 416,441 yy,,tl (1' oc t 3h ' �d 'y ` ..!4 �b � ......VVVVVV111III � L �•'1 � �'J� L 'yy`tco 11 r:Rs.ar ` Iti o. .- ftw �•�� n nv. Vfl� a 1 h .0 Y. it iic/ f"a`.w9 / � Y � ?' . -1'..- *T �T�. Vhf / t 2tY 2g el') Sr Y/2/3 r I I r^ ? � r1n. t{ �iUs30 • M1. • i " ' 1 `I3‘9.4.5,$ YTvPt y.S r... l___ Tt „L., i,1I I. rfA kt, F� r �r H V ..l<4,. t. tisa z!. • 2e y z3 '_ 1/2/3 � M CITY4. M OF COSTA MESA C, %: P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628-1200 • =, ` a: 2( DEVELOPMENT SERVICES DEPARTMENT 54 October 31 , 2002 .a John and Rochna Lalonde 284 23rd Street Costa Mesa, CA 92627 RE: MINOR DESIGN REVIEW ZA-02-67 284 23`d STREET, COSTA MESA Dear Mr. and Mrs. Lalonde: The minor design review for the above-referenced project has been completed. The application has been approved, based on the following project description and findings, subject to the conditions set forth below: PROJECT DESCRIPTION The property is located on the north side of 23`d Street between Westminster Avenue and Santa Ana Avenue, in an R1 (Single-Family Residential) zoning district. Existing is a 1 ,835 sq. ft. 3-bedroom, single-story, single-family house with attached 2-car garage. The applicant requests a minor design review for a second story addition." The proposal consists of a first floor expansion, resulting in a living room, family room, dining room, kitchen, a home office, a bedroom and 2 bathrooms. The second floor consists of 3 bedrooms and 2 bathrooms with a deck at the rear. Also proposed is a relocation of the garage door from the east elevation to the south elevation (facing 23`d Street), and removal of the existing driveway to provide a new one leading straight into the garage. The resultant building area would be 4,749 sq. ft. ANALYSIS A minor design review is required for any two-story construction in the R-1 zone to ensure proper design consideration and compatibility with surrounding properties. The proposal conforms to all development standards and the residential design guidelines. The second story area is approximately 77% of the first floor area Building Division(714)754-5273 • Code Enforcement(714)754-5623 • Planning Division(714)754-5245 FAX(714)754-4856 • TOO(7141 7545244 • www ni rnctn.mow cs us LA-02-67 October 31, 2002 Page 2 (2,194 sq. ft. second floor including open area within walls/2,859 sq. ft. first floor including garage), and is set back further from the street than the garage and other single-story residences on that street to provide a smoother transition from the single-story homes in the area. The second floor is also well integrated with the first floor configuration and the proposed construction incorporates variation in roof forms, orientation and pitch. The elevations incorporate a combination of wood siding and stucco as well as multiple building planes and offsets for an interesting building mass. The second floor windows and deck are placed to minimize direct views into the windows of existing, neighboring structures. All the windows proposed on the right (east) side are non-viewing windows (i.e. bathroom, closet, staircase) to provide light into the rooms. The bedroom windows on the left (west) will not have a privacy impact on the adjacent residence because in addition to the 5 ft. side setback, the property is separated from the adjacent residence by a 10 ft. wide driveway. There are also no bedroom windows on that side of the neighboring residence. A 2"° floor deck is located behind the master bedroom on the left (west) side of the property, where it overlooks the neighbor's driveway area. No privacy impact on the residence to the rear is anticipated because the deck and windows are set back approximately 63 ft. to 70 ft. from the rear property line. The two adjoining property owners on 23' Street have reviewed the plans and have no objections to the 2n° floor addition. Letters stating as much, with property owner signatures, are included in the project file. The garage as shown on the floor plan, is 19.5 ft. wide. However, the applicant is planning to widen it to a minimum 20 ft. interior dimension. A condition has been included to require that the plans be revised to show such dimension at the time of submittal for plan check. FINDINGS 1 . The information presented substantially complies with Section 13-29(e) and 13-29(g)(14) of the Costa Mesa Municipal Code in that: a. The proposed development and use is compatible and harmonious with uses on-site as well as those on the surrounding properties. The project meets or exceeds all residential development standards and the residential design guidelines. b. Safety and compatibility of the design of the buildings, parking areas, landscaping, luminaries, and other site features including functional aspects of the site development such as automobile and pedestrian circulation have been considered. ZA-02-67 October 31, 2002 Page 3 c. The project is consistent with the General Plan. d. The planning application is for a project-specific case and does not establish a precedent for future development. e. The proposed development, as conditioned, is substantially compatible and harmonious with existing and/or anticipated development on surrounding properties. This includes site planning, landscaping, appearance, scale of structures, location of windows, and any, other applicable features relative to a compatible and attractive development. The neighborhood consists of a mixture of 1- and 2-story structures. The elevations incorporate projections and offsets to create an interesting building mass and the design of second floor windows will minimize views into adjacent residences. • 2. The project has been reviewed for compliance with the California Environmental Quality Act (CEQA), the CEQA Guidelines, and the City environmental procedures, and has been found to be exempt from CEQA. 3. The project is exempt from Chapter XII, Article 3 Transportation System Management, of Title 13 of the Costa Mesa Municipal Code. CONDITIONS OF APPROVAL Ping. 1 . Street address shall be displayed on the fascia adjacent to the main entrance or front door in a manner visible from the public street. Numerals shall be a minimum 6" in height with not less than '/z " stroke andhshail contrast sharply with the background. 2. The site and floor plan shall be revised to reflect a minimum 20 ft. interior width for the garage as part of the plan check submittal package. 3. The subject property's ultimate finished grade level may not be filled/raised in excess of 30" above the finished grade of any abutting property. If additional fill dirt is needed to provide acceptable onsite stormwater flow to a public street, an alternative means of accommodating that drainage shall be approved by the City's Building Official prior to issuance of any grading or building permits. Such alternatives may include subsurface tie-in to public stormwater facilities, subsurface drainage collection systems and/or sumps with mechanical pump discharge in-lieu of gravity flow. If mechanical pump method is determined appropriate, said mechanical pump(s) shall continuously be maintained in working order. In any case, development of subject property shall preserve or improve the existing pattern of drainage on abutting properties. ZA-02-67 October 31, 2002 Page 4 4. The conditions of approval and ordinance or code provisions of minor design review ZA-02-67 shall be blueprinted on the face of the site plan as part of the plan check submittal package. 5. The applicant shall contact the Planning Division to arrange for a Planning inspection of the site prior to the release of occupancy/utilities. This inspection is to confirm that the conditions of approval and code requirements have been satisfied. Eng. 6. Maintain the public right-of-way in a "wet-down" condition to prevent excessive dust and promptly remove any spillage from the public right-of- way by sweeping or sprinkling. CODE REQUIREMENTS The following list of federal, state and local laws applicable to the project has been compiled by staff for the applicant's reference. Any reference to "City" pertains to the City of Costa Mesa. Ping. 1 . Approval of the Zoning Action is valid for one (1 ) year and will expire at the end of that period unless building permits are obtained and construction commences or the applicant applies for and is granted an extension of time. 2. All contractors and subcontractors must have valid business licenses to do business in the City of Costa Mesa. Final inspections will not be granted until all such licenses have been obtained. 3. Construction, grading, materials delivery, equipment operation or other noise-generating activity shall be limited to between the hours of 7 a.m. and 8 p.m., Monday through Friday, and between the hours of 8 a.m. and 7 p.m. on Saturday, Sunday, and Federal holidays. Exceptions may beomade for activities that will not generate noise audible from off-site, such as painting and other quiet interior work. Bldg. 4. Comply with the requirements of the Uniform Building Code as to design and construction. Fire 5. Provide approved smoke detectors to be installed in accordance with the 1997 Edition of the Uniform Fire Code. Eng. 6. At the time of development submit for approval an off-site plan to the Engineering Division and grading plan to the Building Division that shows sewer, water, existing parkway improvements and the limits of work on the site, both prepared by a civil engineer or architect. Construction access approval must be obtained prior to building or engineering permits being issued by the City of Costa Mesa. Pay off-site plan check fee to the Engineering Division. An approved offsite plan and fee shall be required prior to engineering/utility permits being issued by the City. 7. A site access permit and deposit of $350 for street sweeping will be required by the Engineering Division prior to the start of any on- or off- 2A-02-67 October 31, 2002 Page 5 site work. 8 Submit required cash deposit or surety bond to guarantee construction of offsite street improvements at time of permit per Costa Mesa Municipal Code Section 15-32, and as approved by City engineer. Cash deposit or surety bond amount to be determined by the City engineer. 9. Obtain a permit from the Engineering Division at the time of development and then construct P.C.C. driveway approach per City of Costa Mesa standards as shown on the offsite plan. Location and dimensions are subject to the approval of the Transportation Services Manager. A.D.A. compliance is required for all driveway approaches. 10 Obtain a permit from the Engineering Division, at the time of development and then remove any existing driveways and/or curb depressions that will not be used and replace with full height curb and sidewalk at applicant's expense. Trans. 11 Close unused drive approach with full height curb and gutter. 12 • Construct residential driveway approach at location specified on submitted site plan. Maintain 2' from adjacent property's top of 'X' to top of 'X' of new drive approach. Refer to City standard for residential driveway approach for details. 13 Remove or relocate parkway tree to accommodate new drive approach. 14 Applicant is hereby advised that no removal of trees from the public right-of-way will be permitted without specific approval from the Parks and Recreation Commission and compliance with mitigation measures as determined by the Commission to relocate the trees and/or to compensate the City for the loss of trees from the public right-of-way. Conditions of the Park and Recreation Commission must he incorporated onto the plans prior to plan approval. The approval process may take up to three months, therefore, the applicant is advised to identify all trees of#ected by the proposed project and make timely application to the Parks and Recreation to avoid possible delays. SPECIAL DISTRICT REQUIREMENTS The requirements of the following special districts are hereby forwarded to the applicant: Sani. 1 . Developer shall contact the Costa Mesa Sanitary District at (949) 631- 1731 for current district requirements. 2. Applicant shall pay all current sanitary district sewer connection charges. School 3. Pay applicable Newport Mesa Unified School District fees to the Building Division prior to issuance of building permits. ZA-02-67 October 31, 2002 Page 6 Upon receipt of this letter, your project has been approved, subject to the above- listed conditions. A copy of the conceptually-approved site plan is enclosed. The decision will become final at 5 p.m. on November 7, 2002, unless appealed by an affected party or a member of the Planning Commission or City Council, including filing of the necessary application and payment of the appropriate fee. If you have any questions regarding this letter, please feel free to contact the project planner, Wendy Shih at 714-754-5136 between the hours of 1 p.m. and 5 p.m., Monday through Friday. Sincerely, ?2, cy‘n-- • PERRY VALANTINE Zoning Administrator • Enclosure: Conceptually-approved plans cc: Engineering/Development Services Rudy Jureack Fire Protection Analyst 20351 Irvine Ave., C5 Water District Newport Beach, CA 92707 Building Division PLANNING APPLICATION SUMMARY Location: 284 23t° Street Application: ZA-02-67 Request: A minor design review for a second story addition to an existing single-family residence. SUBJECT PROPERTY: SURROUNDING PROPERTY: • Zone: R1 North: R1 Single-Family Residence General Plan: Low Density Residential South: R1 Single-Family Residence Lot Dimensions: 50' x 180' East: R1 Single-Family Residence Lot Area: • 9,000 sq.ft. West: R1 Single-Family Residence Existing Development: Single-story, single family residence and a 2-car garage. DEVELOPMENT STANDARD COMPARISON Development Standard Required/Allowed Pr000sed/Provided Lot Size: Lot Width 50 ft. 50 ft. Lot Area 6.000 sq.ft. 9.000 sa.ft. Density: Zone 1 du/6,000 sa.ft. 1/9,000 soft. General Plan 1 du/5,445 sq.ft. 1/9,000 so.ft. Building Coverage: Buildings NA 32% (2,859 so.ft.) Paving NA 3% (320 sq.ft.) Open Soace 40% (3,600 soft.) 55% (5,821 so.ft.) TOTAL 100% 100% 19,000 sa.ft.) • Building Height: 2-stories/27 ft. max. 2 stories/26 ft. Setbacks (house): Front 20 ft. 20 ft. Side (left/right) 5 ft./5 ft. 5ft./5ft. Rear 20 ft. 63 ft. Parking: tt Covered 2 2 Open 2 2 Guest N/A N/A TOTAL 4 4• Driveway Width: 10 ft. min. 16 ft. NA Not Applicable or No Requirement CEQA Status Categorical Exemption: Class 3 Final Action Zoning Administrator * Plan shows 19.5' wide- garage, however, the applicant will widen to 20' clear interior. See condition of approval no.2. pSTA F 9 CITY OF COSTA MESA 4 BUILDING DIVISION • r,„;' + DEVELOPMENT SERVICES DEPARTMENT PE T NUMBER ti J. IPPNII PERMIT 03-00228 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 284 23RD ST Status: ISSUED Suite No Applied: 03/28/2003 Vicinity: Issued: 03/28/2003 Parcel Nunmber: 11913325 Applicant: LALONDE, RACHNA ISSUED BY: Address: 284 E 23RD ST Phone: 949-574-5204 COSTA MESA,CA Zip: 92627 Owner LALONDE, JOHN AND RACHNA Address 284 E 23RD ST Phone: 949-574-5204 COSTA MESA,CA Zip: 92627 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 000000 SCOPE OF PERMIT ADDITION AND REMODEL TO EXISTING SFR.ADD 1221 SQ. FT. FIRST FLOOR AND ADD 1,890 SQ. FT.NEW SECOND FLOOR.ALSO ADD 175 SF BALCONY.EXTENSIVE REMODEL OF 1349SF EXISTING HOUSE.EXISTING 3 BEDROOM HOUSE WILL BECOME A 4 BEDROOM HOME. RESIDENCE CURRENTLY HAS 2 BATHROOMS.AFTER REMODEL AND ADDITION THE RESIDENCE WILL HAVE 4 BATHROOMS. CHANGE DRIVEWAY APPROACH AND RELOCATE GARAGE DOOR TO FRONT OF GARAGE INSTEAD OF SIDE REMOVE EXIST.FOOTONG AT THE EXTERIOR OF THE GARAGE AND RECONSTRUCT AS PER CITY STANDARD.REROOF EXISTING HOUSE WITH COMP SHINGLES. ELECTRICAL TO INCLUDE: 115 LIGHT FIXTURES,80 OUTLETS,78 SWITCHES, 1 SERVICE TO 200 AMPS,2 MOTORS TO 1HP,7 COMMUNICATION DROPS, 1 SUB PANEL TO 200 AMPS,AND 7 LOW VOLT WIRING SYSTEM.REF.: B02-02012 FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res.a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0 Lighting Fixts $91.35 115 up to 50 kva/kw $0.00 0 Recept Outlets $65.80 80 up to 100 kva/kw $0.00 0 Switches $64.34 78 over 100 kva/kw $0.00 0 Non Res Appl 50.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $175.00 7 Service to 200a $30.50 1 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 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 18 ays,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 wor must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final appro will result of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) 4 DECLARATIONS 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, 1 ❑ 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 carder 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 mannor so as to become subject to the workers' compensation laws of California,and agree ih. 5 . become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these prom/ens. i q/q�j �7 R/ 2 Applicant Signature: : 4 .f iii- ...1-/pd€- Date: c3/ - S c3 3 WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100.000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR COOE,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.a Class N 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). 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 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 r-. 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]� 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 properly who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exe pt r ecyn - IYA' u mess and Professions Code for this reason: Signature: ,1 Nle (r' ��•--/ Expires: .a ()CO Verification of Ownership by(type of docu en,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 Wit 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? 0 Yes 0 No (Section 25533 of the California Health and Safely 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 neetl 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 end 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 apgermit for such construction or modification from the South Coast Air quality Management District or from any other air pollution control district or agency? Yes O 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 pan 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 listricr 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 (II 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 a• :e to comply with all state laws • city• :minces relating to buil0ing construction,and authorize representatives of the City of Costa Mesa to enter upon the above-des .ed prope- for inspection p a I .gree of to•, py or allow occupancy of any building authorized by this pe it until fin i inspection. A .14—, ./mss.%'_ Ili ill.`.-_ r9�.A��J SlgnatureSf :!al• ner(s) ate And/Or Authorized Applicant Date cODE I INSPECTION TYPE PATE XMAS ODE( INSPEOTIONTYPE PAM IDES 1616 Fixed System Final Fire Prevention 206 Final Mechanical Al 1266 Pool Spa Final 208 Final PlumbingII ., ______ __ 200 Final Re-Roof 210 Final Electrical / / `/ 201 Final Block/Retaining Wall 212 Final Fire Prevention I . 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy .0 'F CITY OF COSTA MESA t BUILDING DIVISION Y% 141,1 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUM R ril!f PERMIT -`"pPoxmia 03-00326 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 284 23RD ST Status: ISSUED Suite No Applied: 07/14/2003 Issued: 07/14/2003 Vicinity: VV Parcel Number: 11913325 ISSUED BY: y„ ) Applicant: LALONDE, RACHNA Address: 284 E 23RD ST • Phone: 949-574-5204 COSTA MESA,CA Zip: 92627 Owner: LALONDE, JOHN AND RACHNA Address: 284 E 23RD ST Phone: 949-574-5204 COSTA MESA,CA Zip: 92627 Contractor: Address: • Phone: Zip: License: SCOPE OF PERMIT ADDITION AND REMODEL TO EXISTING SFR.ADD 1221 SQ. FT. FIRST FLOOR AND ADD 1,890 SQ. FT.NEW SECOND FLOOR.ALSO ADD 175 SF BALCONY.EXTENSIVE REMODEL OF 1349SF EXISTING HOUSE. REF: B03-02012.MECHANICAL TO INCLUDE:2 FAU UNITS/3 FACTORY FIREPLACES,4 VENT FANS TO A SINGLE DUCT/2 NC COMPRESSORS. FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $29.60 2 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0 Inst/Rep.Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $31.95 3 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct $29.00 4 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp $29.40 2 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 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: 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(WOO) 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 compen :ion In rance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'comp:nsa•a ns mice,i:r d policy number are: Carrier: Policy Number: his section need n• 'a completed 11th4•:mit is valued et one hundred dollars($100)or less.) rtify that in the performance of the work for which this permit' ' ued,I shall not employ any person in any manner so s to become subject to the workers' compensation laws of California,and agree at if I should b-••m: .••,-ct to the workers'compensation provisions of Se ion 37 of the Labor Code,I shall forthwith ---._comply with these provisi� f Applicant Signature: AL__ i -r :t_ i • Date: O WARNING FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALI1 S ANDC IL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST 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 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.# 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: 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 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 s.). (r _❑ Pam'aa_amp der sec. Bu s nd Professions Code for this reason: 2/ ' , ' I O3 l Signature:C/ - iI Date: w Owner ID ven led by drivers 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 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 California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes LJ No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 W III any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑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 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 an ' ordi ces relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-describ roperty i inspection purpo s.I : t tallow occupancy of any building authorized is per0lit p inel inspection. Sign lure al Owner(s) / (T�� • And/Or Authorized Applicant Date ��AjggjEE 6 CODE I - INSPECTION TYPE PAIS INTTTIALS CODEI INSPECTION TYPE - q LS 1/41 1616 Fixed System Final Fire Prevention 206 Final Mechanical t 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 • Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. IlJe® CItY OF COSTA IME(S�A COJMSa UC ION PERMIT PEWITl//NNO. TRACT NO. LOT NO. UNIT NO. 2 26164 EoOO TI Project Address •el D y \ 3 1 I ` 7 21 •• Applicant's Mailing Address ee. COA-TC0.S.Le TYPE OF CONSTRUCTION H NEW U ADD U ALTERATION H REPAIR (� 5 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# I Zone J Owner's Name /S M P'1� Phone DESCRIPTION OF WORK/USE OF BLDG. - U ' Address de Q/yE.rC S Main Building: - Accessory Building: E • Z Arch/Eng. TYPE OF PERMIT ❑ GRADING 0 FOUNDATION ❑ STRUCTURAL T Front O • (5) Address gb & HEATING CO. ❑ TENANT ❑ ELECTRICAL PLUMBING CI MECHANICAL B Rear - - N yy�� Contractor's Name 8 OMA'(�AkPh6he ❑ OTHER AC Right - N Address(mailing) IR1/Ifi! CA 92714 PROJECT DESCRIPTION SQ. FT. - OCCUPANCY • K Left G I CONSTRUCTION TYPE VALUATION $ S • r- City License No. 3073r (714) 859-9005 • ZONE • _ GRADING CU.YDS. ACRES Ping. Ref.# Parking Req./Provided • RE LICENSED CONTRACTOR DECLARATION Q I hereby affirm that0) I am licensedion under provisions charter i (commencing Remarks: Planning Notes: M with section 7000) of Division 3 of the Business and Professions Code, and my license is in full orc j�d effect. '//�p T License pass) Lice No.ro7 7 - 7' - $• Date 2:�-$t` Signature 4:001a- 7..c........01. PLUMBING FEES a w WORKERS'COMPENSATION DECLARATION l , I hereby affirm that I have a certificate of consent to self-insure or a certificate — Bar Sink • Showers ELECTRICAL FEES • f Workers' Compensation Insurance, or a certifie copy hereof ` _ 'I �Jd Backflow Preventer Service Sink Automatic Washer - Transformer-❑ 15-50 KW 800, Lab. C.171 �lfTfw - 0 SO+KW P icy No. [YL Company J Backflow Irrigation Sewer Cap Construction PoleSub. Certified copy is hereby furnished. -- Certf'f' d{Fo-py'Wiled with the city B Divisio Bathtubs Sewer Connection , Cooking Unit • Meter ❑up to 100 amps • ate ( N Applicant/ EXEMPTION FROM WORKERS'COPENSAI DECLARATION Clarifiers Solar Collectors Dishwasher • Meter Dover 100 amps (This section need not be completed if the permit is for one hundred ($100) or — less). Dishwasher I Solar Piping Dryers ❑Gas ❑Electric Sub•Panel 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 b me ect to the Drinking Fountains Solar TankFan Workers'[lmp1.enspJ n Laws of Calpforry} / - Motors 001 HP ❑1X-8 Date /A m y Signature ��Li�Za � Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar 09-15 HP 016-15+ NOTICE:If,after ming this declaration, you should become s4bject to the - Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks - • - • Urinal - Fixtures - - Microwave - • comply .with such provisions or this permit shall be deemed revoked. • - CONSTRUCTION LENDING AGENCY - - Gas Service . Outlets • Water Closet - Device Boxes I hereby affirm that there is a construction lending agency for the performance - - Pole Light of the work for which this per issued (Section 3097 Civ. 'C.) Interceptors Water Heater .Z OD` Outlets Lender's Name /(fff��x - Range Lender's Address '/ ✓ r Kitchen Sink Water Service OWNER BUILDER DECLARA ION • Switches Sign I hereby affirm that I am exempt fr m the Contractor's License Law for the Lavatories - following reason (Section 7031.5 Business and Professional Code: Any city or Garbage Disposal Standing Sections county which requires a permit to construct,alter,improve,demolish or repair P-Trap any structure, prior to its issuance, also requires the applicant for such permit Generator ❑0-5 KW ❑5-15 KW Trash Compactor to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains the Contractor's License Law(Chapter 9 (commencing with Section 7000) of - . - - •Givision 3 of the Business and Professions Code) or that he/she is exempt - trefrom and the basis for the alleged exemption. Any violation of Section - - . 31.5 by any applicant for a permit subjects the applicant to a civil ' — natty of not more than five hundred dollars ($500). ❑ I, as owner of the property or my'employees with wages as their sole ' Reinspection-Fee I $15 Issue Fee $ 3 compensation, will do the work, and the structure isnot intended or offered Reinspection Fee I $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's ' i MECHANICAL I FEES - License Law does not apply to an owner of a property who builds or improves I __ thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0 sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0 Zoning Approved By Date pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By Date rove for the purpose of sale). Z I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Dat tractors to construct the project (Section 7044,Business and Professions Code: • The Contractor's License Law does not apply to an owner of property who Duct-Ventilating _ - _ ❑0-100,000 BTU ❑100,000 BTU SUMMARY OF FEES builds or improves thereon,and who contracts for such projects with a con- ' tractor(s) license pursuant to the Contractor's License Law). I am aware thatBUILDING PERMIT $ SMIP $ proof of their Worker's Compensation insurance should be provided to me. Exhaust System 0 Multiple 0 System Repair/Alteration • PLAN CHECK $ PERMIT ❑ lam exempt under Section •�//, e.& P.C.for this reason Firepl/Fact.Bit. ICBG# PLUMBING $ `CO ISSUANCE $ - Date Owner Heating System&Ducting _ PLAN CHECK 25% $ ENERGY P.C. $ I hereby certify that I have read this applicat on and state that the above ❑O-100,000 BTU ❑100,000 BTU - ELECTRICAL $ 'GRADING $ information is correct. I agree to comply with II city and county ordinances and state laws relating to building construction, and-hereby authorize repre- - PLAN CHECK 50% $ MICROFILM $ sentatives of this city to enter upon the above-mentioned property for inspection purposes. J 1,12 MECHANICAL $ TOTAL FEE $ r Signature Date11234 Drivers' License or S$* Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ CMF 0865-46,rev.4/84 White-Building;Canary•Applicant;Pink-Accounting;Goldenrod -Assessor • CONSTRUCTION AND PLANNING 1- POOL PA APPROVALS Permit# Date Inspector APPROVALS Permit Date Inspector 1. Temporary Electrical Service or Pole .. 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. ElectricaliConduit Utility-Undrgrnd. 54. Forms • • 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement • 56. Rough Plumbing & Pressure Test tm 6. Electrical U r .r • 57. APPROVAL TO COVER-GUNITE A 7. Footings O m • 58. Electrical Conduit-Undrgrnd. U 8.-Foundation 5.i Q 59. Gas Pipe, 0:Undrgrnd., Test A 9. Water Pipe-L i h 60. Backwash Lines, P-Trap, 0 Undrgrnd. 1 10. Structural FlArtys2m /, 61. APPROVAL TO DECK . 11. Property Sews erne & House Connection-- 62. Backwash & Receptor-Final • 12. Sewer Cap i 63. Heater & Vent-Final t,. 13. Roof Drains t 64. Plumbing System - Final r 14. Rough Plumag 65. Electrical-Final 15. Rough Electr1�al-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough&Test 72. Underground Flush 24. Roof Framing- 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing - 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing. 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing ' HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace • 38. Final Plumbing the/al 007 39. Water Service-Final D . • - . • 40. Gas Service-Final • 41. Solar Domestic-Final , 42. Backflow Preventer 43. Backflow Irrigation . ,_ ,. • _ . •. 44. ,Landscape Irrigation System 45. Sound Attenuation • 46. Handicap Regulations • 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison . 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY • • No. Date ' OWNER KOSHMAN, WALTER H. DATE 6-22-61 JOB ADDRESS 28li£•23rd Street BUILDING PERMIT NO. 1b706 GENERAL CONTRACTOR Romar Builders VALUE $ 13,893.00 AP.No. 119-193-25 LOT TRACT FIRE ZONE DESCRIPTION OF WORK Res-w/att-Ear. IN!EOTIONS 7./ .(/ DATE GROUP `V,. Z I & J TYPE V ZONE R_)1 Cay; ",rground Soil "1-CU.G. WaterfrMS 2-/9-o/ PERMITS ISSUED Ui rground Gas SUBCONTRACTOR DATE NUMBER Overhead Water and Gas j Rough Heating kt ,1 , �u.Ra b.- fin -r11,4 -l 13-C 1 3 oY 71 k Rough Plumbing S - !l•IY-�/� d 3 .707 �.i✓ Miscellaneous Q� Prop. Swr.•Lig�House4eC(4 vr. _�1 tat/G1. ' tn.-w .. 'Pater! 3 ( it/.3 v IWC Sprinkling System rye/ Heating, Final ��_ �? ,l / t Plumbing Fixtures ).- LT 1" Final Gas Test /y fit 1/..57/4/ / Construction Pole _ ��l Underground Power _ Rough Wiring , -%ce _:gr61 it fa-12,0-2-1 oI-12 41 LTj-,J-1 " Trenches NTWorms( ;Ye Steel '1-,-0-to I Floor System _ Steel Reinforce Chimney Re-Rod - Bond Beam SheathingG� F-:;?1e and Flashing r o- $ _ ( - 1::<—ti' g, In Out e_ S P Iter, brown coat ... . -1 1 Plumbing Fixtures, Final ,h J/.,7,� Electric Fixtures, Final Y//J /(3")-4- 'N Building, Final • _ OCCUPANCY - - \• Form 210-5M-11-59 5-B P 14706 1470e COSTA MESA BUILDING-SAFETY DEPARTMENT F RECEIVED P. O. BOX 917 COSTA MESA. CALIFORNIA di -L I—S(QFor Applicant fo Fill In ComplefelY APe �' ERMIT \\TYPE OR PRINSSA�+ BUILD ADDRESS "70•91 - f ` .9.7'44--31 J T //�� COSTA �� r(OROq�M EESA. CALIFORNIA For Office Use Only N OWER f(/I7/L7 C/L s�/'/AN I RECEIPT NO. I PERMIT NO. /!/,7b' AMAIL DDRESS 8o Jen t Co/y - 4,K C RECEIVED BY I DATE/ 1 9C`v D 1 I tipsatipowrs�'ISSUED S7_Da N a f1'� /5 ,yam ` TEL. BUIL ING '7O . - 3 /)C..{/ 1 y/— CITY Ave NO. ADDRESS ,- 7� ��J' 1 i� ARCHITECT TEL. COSTA MESA. CALIFORNIA OR ENGINEER NO. p(�///'''/CJI ADDRESS FIRE ' 7� // Q APPROVE‘.. TYPE oROU / CONTRACTOR /'J p J//7/L az D BYPROVE DATE Z/ .�/ ADDRESS Z9-22 gest /Oo,Pr ,�1vo, ZONING 111 r° --� t. /�^ /79L--� oN PNL.ANB L/ B8 LDINO ^"'� CITY {�O�'T//jA� ///vJ� I ` I (/DI NGS STATE NO. �/7y 1i� TEL. NO. DESCR TilL 3 0 0 Rb 4.T/0/„T/O/ DESCRIPTION / ��L}}}} ✓LV / SIZE ��JJ NO. OF BLDOB.0 /JC/=1R. — OF LOT ��D K/fJD NOW ON LOT A.P.NO. `V�// {/SQL ?- USE OF YARDS EVES EXISTING BLD _ APPROVED ALLOhVED SETBACK LINE FROM Ape I (CENTER LINE ST.I ..-0 AI �7 CENTER OP STREET REAR YARD v FRONT .' `/ FT. 7 IN. SIDE YARD I LEFT SI I RIGHT /2. I R.SIDE f 2.-t-rT IN. DESCRIPTION OF WORK ,,'Iµ R.SIDE ..5_ FT. IN. \� is NEW I � II A4TERATION I II ADDITION I REAR JJJ...(((yyy REPAIR I II MOVING I 1 NO. OF /II DEMOLISH I BYPR � (A w DATE ��/ �� L BUILDING ,3�au ROOMS (p STORIES SIZE /P 1/ EXTERIOR WALj�, ROOF I COVERING /(SGA COVERING .J j(/[,('(J n USEyyF BUILDING AND WORK TO BE PERFORMED ---(53 -a1/21/61-6- 1/Lf/17 4 4tez4,w6 ti W)/ 4 77,417c to ? _2., C4A 6;at4GcN-- tiro I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE IS CORRECT AND AGREE TO COM- PURPOSE OP ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY IN CES AND STATE ULATING BUILDING CONSTRU ON. VALUATION 30 SIGNATURE OF ♦11 PERMIT FEE ${3 j PERM ITTEF - 12 j Z13 • / / Id' o $ 3 `6 PLAN CHECK $/ ((U" AUTHORIZED AGENT 4t� G r TOTAL FEE 5 y ' OWNER KOSHMAN, W. H. DATE 9-20-62 \, JOB ADDRESS 284 E. 23rd. St. BUILDING PERMIT NO. 17853 ^r' GENERAL CONTRACTOR_ _ Omer-Bdr. VALUE $ 30.00 C AP No. 119-133-25 LOT TRACT FIRE ZONE DESCRIPTION OF WORK Alt.Pvt.GeragE I' ?ECTIONS Signature DATE GROUP MAI TYPE V ZONE R-1 s. PERMITS ISSUED Gas SUBCONTRACTOR _ DATE NUMBER Water _ Rough Corn. Refrig. ❑ Air Cond. 0 Rough Heating _ Rough Plumbing Miscellaneous Prop.Swr.Line 0 House Con. 0 St.Swr. ❑ _ Sprinkling System Construction Pole Underground 0 Power ❑ Rpugh Wiring '1 renches LJ Forms U Steel Remt. U Floor System Bond Beam 0 Steel Reinforce U _ Sheathing Frame and Flashing Lathing — In 0 Out 0 _ PIn=ter, brown coat r ;. 0 Air Cond. 0 Final Htating, Final • Plumbing Fixtures, Final Final Gas Test Electric Fixtures, Final Building, Final OCCCY OCCUPP ANCY mars Red.RM — 7.R1 I'I c. . : 17853 F E RECEIVED -COSTA MESA BUILDING-SAFETY DEPARTMENT SEP D A P. O. BOX 917 COSTA MESA. CALIFORNIA FINANCEE DEEPP T. CITY OF COSTA MESA For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING 4 B.4 a3�1 BUILDING ADDRESS 1 �,' I COSTA MESA.ESCALIFORNIA _ For Office Use Only V'� M OWNER . IL• •`V�(L1V„_YJVv _ . J I RECEIPT NO. I PERMIT�� 3 MAIL A - RHCHIV{D BY I DAj�RHCB{V HOD OATBrTI BHj(a 6 ADDRESS ^A.I.-/W--� l///�'. (//]�r-,2 ^, 111 ((%/ �J/ TEL. �^�L BUILDING F i� CITY NO. ,I -�F•,� ADDRESS ARCHITECT TEL. `f� COSAT/A MESA. CALIFORNIA LH eNL'INtt)1 NO. v A06RESTs , FIRE J��M1�-Y P,= GROUP a '• qq�� JJ ZONE J ( I - I/(�NER-/J a/LDE I BYPROV I k' 21 DATE 01\ ZONI G yy�¢ ZONP,.�_ I PLANS a I BUILDING HC' - e�� LEGALSTATE TEL. ✓ /wt 4s K-/o/ rA- 3a C DESCRIPTION OF Lot 't ♦ I NOW ON LOT I A.P.NO. I / / — /33 - .LS YARDS EVES EXISTING BLDG. _ \, _=L'4. APPROVED ALLOWED SETBACK LINE FROM . (CENTER LINE BT.) CENTER OF STREET REAR YARD FRONT FT. IN. SIDE YARD I LEFT I RIGHT R.SIDE FT /f V IN. DESCRIPTION OF WORKL.SIDs "r / NEW I V ALTERATION ADDITION I REAR E `-f// I FT. p IN. III MOVI G V DEMOLISH I REPAIR APPROVED"�/'n DATE iilaL. BY I�f V BB -Pi- BUILDING •7 O )/1 NO. OF ��-C- /JC / a ROOMS "'S O�RIES��,""" EXTERIOR WALLq ROOF COVERING cJ �C�-�COVERING Q USE OF BUILDING AND WORK TO BE PERFORM D `_ I , I .. ATHAT THE THAT I HAVE READ THIS APEE TO CION THE AMOUNTE SHOWN UNDER VALUATION IS FOR ONLY. AND + ATE THAT CI Y NANOVE IS CAND AGREE U COW PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. BUY W H ALL CITY TIORDINAN 8 AN A LAWS REGULATING SUILOINO CONSTRUCTION. VALUATION� r7( SIGNATURE OF 14./1/4-*-- A-_ ` to PERMIT FEE $ IT/ PERMITTEE �D —, ,_ $ Y. PLAN CHECK $ AUTHORIZED AGENT o TOTAL FEE - r -- 4