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Home My WebLink About322 23RD ST - Building Permits(714) 754-5273 • Fax (714) 754-4&56 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job nddress: 322 23RD ST Suite: Vicinity: Parcel Number: 11933211 I ApplicanC LEMUS ,RAFAEL Address: 2016 WALLACE AV UNIT B I COSTA MESA, CA Owner: MC KEE, JAMES W TR Address P O BOX 205 � � CORONA DEL MAR, CA � Contractor. LEMUS ROOFING Address: 2016 WALLACE AV UNIT B COSTA MESA, CA Zip: 92627 Arch : Address: Phone: ! Zip: � License: Zoning: ISSUED BY: Phone: 949-642-7057 Zip: 92627 Phone: Zip: 92625-0205 Phone: 949-642-7057 License: 826813 TEAR OFF WOOD SHAKE INSTAL ii/2" CDX AND 30 COMP. Plan Check: Permit: SMIP Res: SMIP Com: Other: Inspection: Total $0.00 $111.25 $0.50 $0.00 $0.00 $o.00 5111.75 SETBACKS MAIN STRUCTURE Front 0- 0 ACCESSORY Front 0- 0 PARKING Existin : 0 NOTES: Rear 0- 0 Rear 0- 0 Reqvired: 0 Eng: Address: FEESUMMARY PLANNING & ZONING LeR 0- 0 Left 0- 0 Pr000sed: 0 Calc Valuation: Claim Valuation: Right 0- 0 Right 0- 0 Status: ISSUED Applied: 09/07/2004 Issued: 09/01/2004 Phone: License: ss,000.00 ss,000.00 NOTICE: The work authonzed by this permit shall comply with all applicable handicap accass requirements under Califomia statutes and related regulations. (Ord. Nb. 92-28, § 1, 72-21-92) 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 ihis permit to be considered legal, such work must comply with all epplicable codes, and all requlred Inspeetione end tinel approval must be obtained. Failure to obtain inspections and final approval will result in the ezpiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 :aae>elaoo� WORKERS'COMPENSAnON DECLARArON: I hereby ettirtn under penalry of perjury one oi Ihe fdlowinp dedarations: ❑ I h ve end will maintein a ceNficate of consent ro sell-Insure for workers' compensatlon, es proWAetl for Dy secUon 3700 of ihe Le6or Cade, lar Ne Oedortnence o1 ihe rk tor whlch Ihis permit Is issuetl. end will maintain workers' compenSaUon insurence. es required by secfim 3700 of tlie Lebor Code, tar Na perto(mance of Na work for wNch Ihis pertnit Is Issuetl. My P umber: _� � �-4 �� iy,__ or IB55.) ❑ I ceNfy Ihat In the pedormance of the work tor w�lch t�is pormit is I55ueQ I shall not employ eny person in eny manner so es to hecome sub�ect to t�e workers' compensetlan lews at Califomla, end egrae that If shoultl �ecome suD�ect ro the workers' compensatlon provisions of Section 3700 af the Lebor Code, I shell tort�wiN p SlgneWre• Pro .V�� 0�:2 � � � "/'� � �� I AR RE TO SECIIRE WOPKERS' OOMPENSATIO COVEMQE IS UNLAWFUL AND SHr1LL SU6IECT OYER TO IMINAL PENALTIES AND CML FlNES UP TOONE HUNDRED T/KKl$ANODOLIARE�5100,000),INADDf710NTOTNEC0.STOFCOMPENSATION,OAMAGES0.SPROVIOEOFORINSECTI FTFIEIABORCOOE,INTEREST,ANDATTOfiNEVSFEES. DECLARATON: eHirm thet I em Sipneture: 9(cammendng with Section 7000) ol and CONSIAUCTION LENDING AGENGY: ❑ I �ereby eHirtn thet Ihere is a constructlon lentling epency lor t�e peAortnance oi t�e work tor whic� ihis pertnit Is Issued. (Sec. 3097, CMI Cade). Lentlers Neme: Lenders Address: Slgneiure: Date: my Ilcensa Is ln full OWNER-BUILDER DECLARATIONS: I hereby aHirm Ihet under penalry of per�ury thet I em EXEMPT fROM THE CONTRACTORS LICENSE LAW for the tollowing reeson (Sec. 7031.5, Business end Prafesslons Code: Any ciry or county which requires e permit to construct, alter, improve, demolish, ar repair eny structure, prlor to its issuance, elso requires Ihe eppllcant for such pertnit b tile e signetl stetement that he or she is Ilcensed pursuant to the proNsions ol ihe Conlractors Ucense Lew (Chapter 9(cammencing wlth SecUon 7000) oi Divislon 3 ot Iha Business end Professions Catle) or Ihat he or she is e:empt Iheretrwn entl Ue basis for t�e ellegeA e:emptlon. Any Wolation of Section 7031.5 by eny epplicent for e pertnit subjects the epplicant to e civil penalry of not more than Ilve hundred dWlare (5500).): ❑ I, es owner of t�e property, or my emDloyees wit� wages as their sde compensation, WILL DO THE WORK, end the structure is not Inte�Metl or oflered lor sale (Sec. 7044, Business and Professions Cotle: TTe Contrectors License Law tices not appy lo an owner ot properry who builds or improves thereon, and who Coes such work himself ar herself or Ihrough his or her own employees, provided that such Improvemenls ere not intended or offered for sala. If, however, the bullding or improvement is sold within one year of completion, the owner-builder will heve tha burden ot D��ng that he or she did not build or impmve for purpose ol saleJ. ' ❑ I, es owner of the property, am EXGLUSIVELV CONTRACTING WRH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business antl Professions Code: The contractars License Law does not eppy to en owner oi property who builds or improves Ihereon, end who contracts for such proJect with a contreaor(s) license pursuam to the Contracrors License Lews.�. ❑ 1 em e:empt under sec. Business and Professions Cotle for this reeson: SigneWre: Date: Owner ID verllietl by tlrive/s licensa. ❑ Yes ❑ No Drivefs License No. Veriilcatlon ol Ownershlp by (rype oi tlwument, i.e. - properry tax blll or deetlJ: Expires: DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATON: ❑ I hereby certify that no excavatlon fNe (5) or more taet in tlepth inta which e person is requiretl �o descend, will be mede in connectlon with work euthonzed by Ihis permit, end that no building sWcture, sceMolding, telsework, or OemWition or tlismentling thereof, will 6e more �han thirry-six (36) feet �igh. (Chap. 32, Grp 2, Art 2, Sec. 341, Tltle 8, Celltomia Administretiva CoOe). ❑ As owner-builder, I will not employ enyone to do work whic� woultl require e pertnit from Ihe Dlvision ol Indusirial Sefery, as notetl ebove, unless such pewon has e permil lo tlo suc� work from the OiNsion. SlgnaWre: Data: Dlvision 01 InAuslrial Setery Pertnit Num6er: ICERTIFlCATE OF COMPLIANCE AND AUT}iOR¢ATON OF ENfAY: I certify under penalry of perjury that I heve rea0 this application and state t�at lhe intortnation given is I correcL I egree to wmpty with ell stata laws entl city ordinences relating to builtling construction, an0 euthonze representa�ives ot the Ciry ot Costa Mesa to enter upon the eDove-describotl property for inspection purposes. I egree not ta accupy or allow occupancy of eny 6uilding authonzed by this permit un�il linel inspection. GOOE 1, INSPELTIONTYPE 1678 Fixed System Final Fire Praventlon 1288 200 207 202 203 Pool Spe Finel Finel Re-Root Flnel BIaWReteining Well Final Fectory Fira Place Finel Sign 204 Final Demolltion PdIE ItIIIDAIfl CO�E I INSPECTION TYVE 206 Finel Mechanlcal 208 Finel Plumbinp 210 Final Electricel 212 Final Fire PrevenUon 220 Finel Plenning Approval 222 Flnel Slte 250 Final Building/Occupency QAffi It�S Job Address: 322 23RD ST Suite No Vicinity: Parcel Nunmber: 1t933211 Applicant: MC KEE,JOYCE Address: P O BOX 205 Owner: Address Contractor: Address: Arch / Eng : Address: ISSUE FEE Backflow irrigation Backflow Preventer Bathtub Clarifer System Connect Qce,Soda,etc) Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Orinking Fountain Expansion Tank Gas Earthquake Valve CORONA DEL MAR, CA MC KEE, JAMES W TR P O BOX 205 CORONA DEL MAR, CA OWNER BUILDER PLUMBING PERMIT Phone: 949-633-1849 2ip: 92625-0205 Phone: Zip: 92625-0205 Phone: Zip: License: 000000 Phone: Zip: License: SCOPE OF PERMIT GAS RE-PIPE, 5 OUTLETS. NO OTHER WORK AUTHORIZED BY THIS PERMIT. AMT $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 FEE SUMMARY QTY AMT Laundry Tub / Washer $0.00 0 Landscape Irtigation $0.00 0 P-Trap $0.00 0 Pressure Re9ulator $0.00 0 Process Piping (per 10 k) $0.00 0 Receptors g0.00 0 SepticTank $0.00 0 Sewer Cap (or Demo $0.00 0 Sewer Connect $0.00 0 Sewer Private Line $0.00 0 Shower $0.00 0 Sink, bar $0.00 0 Sink, commercial $0.00 0 Sink, Floor $0.00 �TY 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Status: ISSUED Applied: 01/20/2004 Issued: 01/20/2004 ISSUED BY: SumpPump Swimming Pool Trap Pnmer Urinal Vacuum Brkr Bkflow(1-4) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) Water Heater / vent Water Piping (Inst or Rep.) Water Re-pipe Water Service AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 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) EXPIRA710N: 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 orde� for ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inapectiona and flnel approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiratlon of this permit. FOR INSPECTIONS CALL: (714) 7545626 zaas-aela�oo� WORKERS' COMPENSATION DECLARATION: - I hereby affirm under penalty of perjury one of the foliowing declarations: ❑ I hava end will maintain a certificate of consent to self-Insure for workers' wmpensetlon, as proWded tor by section 3700 0l the Labor Code, for the pertormence of the work for whiCh IhiS permii is issuetl. \ ❑ I heve entl will maintain workers' compensation Insuranca, as required by section ot the Labor Code, lor Ihe peAortnance of tha wo for which this pertnit is issued. My wo�kers' compen!5,a,tlon In5nuren a carrier and polic pmber are: Carrier: �I [ �� Poliry Number: O �(This s ction need not be com�gtgdd the permit is va�u al ie hundrel tl tlollers ($100J �/ess.J., � ertily thet in the pertormence oi lhe work for whic i this permit is issued, I shall not employ eny person in eny manner so s to become subject to the workerg' compensatlon laws ol Celifo la, end egree t t il I sh ecome sub�ect to the workere' compensetion provislons ol Se ion 370 oi the Labor Cotle, I shall forthwith comply with Ihese pmvisi �' C 1 r, Applicam Signemre: u Dete: ` �1 WARNINO:FAILURETOSEC W ERS'COMPENSATIONCOVERAGEISUNLAWFULANDSWILLSUBJECTANEMPLOYERTOCFIMINPL ENALTIE ANDCIV FWESUPTOONEHIINDREO T}IOUSANDDOLLRRE(5100, ),1 DIiIONTOiHECOSTOFWAIPEN5AT10N,DAMAGE50.SPROVI�EOFOFINSECilON3lOfiOFTHEt/.BORCODE,IMEREST,ANDATTORNEY'SFEES. �'�� LICENSED CONTRACTORS DECLARATION: 1 hereby eNirm that 1 am licensetl under provisions ot Chapter 9(commencing with Section 7000) ot Division 3 of Ihe Business and Pmtessions Code, antl my license is in tull force and eMed. Llc. x Class a Comractors Slgnature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby attirm that thera is a constmction lending egency for ihe peAormence ot the work for which Ihis pertnii is issuetl. (Sec. 3097, Civil Code). lenCels Name: Lentlers Adtlress: Signature: Date: OWNER•BUILDER DECLARATIONS: 1 �ereby ettirm that under penalry of perjury Ihet I am EXEMPT FROM THE CONTRACTORS LICENSE LAW br the lallowing reason (SecJ037.5, Business antl Protesslons Code: Any city or counry whic� requires e permit �o bonstruct, alter, improve, tlemolish, or repeir any sWCWre, pnor to its issuance, also requires fhe epplicant tor such pertnit to flle e signed stetement ihat he or she Is licensetl pursuant to ihe provisions oi the Contracbrs License Lew (Chepter 9(commencing with Section 7000) ot Divislon 3 o1lhe Business entl Professions Code) or ihel he or she is exempi therefrom end ihe be5is for ihe allegad exemption. Any violetion of Section 7037.5 by any epplicant tor e permit suplects ihe epplicent to e civll penelty of not more than five hundred dollers ($500).): �� I, es owner of the pmperry, or my employees with wages as their sole compensation, WILL DO TME WORK, end the strucNre Is not intended or oltered lor sale (Sec. '\ 7044, Business and Professlons Code: The Contractors License Law tloes not apply to en owner of property who builtls or improves thereoq and who tloes such work himself or herself or �hrough �is or �er own employees, provi0etl that such improvements ere no� intentletl or oHered for sale. If, however, the builtlinq or Improvement is sold within one yoer of completion, ihe ownerhuilder will have the burtlen ot proving that he or she ditl not builtl or improve for purpose of sale.). ' ❑ I, 85 owner Of ihe properry. em E%CLUSIVELY CONTRACTING WITH IICENSED CONTRACTORS to construct tha pmject (SecJ044, Business and Protessions Cotle: The contractors License Lew does not eppiy to en owner ol pmperty who bullds or Improves Ihereon, and who coniracis for such prolect with a conirector(s) license pursuant to the Conirectors License Laws.). ❑ I em eaempt ufjQer sec. eusiness and Professions Code tor lhis reason: Signature: _ Owner ID ven Verifice�ion 0� � ��F Date: Iicensa. �Yes ❑ No Driver's License No. Expir05: by (type ot document, i.e. - property teu bill or deatl): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify thet no ezcevetion five (5) or more feet in depih into which a person Is requireG 10 descend, will be mede in connection wich work authorized by this permit, end that no builtling sirucNre, scaHoltling, falsework, or demolition or dismantling Ihereot, will be more than Ihirry-six (36) feet high. (Chep. 3.2, Grp 2, Art 2, Sec. 341, Title B, Celifomia Atlminisirativa Code). ❑ As owner-builtler, I will nol employ anyone to do work which would require e permit from ihe Division of Industnal Safery, as notetl above, unless such person hes a permit lo do such work trom the tlivision. Signature: Date: Division of Industrial Sslety Permit Number CERTIFICATE OF COMPLIANCE AND AUTHORIZATON OF EMAV: I certify under penelty of perjury thet I heve reatl this application antl state thet Ihe informetion given is correcL I agree to comply with all state laws end ciry ortlinances relating to buittling consWction, and aut�orize re rasentatives ol the Clty of Coste Mesa to enter upon Ihe ebova-described oparty for inspection �urp9se . gree not to occupy or allow occupency ol any huiltling emhorjZ�d by this pqrmit unti_ I fjnal inspeclion. lv{ Gf �!'1 0\ n l/. i //[,/ l�lJ� l \�t" Slgnaiure Of egal Owner(s) Data And/Or Authorized Applicant Date COOE I, INSPECTIONTYPE 161fi Fi:ed System Final Fire Prevention 7286 Paol Spe Finel 200 Finel Re-Rooi 201 FIneI BIaWRetaining Well 202 Final Factory Fire Place 203 204 Final Sign Final Oemolitian p�j[ ��j j�Q�,( INSVECTIONttPE 206 Finel Mec�anical 20H Final Plumbing 210 Final Electrical 212 Final Fire Preveniion 220 Final Planning Approval 222 Final Site � 250 Final Building/Occupancy PdT� It�ELi r��_��1,•�