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Home My WebLink About241 16TH PL - Building Permits STU CITY OF COSTA MESA j I 4BUILDING DIVISION > y ? DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER PERMIT 4INTxtregrros# B04-01056 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 241 16TH PL Status: ISSUED Suite: Applied: 0si/09/2004 Vicinity: ROOF Issued: 06/09/2004 Parcel Number: 42520111 Zoning: Applicant: JOHN SKIRZYNSKI ISSUED BY: 15"` Address: 10782 S MEADS AV Phone: (714)771-0118 ORANGE,CA Zip: 92869 Owner: HOSFIEL, KEITH W TR , Address P 0 BOX 2561 Phone: NEWPORT BEACH,CA Zip: 92659 Contractor: SHARP ROOFING Address: 10782 S MEADS AV Phone: (714)771-0118 ORANGE,CA Zip: 92869 License: 571575 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: • SCOPE OF PERMIT TEAR OFF EXISTING ROOF.TEAR OFF EXISTING ROOF. INSTALL 30 YEAR G.A.F.SHINGLES OVER EXISTING SHEATHING, REPAIR/REPLACE SHEATHING AS NEEDED,15#FELT FOR SFD.6 SQUARES.PARTIAL RE-ROOF. FEE SUMMARY Plan Check: $0.00 - _ _ Calc Valuation: $1,100.00 Permit: $41.80 Claim Valuation: $1,100.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $42.30 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 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 244636(6/00) DECLARATICOVS r WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ! • ❑ I have and this ein a certificatessof consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit IS issued. -❑,..,‘I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. --,My workers'coy,pensation Insur_erce carrier and policy number are: �t (Canier:� .'�-_ WY CPoticyNumber:., -7.--'3C 001 J W^ Oy (This section need not be completed if the permit is vaned at one hundred dollars($100)or less.) - ❑ I certify that in the perform: :of th w.rk fo - is permit is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws• all'. la,an a, a1wFy d become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these p . •io i _ ` U, Applicanl•SignetuFe: / (--Dater— D y tWARNING:.FAILURE TO SEC E WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER.TO CRIMINAL PENALTIES AND CIVIL RNES UP TOONE HUNDRED l -THOUSAND DOLLARE(5100,r..),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisl ns of Che r 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full forst act effect lac:e� /r}Z 7� , DatClt. -. 3 Contractors Signature: �/ '�` Date:. 6 ^ Ci —ti 4 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 toe civil penalty of not more than five hundred dollars($500).): ❑ I,es 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 Driver's 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: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 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 Cale provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the Califomia Health and Safely Cade 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 a plication aggermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? la Yes 0 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 he constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Ves 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑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 ken 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 up n 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. 4ig)!` r Owners) r-, Date V 44--•/•-. gr' ioe4---- And/Or-Autorized Applicant . ` .. - Date .. j CODE I INSPECTIONTYPE PAIL INTRIAL$ CODE it INSPECTION TYPE alri INIIDAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing ' 200 Final Re-Roof 6-110-046-110-04 -41-AAA 210 Final Electrical 201 Final Block/Retalning Wall 212 Final Fire Prevention i I 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 BUILDING DIVISION > -' '.4 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER terPERMIT ttPa,,n P02-00122 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 241 16TH PL Status: ISSUED Suite No Applied: 03/04/2002 Issued: 03/04/2002 Vicinity: e Parcel Nunmber: 42520111 ISSUED BY: C Applicant: HOSFIEL, KEITH W TR , Address: P 0 BOX 2561' , Phone: 949-642-5722 ' ' NEWPORT BEACH,CA Zip: 92659 - , Owner: HOSFIEL, KEITH W TR Address P 0 BOX 2561 - Phone: 110 NEWPORT BEACH,CA Zip: 92659SISJ5 ��ff�// • oA •• 1 Contractor: OWNER-BUILDER t • • ' • . _ Address: , Phone: Zip: License: 0 - Arch/ Eng: ' . Address: Phone: Zip: License: • - SCOPE OF PERMIT _ PLUMBING TO INCLUDE: 1 BATHTUB, 1 GAS REPIPE, 1 LAUNDRY TUB/WASHER, 1 SERVICE/MOP SINK AND 1 WATER RE-PIPE. FEE SUMMARY AMT QTY-r> AMT ()TY - • 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 Bathtub $9.80 1 - 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 $0.00 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 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $9.80 1 Gas Earthquake Valve $0.00 0 Sink,Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $0.00 0 Sink,kitchen $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $9.80 1 OTHER $0.00 Gas Repipe $9.80 I Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $72.50 COMMENTS I SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. , FOR INSPECTIONS CALL: (714)754-5626 244646(600) DECLARATIONS - WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ' . 0 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. pI 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.) Lcertify that in the performs e of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation law li rnia,and agree 1 at If I s ople(become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with thes rovi ns. 2 'J PGlicaiit Signature: '2.S' �' 'tate:; > >7 — 'l — 0 2__ WARNING:FAILURE TO SE RE WORKERS'COMPENSATIO COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(S100,000),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 N 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 Cafe). Lenders Name: Lender's Address: Signature: Date: • OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant 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 orrherself 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 withinone year of completion,the owner-builder wit have the burden of proving that he or she did not build or improve for purpose of sale.). atr ❑ I, s owThe of tra_tors Llce am,EXCLUSIVELY a CONTRACTINGanownerWITH LICENSED CONTRACTORS tor on, rdct the ntfor su70ch Business and Professions Code:The contractors Licenee'Law,tloes not apply to an owner of progeny who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contradtor9'License La.�, I am exemp •• .- sec. a. =V„ Business and Professions Code for this reason: Signature`' ' _ -, I '! I' pate: — — 12 wrier ID Terni•: by drivers license. F. Yes 0 No r ver_lite Lice se No.. • • —. xpgesl'r 30"0 Z Verification of Ownership by(type of docu ent,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,faisework,or demolition or dismantling thereof,wit 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? ❑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 lime 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 wit the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No w (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 wit the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 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 permit 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 0 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 if a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE 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 :• 'e o 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 abov: propert for' act n pu sed.raa ree not to occupy or allow occupancy of any building authorized by this permit until final inspection. -.S naNre, 'eget Ownei(s)__, . C P'Date- j And/Or Authorized Applicant Date CODE 0 INSPECTION TYPE all INTmALS CODE I INSPECTION TYPE PATE INITIALS 1616 Fixed System Final Fire Prevention _ 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy attributes : Costa Mesa Parcels Page 1 of 1 Map Layer At.-.outes for Parcels • Property Address Address 1 241 E 16TH PL Address 2 COSTA MESA CA 92627 Parcel Information Assessor Parcel Number 42520111 Legal NEWPORT HEIGHTS LOT 53 SE LY 140.3 FT SWLY 137.5 FT NELY 162.5 FT I N LOT Range Township Section Quarter Section Area 15766.390429999999 Acres 0.35999999999999999 Owner Information Owner HOSFIEL KEITH W Owner Address 1 PO BOX 2561 Owner Address 2 NEWPORT BEACH CA 92659 Property Specs Year Built 1976 Building Square Feet 6504 Building Count 1 Stories Number 0 Parking Spaces 0 Number of Units 8 garage Square Feet 1282 Front Footage 137 Depth Footgae 115 Bedrooms 0 Map Layer Attributes For Address Points Address 241 16TH PL Apt/Suite City State Zip Building ID APT/Space Phoen SIC Code 0 Data Siurce parcels Plan Type http://mesagis2x/website/costamesa/parcel/default.asp?opt=attributes&sessid={50924820-52CC-427C-9... 02/19/2004 Property Profile a Page 1 of 1 DataQuick.* a.e.ra hu.w.twi+6 �.11lllll/ land and property data you can build a,- Property Profile Primary Owner: HOSFIEL,KEITH W TR Secondary Owner: Mail Address: 0 PO BOX 2561 NEWPORT BEACH, CA 92659 Site Address: 241 16TH PL 7 COSTA MESA, CA 92627 ? Telephone Number: r ' • 'sY APN: 425-201-11 L,." n Reference APN: <.. S` 6AUFORNA V Census Tract: 633.007 Housing Tract Number: 516 Geo Level:0 Lot Number: 53 Page Grid Old: 31-C3 Page Grid New: 88845 Legal Description: NEWPORT HEIGHTS LOT 53 SE LY 140.3 FT SWLY 137.5 FT NELY 162.5 FT I N LOT Subdivision: Property Characteristics Bedrooms: Year Built: 1976 Square Feet: 6,507 Bathrooms: Garage: Y Lot Size: 15,854 sq ft/0.36 acres Total Rooms: Fireplace: Number of Units: Zoning: Pool/View: Use Code: Multi-family Res(5+Units) Heating/Cooling: Sale& Loan Information Transfer Date: 03-01-1976 Seller: Document: 0000393778 Transfer Value: $67,500 Cost/Sq Feet: $10.37 Title Co.: First Loan Amt: Lender: Last Trans W/O$: 00-00-1990 Loan Type: Interest Rate Type: Last Trans W/O$ Doc: 0000393778 Assessed& Tax Information Assessed Value: $307,515 Percent Improvement: 63.32 Homeowner Exemption: Land Value: $112,797 Tax Amount: $3,617 Tax Rate Area: 15007 Improvement Value: $194,719 Tax Status:current O 2004 DataQuick Information Systems.This information is compiled from public documents and is not guaranteed. [ Report Menu] [Select New Target Property] http://www.gotitle.com/cgi-bin/profile.asp?rmt=TOPS&graphic=%2Faccounts%2FT07378%2Fcompan... 02/19/2004 CITY OF COSTA MESA ��. .i 4 BUILDING DIVISION > • r.,.•' ,ii DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 1. 1 •-•w I 4 44* PERMIT P02-00168 4t411.01;rn so(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 241 16TH PL Status: ISSUED Suite NoApplied: 03/04/2002 Vicinity: RESIDENCE AND ATTACHED GARAGE Issued: 03/04/2002 Parcel Nunmber: 42520111 1 Applicant: HOSFIEL, KEITH W TR ISSUED BY: CC'S / 1r Address: P 0 BOX 2561 - , ' • Phone: 949-642-5722 NEWPORT BEACH,CA Zip: 92659 Owner: HOSFIEL, KEITH W TR Address P 0 BOX 2561 Phone: NEWPORT BEACH,CA Zip: 92659 Contractor OWNER-BUILDER , Address: • 1 - • •• - - =Phone: Zip: . License: 0 - - SCOPE OF PERMIT ELECTRICAL TO INCLUDE:SERVICE TO 100 AMPS(REPLACING),5 LIGHTING FIXTURES,8 RECEPT OUTLETS AND 4 SWITCHES. 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 $5.50 5 up to 50 kva/kw $0.00 0 Recept Outlets $8.80 _ 8 • - up to 100 kva/kw $0.00 0 Switches $4.40 4 • 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/CM $0.00 0 Service to 200a $30.50 1 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 $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $72.70 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS 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)7545626 244646(&to) DECLARATIONS ;,-• moi, WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) -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 alitornia,end agree that If lc d become subject to the workers'compensation provisions of Section 3700 of the Labor Code, shall forthwith comply with Ihe'se gr Islons. u Iicant:Signature: o . &ate:'`:`, S- —I-0 2 WARNING:FAILURE TO ECURE WORKERS'COMPENSATI 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 MST 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.Llc.# 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 sate(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 o the Contractors Licens Laws.). I am exe or,sec.c.. " ti Business and Professions Code for this reason: ignat'ure:' " s Q. Irk ►�Date� J .�—' L{— 2 wner ID verifi d b driver's license. Yes ❑No iiv'ars L'irznse''No: ,wilei7I9-:iQ-02 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 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 ❑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 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? IYes 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 ❑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 abov:k crib cd propert fo ,s•:ction purpo.: . agree not to occupy or allow occupancy of any building authorized by this permit unfit final inspection. :.nice __. - 3 ' � -02 S nature 07'. gal 4.,,'', 'J Daten';i;l.• And/Or Authorized Applicant Date CODE I INSPECTION TYPE DATE INTrlAL$ COPE( INSPECTION TYPF QejF INTIIIALS • 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing /, 200 Final Re-Roof 210 Final Electrical 1/10%Z .i_ 201 Final Block/Retaining Wall 212 Final Fire Prevention o ))) 202 Final Factory Fire Place _ 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition — , 250 Final Building/Occupancy / l 4`-9 CITY OF COSTA MESA o,c;�� BUILDING DIVISION ( � DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER ' PERMIT M02-00098 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 241 16TH PL Status: ISSUED Suite No Applied: 03/04/2002 Issued: 03/04/2002 Vicinity: GARAGE • Parcel Number: 42520111 ISSUED BY: _ VI- Applicant: HOSFIEL, KEITH W TR Address: P 0 BOX 2561 Phone: 949-642-5722 ' NEWPORT BEACH,CA - Zip: 92659 Owner: HOSFIEL, KEITH W TR Address: P 0 BOX 2561 Phone: NEWPORT BEACH,CA Zip: 92659 Contractor: OWNER-BUILDER • •- Address: e• ', i , ' , -Phone: - Zip: License:0 SCOPE OF PERMIT MECHANICAL TO INCLUDE:INSTALL 1 FAU< 100 K BTU AND GAS PIPING. FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $14.80 1 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 $6.15 1 , 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 Furnace $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 TOTAL CALCULATED FEES $44.45 COMMENTS /SPECIAL CONDITIONS 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 it 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 the work for which this permit is issued. My workers'compensation Insurance carder and policy number are: Carrier: Policy Number: (This section need not b completed If the permit is valued at one hundred dollars($100)or less.) f-rs 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 al rnia,and agree that If I sho become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these ov ns / \ — 14 _ O 2 ��(p�'ptlicant.Slgnature^= 4-,itil ) art Date:`- 3 -WARNiNG:FAI UL RE TO SECURE WORKERS'COMPENSATI COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMI'CO?ER 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 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 end 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). 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 pursu-• to the Contractors Licens1},:. .). T am a :m., ender s.c.- C a. ALA +la Business and Professions Code for this reason: gnature_v tii � Date:'- -�— -0 llII��e (,� 'O D ve lied by driver's license. IT es 0 No rivers License No. OExplres! 1-76-0? Verification of Ownership by(type of doc ent,i.e.-property tax bill or deed): DIVISIONOF 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,Gm 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 lime 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 feel 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 a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes 0 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑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 ag :e 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 :so ve-•esc-•ed property f-ins section os . ree not to occupy or allow occupancy of any building authorized by this permit until final inspection. -➢ +Tule OCLegal Owner(-)_' �. And/Or Authorized Applicant Date goes! INSPECTION TYPE all Male CODE! INSPECTION TYPE MIL 1616 Fixed System Final Fire Prevention 206 Final Mechanical #9-5-139. 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 . . . COUNTY OF ORANGE application for Building Perm' . • BUILDING DEPT. Permit No eri 3 W Co 636 No.Broadway AND FOR A Santa An;California - ' Phone;KZ 2-6221 Certificate of Use and Occupancy Date /-- 7-S3 1. OWNER'S NAME Nel 2. • \\//1-LIA1-1 t'l. PO Ltrob...( PHONE:iv-A.4-a" S°Cie 2 .'t MAILING ADDRESS 2' S leoith r-ft, LA-ca an co S-T 4 VI W'S ies- Name 414 L Lil-c.--/ Name kii -l_ 1L4401 NI • Po 1-.fts 7-a n4 v(14 r nail-se (Architect.or-Engineor4 (Contractor) ith Address 2-/p f 2- sill-'-'-'P 0 an* g 1-- in- Address 2 4 5- I (0 PLeic•E- City .1•147.:-44-7.0 i2..r i!,9ei c.r/ City 74— i.,7 LS-A ' State State • Lie. No - .eed:eilE-7 Phone 1.109-An 2 ”2-to c:.ti Lie. No Atel 14-r— Phone)35-4C°^I $.0 72-- t PROPOSED USE• D\-`ic---1.-t-i m G. 2. JOB LOCATION-2 77- ' /6 1-4 PA t c e -51; (House No.)No.) (Name of Street) (Town or School District) NAME OF AND DIRECTION FROM NEAREST CROSS STREET... We.,57./57./.:kan'te- • 3. LEGAL DESCRIPTION: Lot Block Tract (Metes and Bounds Description—Use reverse side of form) 4. CORNER LOT ( vi INTERIOR LOT (t 0.,) THROUGH LOT ( ) SLOPE OF LOT ( ) 5. SIZE OF BLDG • "2-X ea 3 2.2-- AREA• "7----- -f 50 P X SIZE OF LOT• WO -X I 37, g AREA:J.,+2 A cr) .5.0, at:7. 6. HEIGHT OF BLDG ' I i- PT. CEILING HEIGHT- gr F7. NO. OF STORIES 0 "E C. 7. NO. FAMILIES ON r Size of Smallest Bedroom• I 0 —X 1-3 Size of Kitchen g b X / 7i''' 8. EXTERIOR WALL CONSTRUCTION• .,S Tu c c•- c) INTERIOR WALL COVERING PL ii-S-tre r? (Frame,Stucco, Etc.) (Plaster-Drywall, Etc.) ROOFING COVERING C-e) nil p 0 c i Tr a at 6 #i Ai t; 1.Sr 5 9. STATE HOW MANY BUILDINGS NOW ON LOT AND GIVE USE OF EACH 2..7 g. <2)..?„?.0.?..„,..c.;_s e.",..ortr. r•s s.' cu E 009t-av 10. SETBACKS: Front Yard From Center Line of Street 0 EL Oa, avy ..074.4c. .5 Nearest Side Yard...L 7 CI, Rear Yard et,. ..F7: Distance in Feet Between Bldgs. on Same Lot 2 •-• F r. (Property Line) (Property Line) 11. A COMPLETE PLOT PLAN IS REQUIRED, SHOWING ALL STRUCTURES AND USE OF EACH. ° ( 4 1( 12. (a) Footing: Width Depth in Ground /a- Width of Wall ""--- • ,/ t. (b) Size of Studs 2-X 171 Spacing /6 "CC Material of Floor cc-A.-et:ma - 4rfilie3C7 )7[4 (c) Size of Floor Joists• AtnYe-- Spacing -- - "CC 01 • . (d) Size of Rafters #- ,••• -r n Spacing '2-4 "CC 13. VALUATION OF,,PROPaSEDAORK: .Including all labor:plumbing,electrical wiring, heating, fire sprinklers, painting and sewage disposal $ (67.2..r..0 -- 14. I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION IN THIS APPLICATION IS CORRECT AND THAT THE CONSTRUCTION WORK WILL CONFORM TO ALL LAWS OF THE COUNTY OF ORANGE AND THE STATE OF CALIFORNIA APPLICABLE THERETO. Signed. dirtire (6)(1-Q(1 (Owner) Plans Filed.........../ - 7 "" -5-3 By• (Authorized Agent) FOR DEPARTMENTAL USE ONLY S . - CHECKING BY FEE : Bldg. Permit - FEE:: /lc ° .e GROUP APPLICATIO/000 HEALTH , el Ci Plan Check - $ , nti ada TYPE _-Z ZONING " FIRE Total • • • $../....t - DIST. CR ti PLANS AND MARSHAL Receipt No. • MAP SPEC'S STATE Paid to • • --. - • SHEET NO c5-- CORRECTIONS ENGINEER Date if — 7 —5 5 --VERIFIED_- --- tv:z.artl'. t } INSPECTOR F7 DATE il• 3 WWI r= rj ealir ='=7:Hir ......24Cliss. S000-7-52 t )1‘1 . 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FOR APPL/CANT TO FILL /N COMPLETELY APPLCARAPRIPAIRMIT TYPE OR PRINT BUILDING))) //I//'I BUILDING BUILDING aV 4 / & /‘ M •y ��A ' ADDRESS oli / YYY ..<LffG6CCi�CVV COSTA MESA, CALIFORNIA FOR OFFICE USE ONLY MO /1• /l I RECEIPT NO.1 -12PFyi NO, OWNER % r I, 1/) //��// /✓✓"�i V/./{�`/�J�{��J- /� ij M�SS®( ADDRESS/S V1 /�•,,_ I1,/ 'y' 2g "r ite- RECEIVED B.Y{ )D�![ft IVJE/D/ I D(A)/T/fE/IiSUEDO {� /Y �' TEL. NO. ADD E{IIsNs ,JL 'y/ ,//tI( /E/J]tZ / .42,42.---- cm' `/G ARCHITECTLIC. COSTA MESA, CALIFORNIA OR (NEER, NO. ZONE TYPE GROUP STATE ADDRESS ,� }--yl// /J a CONTRACTOR 04 ✓ ' ✓'' - L C NO. APPROVED 1 ✓../ DATE)2/90 ADDRESS �ONING �I LEGAL LOT I ZON(FJ' NO.OF USE OF NEW ty wi DESCRIPTION NO./ Ala BLOCK T' /• PLANS Y I BUILDING• .{ A.P.NO. ��(// I (�k/.7� '/ G • / BYIIIPAAAROVED / •`�� ,'�(�E�SD.�A nig,- ALLOWED I �I/'I�P SIZE I / 0 Y )3 I y I NOW ON LOTNO.OF S REQUIRED (�/ ALLOWED OF LOT //� USE OF // //A .I (CENTER LINE ST.) �•'� / EXISTING BLDG, aLY iaiden„ FRONT Q'�(Q/ FT. IN, SETBACK LINE FROM CENTER OF STREET REAR YARD R.SIDE 107 FT. IN. SIDE YARD I LEFT I RIGHT L.SIDE FT. IN, DESCRIPTION OF WORK REAR y FT. IN, NEV II ALTERATION I II ADDITION I ,/ I REPAIR �/ 7I II MOVING II DEMOLISH I S ZSUIE LD1// /I,✓ ROOMS STORIES EXTERIOR WALL ROOF COVERING VEeRING USEOF IL AND WO BE PERFORMED I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION.///�� -- SIGNATURE OF Q4// 11 K?cs VALUATIO O'l PERMIT FEE $ (�/ PERMITTEE / , l VV7 V �_ $ • PLAN CHECK S l I AUTHORIZED AGENT TOTAL FEES t •-