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Home My WebLink About256 22ND ST - Building Permits CITY OF COSTA MESA 44, .E BUILDING DIVISION ` a Fc• �I DEVELOPMENT SERVICES DEPARTMENT \\ \D PERMIT NUMBER ( r �• PERMIT 11 • 04-01141 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 256 22ND ST Status: ISSUED Suite: Applied: 06/23/2004 Vicinity: FRONT OF S.F.D. Issued: 08/16/2004 Parcel Number: 42608116 Zoning: Applicant: TANKERSLEY, TODD ISSUED BY: Address: 256 22ND ST Phone: 949-631-0859 COSTA MESA,CA Zip: 92627 Owner: TANKERSLEY, TODD Address 256 E 22ND ST Phone: COSTA MESA,CA Zip: 92627-1812 Contractor: Address: Phone: Zip: License: Arch : Eng: EW WEBB ENGINEERING INC. Address: Address: 1660 CHICAGO AV Phone: SUITE M9 Phone: 909-788-2050 RIVERSIDE,CA Zip: License: 92507 License: 37384 SCOPE OF PERMIT ADD 368 S.F.TO EXISTING S.F.D.AND ADD 18 S.F. FRONT PORCH.WORK TO INCLUDE:ADD A NEW BEDROOM,BATH AND RELOCATE A WINDOW. CONVERT 3 BEDROOM,2 BATH S.F.D.TO A 4 BEDROOM,3 BATH S.F.D. REF:MM-04-25 PLANNING: LOT SIZE=7,013 SOFT. BUILDING COVERAGE=2,129 SO.FT. DRIVEWAY=400 SOFT. TOTAL LOT COVERAGE=2,529 SOFT.(36%) • OPEN SPACE=4,484 SOFT.(64%) FEE SUMMARY Plan Check: $320.29 Calc Valuation: $34,293.36 Permit: $492.75 Claim Valuation: $0.00 SMIP Res: $3.43 SMIP Com:' $0.00 Other: $0.00 Inspection: $0.00 Total: $816.47 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 2446-66(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'compensat•n insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued My workers'coil•°•'ati. urance . ri ..: 'olicy number are: Cartier: 'J O. Policy Number: (This don need not be com•leted if the,. It/s valued at one hundred dollars($100)or less.) - • I certify that in the performance of the ••rk for who.r this permit is issued,I shall not employ any person In any manner so as to come subject to the workers' compensation laws of California.and a• -, - F' out. .- . . subject to the workers'compensation provisions of Section 3 of the Labor Code, shall forthwith comply with these provisions. tel// Applicant' lgnature: Date: O I 4 WARNING:FAILURE TO SECUR a --ti COMPENSATION COVE-. - •WFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENAL IES AND GINL FINES UP O ONE HUNDRED DOLLARS DOLRE(Sty.-.TyADDITION TO THE COS DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTO, EYS 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.LIG.N Class# I 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). Lender's 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 end 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 Cale)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).): as owner of the property,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.). • ❑ I,as owner of the property,em 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 Business and Professions Code for this reason: <(/ /O Signature: Sr Date:ve1/. 6)J Own: a writ'', . v- Ice- `!'� 0 No Drivers License No. Expir s: Verffi • of Ownership, •e 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(38)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title B,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 greeter then 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 II 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 e application aprmit for such construction or modification from the South Coast Air(Duality Management District or from any other air pollution control district or agency? Ul Yes P 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 ayes',the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 II 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 penally of perjury that I have read this application and state that the information given is correct.I agree to comply with all s: - . nd ci ordinances relating to building construction,and authorize represent Lives of the City of Costa Mesa to enter upon the above-described property f• .... -of to occup or: • ,.. 'c oaf•. any building authorizedg s ermit u0tii jnal pection. / - - e•: .Ther(s) Dat nd/Or Authorized Applicant - Date goDE I INSPECTION TYPE PIZ BMW COPE. INSPECTION TYPE DA11 Rill1E1s 1618 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/Retalning 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 40 -�� 10-z 61.9 CITY OF COSTA MESA 4 BUILDING DIVISION • purr rDEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT y -"0•omrso AMG1 GG6^S (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 256 22ND ST Status: ISSUED Suite No Applied: 09/28/2004 Issued: 09/28/2004 Vicinity: , Parcel Number: 42608116 ISSUED BY: ��Iff// Applicant: TANKERSLEY, TODD Address: 256 E 22ND ST Phone: 949-631-0859 COSTA MESA,CA Zip: 92627-1812 Owner TANKERSLEY, TODD Address: 256 E 22ND ST Phone: 9+49-631-0859 COSTA MESA,CA Zip: 92627-1812 Contractor OWNER-BUILDER Address: Phone: Zip: License:000000 SCOPE OF PERMIT ADD 368 S.F.TO EXISTING S.F.D.AND ADD 18 S.F. FRONT PORCH.WORK TO INCLUDE: ADD A NEW BEDROOM, BATH AND RELOCATE A WINDOW. CONVERT 3 BEDROOM,2 BATH S.F.D.TO A 4 BEDROOM,3 BATH S.F.D.REF 904-01141. 1 FAU <100K BTU AND 1 VENT FAN/SINGLE DUCT. 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 $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 $7.25 1 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 / ) NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California states 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 fora 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 carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit/s valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit Is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000).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.Lie.# Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued.(Sec.3097.Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption,Any violation of Section 7031.5 by any applicant for a permit subjects the applicant 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.). • 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: [x / SITS: �,�— ) � / Expires: 7 -- Verification 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? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the 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 ermit 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 8 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 Callfomia 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 w city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described Orope • 'asp coon p o occupy or allow occupancy of any building authorized by this permit until final inspection. gnetu[e,Of-:.-uTne+!� eDate I� And/Or Authorized Applicant Date BODE# IfISPECTIONTYPF QAIE INTrUAI$ CODE# INSPECTION TYPE pp PEE 1616 Fixed System Final Fire Prevention 206 Final Mechanical (7' in-O 5 n 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 • ••CITY DF COSTA MESA r 4;. ►9 BUILDING DIVISION F �I$ DEVELOPMENT SERVICES DEPARTMENT PERMIT UMBER k PK. !! PERMIT ittvumnarto PO4-00611 (714)754-5273 • Fax(714)754-4856 • iwww.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 256 22ND ST Status: ISSUED Suite No Applied: 09/02/2004 Issued: 09/02/2004 Vicinity: -1 ISSUED BY: Parcel Nunmber: 42608116 Applicant: TANKERSLEY;TODD Address: 256 E 22ND 5T Phone: 949-631-0859 COSTA MESA,CA Zip: 92627-1812 Owner: TANKERSLEY, TODD Address 256 E 22ND ST Phone: 949-631-0859 COSTA MESA,CA Zip: 92627-1812 • Contractor: OWNER-BUILDER Address: Phone: i Zip: License: 000000 Arch / Eng: Address: • Phone: Zip: License: SCOPE OF PERMIT DD 368 S.F.TOIEXISTING S.F.D.AND ADD 18 S.F. FRONT PORCH.WORK TO INCLUDE:ADD A NEW BEDROOM,BATH AND RELOCATE A WINDOW. • CONVERT 3 BEDROOM,2 BATH S.F.D.TO A 4 BEDROOM,3 BATH S.F.D .REF B04-01141.1 SEWER CONNECTION, 1 SHOWER, 1 WASH BASIN, 1 TOILET. 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 $0.00 0 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 $9.80 1 Dishwasher $0.00 0 - Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain,Floor $0.00 0 Sewer Connect - $24.65 1 Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $9.80 1 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) DEClARAYIONS 1 C J 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 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 et 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,end agree that II I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND GVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN ADDMON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060E 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.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 sate.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 properly,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) C- se pursuant to the Contractors License Laws.). • I am e :mpt under se _ Business and Professions Code for this reason: / D _ .nature: . " ' i c,no • .-ripe. .. •river's- en Al- 000011111171; , ❑No •river's License No. •' =s: Vert icatio•ao •wnership by( ..e 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 fila 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 Secfion 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 L1 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 mutt 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 E I' 'I certify under penalty of perju t • .. e read this application and state that the information given is correct. I agree to comply With all - r."" and ci ••.�TT5'rting to buildin. •-: . .n,and authorize representatives of the City of Costa Mesa to enter upon the above-described proper pun•- ••� cu. • - •"occupancy of any building authorized by this permit until final inspection i "� � —cam D And/•r Authorized Applicant Date PODS L INSPECTION TYPE PATE IMO CODE! INSPECTION TYPE PATE efTrnAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 8•',7)n.n S • TN 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 1f�! CITY OF COSTA MESA • 4 BUILDING DIVISION - °t; ,,; � f • ^ „ I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER o Vela 'PERMIT `#; 4-01047 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 256 22ND ST Status: ISSUED Suite No Applied: 09/28/2004 Vicinity: Issued: 09/28/2004 Parcel Nunmber: 42608116 WO/Z._ Applicant: TANKERSLEY, TODD ISSUED BY: Address: 256 E 22ND ST Phone: 949-631-0859 COSTA MESA,CA Zip: 92627-1812 Owner: TANKERSLEY, TODD Address 256 E 22ND ST Phone: 9+49-631-0859 COSTA MESA,CA Zip: 92627-1812 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 000000 SCOPE OF PERMIT ADD 368 S.F.TO EXISTING S.F.D.AND ADD 18 S.F.FRONT PORCH.WORK TO INCLUDE:ADD A NEW BEDROOM,BATH AND RELOCATE A WINDOW. CONVERT 3 BEDROOM ,2 BATH S.F.D.TO A 4 BEDROOM,3 BATH S.F.D:REF B04-01141. 11 LIGHTS, 10 OUTLETS, 11 SWITCHES,1 BATHROOM FAN. REVISED 10/12/04:ADD 12 LIGHT FIXTURES,2 OUTLETS AND 2 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) 50.00 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 $24.19 23 up to 50 kva/kw $0.00 0 • Recept Outlets $13.20 12 up to 100 kva/kw $0.00 0 Switches $14.30 13 over 100 kvaRw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $4.75 .1 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 • 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. r. • • • ❑ 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: (Th2 tion need not be completed if the permit is valued at one hundred dollars($100)or less.) 41rTbectify 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' t 'compensation laws of California,a • ,:,A -I if I should become sub': - 'o ers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provi '• (_ y�Apptix�caniSlgnature_ -- Date:T / —/2 — 6 31VARMNG FAILURE T• : •- ER i.•• COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EM M TO CRIMINAL PENALTIES AND CL FiNES UP TO ONE HUNDRED THOUSAND•• ;,j1 ••,000 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 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: 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 JS old 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.). C;E 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: CD ,�Slgnatu Er ues:_ Fs^ — c56 Verification of Owner •': •y(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,Califomia 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 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 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 app lication 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 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? ❑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? 0 Yes ❑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 agree to comply with all state laws an• noes relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspecti•• :• •. - ,• ;' not to occupy or allow occupancy of any building authorized by this permit until final inspection. And/Or Auth• ' :d A••• ant Date CODE A INSPECTIONTYPE / QAIE INTITtAL5 BODE( INSPECTION TYPE PATI tNTITIAL4 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 CITY OF C04&MESA 4 BUILDING DIVISION :al_ :J,,,,,.' DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER t;t% is . ' PERMIT �4. IMO ; E04-01047 wan (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 256 22ND ST Status: ISSUED Suite No Applied: 09/28/2004 Vicinity: Issued: 09/28/2��004 • Parcel Nunmber: 42608116 �j /`/ ° Applicant: TANKERSLEY, TODD ISSUED BY: /// / Address: 256 E 22ND ST Phone: 949-631-0859 COSTA MESA,CA Zip: 92627-1812 Owner: TANKERSLEY, TODD Address 256 E 22ND ST Phone: 9+49-631-0859 COSTA MESA,CA Zip: 92627-1812 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 000000 SCOPE OF PERMIT • ADD 368 S.F.TO EXISTING S.F.D.AND ADD 18 S.F.FRONT PORCH.WORK TO INCLUDE:ADD A NEW BEDROOM,BATH AND RELOCATE A WINDOW. CONVERT 3 BEDROOM ,2 BATH S.F.D.TO A 4 BEDROOM,3 BATH S.F.D.REF B04-01141. . 11 LIGHTS, 10 OUTLETS, 11 SWITCHES,1 BATHROOM FAN. 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(31-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 $12.10 11 up to 50 kva/kw $0.00 0 Recept Outlets $11.00 10 up to 100 kva/kw $0.00 0 Switches $12.10 11 over 100 kva/kw $0.00 0 Non Res Appl $0.00 - 0 Low Voltage Equipment $0.00 0 Res Appl $4.75 1 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 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) I EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days,or if work Is sluspended 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 it 2446-46(6/00) DECLARATIONS U ( 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,-es 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 Ls Issued. My workers'compensation insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed If the permit Is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND 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 COOS.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 e Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant 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 °id 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.). • pI,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 undetse . Business and Professions Code for this reason: eSignatu � ! C) -ACb --6r_� Owner ID verifi•• • dritafIcens: C I-• ❑No Driver s �No. / Expires: 5 - O (l Verification o Ownership by(type o document;i:a.-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 empty anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has e 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 end 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. .... Health .. 4 If an RMPP is presently required,has Section 25534 of the Californiaa Healthh 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 appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? DU 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 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 wort which is the subject of this application,have all of the disclosures prescnbed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to buildin• construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection' uD ?..I agree not to••• • • : ow occupancy of any building authorized by this permit until final inspection. igna ure OLLegal Owner(s) C__ Date And/Or Authorized Applicant Date CODE r INSPECTION TYPE RATE IIRIRAI.S CODER INSPECTION TYPE PAIS MALS 1616 Fixed System Final Fire Preventio/ 206 Final M. anical 1266 Pool Spa Final 208 Final PI mbing 200 Final Re-Roof 21( FD:I E:ct 201 Final Block/Retaining Wall4 ITS 2 • el FI • ' • •tair •- 202 Final Factory Fire Place Fin: P: ing Approval 203 Final Sign 2 Final Site 204 Final Demolition 250 Final Building/Occupancy C SIBS OFBUILDING: 256 22ND ST uNT: CITY OF COSTA MESA - BUILDING PERMIT Yt.KM NO: t. 071914 OWNERSNAALE IF KNOWN BRIGGS E STEVEN R ADDRESS: 256 E 22ND ST PERMIT NO: E 071414 PLAN CHECK NO: N GOO T: N SUPP: A COSTA MESA,CA 92626 CONSTRUCTION TYPE; III-N PERMIT TYPE: ELE PURPOSE: ALT ADPL.MMUNO ADOBES3: • JOB DESCRIPTION : LEGALIZE WORK ALREADY DONE SQ FT: ARCHITECT ORENOPIEER: HASTINGS PARTNERSHIP UC.NO.: C11600 ARMOR ENa's ADDREss: 17500 REDH ILL AV WIT: 210 CLAIM VALUE: CALC-VALUE: GROUP OCC: B-2 / IRVINE CA 92626 CONTRACTORS NAME BRIGGS ELECTRIC ( 714 ) 863-9901 COMMENTS: X CCNTRACTORS'MUSD 16662 MILLIKEN AV +E**Sr********************Srsr********* r*Stsrr*****Serst***********SeyPst*sr*Se SL.************. ADDREss: IRVINE CA !A.m.: 297836 ZONING REQUIREMENTS 92714 to : NONE SETBACKS LICENSED CONTRACTORS DECLARATION:I hereby atm under peruly of perjury that I em licensed under provisions of Chapter B (commencingwith Section 7000)o DMus)3 of the easiness and PSessiats Code,and my license in in NU force and effect. MAIN BUILDING ACCESSORY BUILDING CITY C.NO.: 00661lf LIC.cLAss: C-10 LIC.NO.: 7836 EXE: 12/95 FRNT; FT IN REAR: FT IN FRNT: FT IN REAR: FT IN 9Ca:� !„ LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN anad • •ERs affr DER LARATION:IherebymunderaerlfgeperingthatlanexempttramtheCaaraaas • Law fathe PARKING REQ(7¢3: PROV: PARCEL; 42608116 ZNE; REF NO; following - • ( .•on 7031.5 Bullies'end Professions Code:Any Cly a county Mich requires a permit to cors aha.improve. PLANNING NOTES> demolish.a r..: any structure.prior to/e issuance.the requires the applicant for such perm to file a signed stat I that he or she •licensed pursuant to the provisions d the Contractors License Law[Chaplet m 9(commencing with Seuion 7000)of Division 3 d the > uairesss and Professions Code)or that he or she aexempt thaeham and the basis for the allegedexempton.Myveletion d Section **********************************{t******************************************** /031.Sbyanyapgicanl for apermssubiaw theaPO1cnt toeewe penally of ndmere than five hUrldred datiaT3 ISSWD. DEVELOPMENT SERVICES REQUIREMENTS ❑ i.as owner of the property or my employees wth wages as their sole compensation,will do the wort,and the structure is not intended or offered for sale(Section 7044,BL®Mss and Professions Code:The Contractus License Law does ml appy loan owner of Prof/orb who builds or improves thereon.and does such work tinsel a herself or through he :or her own employees,provided that such ZONING APPROVED BY improvements are not intended or offered for sale.I,however,the Wilding or improvement a Bold within one year of completion,theDATE owmerbuilder win have the burden d proving heor she did not build et improve to the purpose d de). BUILDING APPROVED BY ; contracting with licensed contractors to construct the praise(Section 7044.Business and DATE o Lea ow ns Code Y.am exdulesr o , ntesaons Coda.The Gormands License Law does not apply to an owns,'d property who Wilds or improves thereon end who J contracts for such Projects with a cortrada(s)licensed pursuant to the Contractors License Law). APPLICATION ISSUED BY: DATE: 7 o I am exempt under Section: B.A P.C..for this reason: *************************************** ********************** *********************************************************************** ** *** Date um.r: LEGALIZATION;Y F E E SUMMARY STRUCTURAL S MENT:N I do hereby certify Yat lam aware of end Understand the requirements of Caleomb Haebh and Safely Code Sections 25505,25533,and 25534,and that I or any Mure building eras sant_mkt will nil(thole ere)need to comply will said Mate codes and the requirements for e permtlomatructan or modification hoMthe Ai WWI)/ ananagmenO .ReVWW construction eppiretveare exempt from these PERMIT BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/AES GRADING provisions. Date: Applicant: 50% SM I P/NON-RES WORKER'S COMPENSATION DECLARATION:I herebyaffirm under penalty el perjury one d the blowing declarations: ISSUE FEE 15 , 00 ❑ IhaveaMwilmeidenauddicaedrveentI°sellannabworkea'compmsmom.aaprviledfabySedon37Wdthe Laba BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE Code,fathe padomeaedthe work for Na permit aaeaad. TOTALS----> 30, 00 15 . 00 0 , 00 45 .00 45 . 00 , 00 I have and coil maven waken'ed.My sauce insurance,as equine by Section 3700 d the Labor Code,b the pafinmence d the 'V`jC\work for which this perm b issue.My waken'oomleeselon insurance oma and policy number ve: Carrier: T I G INS EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 45 .00 OVER/SHORT; 00 odic Number: WCP80420871 10/01 /96 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK is section need no,be completed f the perm*is for one hundred dollars(SILO)or less.) 45 .00 LI I cemh that in the performance of the wait for which this pent*is Sued,I shell nil employ any person n any manner so as to become m• . tot . workers'comensation ewe d California.and ... that B 1should become skied to the wakes. *************************************************************** **************** mpas.' • • of Sedia y700 of the Labor Code.I shall forth...,comply with .. 'J.—. Te: Ila 16° Applicant: //_ ��..///yam 4,�/ ening: Enure .newt vartaa'aonw«na0amro is Unlawful,and wDeth)ectm wmplgwrocd nil penalties and TYPE INDIVIDUAL DESCA IP T IO• N F E E BREAKDOWN UNIT COST TOTAL COST civil ane nil to one luardyd thousand dollars($I0000UA N addition to the cost of rornpm.atbre • • • as provided for/n Section 37E5 of the labor Coda,Intone,and attorney's fila. ELE 14 FIXTURES LIGHTING 1 ST 20 EA. . 75 10. 50 • CONSTRUCTION LENDING AGENCY:I hereby arm under penalty of perjury that there is a construction Lending agency for the ELE 6 RECEPT/SWITCH 1 ST 20 EA. . 75 4 . 50 performance of the work to whktt the petrel's Sued(Section 3097.CN.C). LENDER'S NAME: END OF FEES LENDER'S ADDRESS: I certify that I haveread this application and state that the above information is coned.I agree to comply withal city and county ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the abate-mentioned properly for ins n purposes. Giro,. L ` fA /1 I /S e K Prvu � u/l. q .000:4��i /yam i Data/ / S 01 00177377-00177°73 TOT 45.00 .natured• -. 'C A•• : •sada DATE; 03/09/95 TIME: 14:02 (5151'46 WP) White-Building a Safety:Green-Rla Cuuy-Appimnt:Pink-Revenue;Goldenrod-Assessor 1 r CONSTRUCTION AND PLANNING POOL 'A i APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspelttor /J 1. Temporary Electrical Service or Pole' 52. Pool & Equipment Location • . ,., 2. Soil Pipe•Undrgrnd. ;�• - " %� 53. Steel Reinforcement i ;a.iElectrical ndOtr9h11ity-Undrgrnd. 54. FormsI ` li?4,,"Iectricafc Iw ir..Cptirgrnd. 1 55. Electrical Bonding 1 :t •6a teel Rel_Rtorcement' 56. Rough Plumbing & Pressure Test r•p! Clectric l,P?E fgtind. 57. APPROVAL TO COVER-GUNITE - i" !?-:!".-1; y . , 58. Electrical Concru�KUndrgrnd. / . _ I c , ZR. Foundation _. 59. Gas Pipe, 0 Undfgrnd.,Test ,,I' "9. Water Pip=Undrgrjd..1. $ 60. Backwash Lines,6Trap, 0 Ujndrgrnd. ' 10. Structurat'Floor System61. APPROVAL TWi7ECK r , 11. Property Sewe Line.& House`Connection ,.,) •{ 62. Backwash & Receptor-Final ' 12. '$e`'ver Cap t" 63. Heater & Vent-Final 13. Roof Drains .''! 64. Plumbing System - Final ' 14. Rough Plumbing. m 65. Electrical-Final , • 15. Rough EiectricaiicCoaduit 66. Solar System-1 at . i 16. Rough flgctric iris _.• 67. Fencing & Accesspproval.• . . 17. Rough Wiring Sign m 68. APPROVED FjR•PLASTER'ING 18. Rough ElectricaGT Bar Ceiling' ' 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning iFIRE DEPT REQUIREMENT 2Q1. R&ughcFacery.iteplace ; r 2'' ; i~ # ; - APPROVAL ( PA{mit # : •: ' 11 - : - :1 :. 21-i DErets,it StF.ucture I •• •- _ , 7 �a ` 70.�Underg3Hud t{ydro ' r, � (t fls 22- Dotts;.• enu latf * ,`JS ! '$ •-...* • '^ '`••` ,Y , p * c- k f, 1 ` 71. Produetieiging as (I:IOU 23, Gaal Pipe-Rpugh &:Test I m= •- , c' O•* I' r 72. Undergrbuhd Hush * '- .•. 1 f..- � ,. . >~+, t '- _. 2411 Ro`O1 reamfrlg t I Fr• ••*. IT > J '" * '' =• 73" Under r�d.Std r Tank❑Gas 0`O l' r i-. - IS H x a 9 Stagg k i. -'w 0, .•I •a .., - • - --.. , r„,!„_____,25. Roof J3jeathing • :V • c.: ' . N' e 7Q, Overhead Hydro * ~ 20: T-Ear Ceiling (Strgctural) &•titStdocoat 1 '7 to ; 781 Dry Chemical _,.j x " a 'F, ' n 27,; Fran,e•and Flashi T; . • `. id ""C ' -(i ng tr,rr : c• :� 2• * 76. Dry Star 1- . yr•-• z Frt - 28. Lathinn& Siding ' °t `7 E 7 + i "I "I -I; 7jt FIXEDf$YsSTgir*INALI.a r. azEI 29. Insulat4on T. •• ! j I I, * 7g; FIRE PREY. FiffAL • > o: "j:•+-1 ' . S 30. DrywafYNailing ` ,y ; ,r I I ti 1.-I itiEALT74.9EP,).' PEQUI LENT i ... r I .. •, + 7.1 'J31. Plaster'-Brown Coat . ! m^•• I I * .� tr. 7 . FINAL ENSPECTION a x ,: 3 Electrr'oal Power Mefer�Fina1 Cu ' [' 8t FOOD CERTIPCATE l,�$LE(� ~S. w r- C r /J 3a7. Fioje.31 ... :: ,. 31b , ry Notes: 3 13-9$"par��! Qr �{ '' 3G.• Fita1 Hgatirr & Arn-dnditibiursi ,•,j > I I t'It ' ,r. kr:C`.• `.! I-'< * 5 1 • . ,0 V. I W.:. • I, `•`•C) 33., Final Gas Pipe-Teri y -..- . - ! 1 (' ! tc�s C3.-, • c7.^t;r _• ••r r• E,-...-- '11 .�b 36. Hood b7 CanOPY ' _. I ��- ' ,', I I :• t g T no it ▪ 37:.Final Iactory Fireplace c; (II s x a - 38. Final Plumbing * ^-1 * 1P * S - a t t ' 39. Water Service-Fin41 r * u: I '+ ' ' rt rt i °' -7 nt a 1• -t 40. Gas Service-Final r `Ztrn' _: : tr) 11 * , On, 0 - x • - '•41. Solar Domestic•F iQaf T; I r [,, j`; a ;r D 42. Backflow Provence: P of i I b n; .f-• a V ra , 11 .,.,.-. . .-I + , Li [tt t) , i-' 43. Backflow li�gatiop '.SS ., , a ; -F i t-i -/ 44 Landscape trrigation Systerf`1 ra u: I tri W 7 7* 4 I.; ., -i p•O * rJ-u .-).r•r .r 4 v is C cir * ". 3: c. 0cr ' Si-' Z45?Soundt,Att . to uatioft �u E . E t-•• f i1 r t • 6:4i••ci * .- 7 M* II t, M d r• : :r 4f .•Handicap Regulations r-: 6 ! i t:. u: C)C) S * .. �• . S .. , ._ Ir . .I ,n it c, a ,t47;FIJALSTf1CTlJtRE & BUILDING 1 ti f •ca c• e-, 485FINAL PLANNING I • ' i I. ` [ ' m ,1 '-• 49:.E1t�¢tric Releaseto'Edison i t < L ; c ^ • 50;.Gas:Release to Southern California Gas Co 4 !' IV a b 51. CERTIFICATE OF OCCUPANCY c r,c) r e o No Date a. ARTHOFER/HOWARD DEVELOPMENT CO. 1755 ORANGE AVE. • SUITE F • COSTA MESA,CALIFORNIA 92627 • (714) 645-6177 May 30,1973 City of Costa Mesa 77 Fair Drive Costa Mesa,Ca. The undersigned property owners agree to allow ARTHOFbR/HOWARD the devel- opera of the property adjoining theirs at the rear property line to taper the grade from the property line to a point not to exceed 48" and have erected a block planter approximately 15" high at the face. It is under- stood that said developers will erect a 6' fence on their property and that no surface water shall be allowed to flow from their development onto the undersigned parties property. It is further understood that the developer will place Oleander plants and that any and all expense and costs for said work shall be born by the developer ARTHOFER/HOWARD. Atit t j G ` 4�'"/ �; ��;2ca c '��;•, 4( 170. ,43-x& /rs-/ - 75 !s G/i° ?cj /l eek 4.1•'otPi /i e.i(•: ,ae� -, neu��L Address Addres ' L. % • �. , Address i Address (zo-eft ,9<—t ). Address • • • r .l , Ca!,.,r .k'_Y! t TRIALS INSPECTION • CONCRETE • SON ASPHALT • FOUNDATION CONSULTANTS ENGINEERING CONSULTANTS 1330 E. EDINGER, SANTA ANA. CALIFORNIA 92705 PHONE 543-9243 January 9 , 1973 • Arthofer and Howard 1755 Orange Ave. Suite f Costa Mesa, California Attention: Mark Howard . • Reference: Portion Tract 2.94 • s I • a • r Newport Heights Costa Mesa , California Project No. 9R57-983 • • • Gentlemen: • This letter presents -the results of expansion tests performed • on samples representative of Lots 2 and 5 for the above • referenced project. • i i Tests for volume change with moisture were performed on the _ compacted surface material in accordance with the "Test for Expansive Soils" as outlined in the requirements of the Orange Empire Chapter of the International Conference of Building Officials . Confining pressures of 60 and 653 p0unds per square foot were used to determine the expansion index of compacted ;;oils. The samples were remolded to 90 percent of maximum density at optimum., oven dried , and the percent expansion determined no less tnan 120 hours after the satu.iatirn. Pater was . __rs,t added.. hezults a e shown on the enc..,;s'e•J plate, Project No, 9R5 983 January 9 , 1973 Page 2 Maximum dry density-optimum moisture determinations were performed on the samples in accordance with ASTM Test Designation D 1557-70. The results are included on the attached plate. • Results of expansion tests (1 .7 percent under a 60 psf surcharge and 0. 3 percent under a 650 psf surcharge) indicaet that the soils are non-expansive , and therefore no special recommendations will be necessary to protect ffec the prosposed structures fyrm damage., Respectfully submitted, Approved by: CAL-WEST ENGINEERING CONSULTANTS --9147 /LGt7 4 William C. Nix George Bach CE 11092 WCN/ddh Enclosures EXPANSIVE SOILS DATA Project No. 9R57-983 Sample Sample (a) Date of obtaining sample 1 2 • 1/2/73 1/2/73 (b) Location 2 5 (c) Depth of sample 0-1' 0-1` (d) Date of maximum dry density and optimum 1/2/.73 1/2/73 moisture percent determination (e) Maximum dry density in pounds per cubic 121.0 121. 0 foot and optimum moisture in percent 11 .0% 11 .0% (f) Date and dry density and moisture content 1/2/73 1/2/73 of test specimen at start of test 111. 3pcf 111. 3pcf 11% 11% (g) Date and saturated moisture content of 1/9/73 1/9/73 test specimen at completion of test 14% 14% (h) Surcharge- ponds per square foot 60 650 (i) Size and volume of ring 2. 5"ID 2 .5"ID 1"deep 1"deep (j ) Test results expressed in percent change from original height 1.7% 0. 3% r EXPANSIVE SOILS DATA Project No. 9R57-983 Sample Sample (a) . Date of obtaining sample 1 2 1/2/73 1/2/73 (b) Location 2 5 (c) Depth of sample 0-1' 0-1' (d) Date of maximum dry density and optimum 1/2/73 1/2/73 moisture percent determination (e) Maximum dry density in pounds per cubic 121 .0 121. 0 foot and optimum moisture in percent 11.0% • 11 .0% (f) Date and dry density and moisture content 1/2/73 1/2/73 of test specimen at start of test 111.. 3pcf J11 . 3pcf 11% 11% (g) Date and saturated moisture content of 1/9/73 1/9/73 test specimen at completion of test 14% 14% (h) Surcharge- ponds per square foot 60 650 (i) Size and volume of ring 2.5"ID 2. 5"ID 1"deep 1"deep (j ) Test results' expressed in percent change from original height 1.7% 0 . 3% &JOB ADDRESS 256 E. 22nd $t. BUILDING PERMIT NO. 35663 'GENERAL CONTRACTOR Owner Builder DESCRIPTION of WORK Res. w/att.Gar AP No. 118-161-02 LOT TRACT FIRE ZONE VALUES 27,000.00 INSPECTIONS Signature Date GROUP T & J TYPE j7 ZONER-1 sol (VLA/—Z--7 PERMITS ISSUED 1-l1GAS 3 SUBCONTRACTOR I�WATER tire Date Number Signature /12.1—(o'7, rw `J, Plumbing J / ROUGH PLUMBING 44 5 ' -, G y�2 , Piy . 1`•,7 9/7i_C 3c2-�' NPurp2 — PROP. SWR. LINE OUSE CON. 44 5y-s-73 /p // //// SPRINKLING SYSTEM 4-ic/, --1-3--7, !tie /y��,��r� // ' /,% .t_ 2aa MISCELLANEOUS q efiernQ„ 4&e ',Gl - 4,/ _?2 6,3c 49 ROUGH HEATING AND AIR CONDITIONING /�'js).--.W . / 11 / TEMPORARY SERVICE OR POLE UNDERGROUND ❑ POWER ❑ ROUGH WIRING �� ,Y-1 Y•23 - Heat' a and Vent. TRENCHES El FORMS El STEEL REINF. R A_/.�3--7 y� � /U ( 7�_ - • , 1� , 5164/4 .•••FLOOR SYSTEM 44/yb - /✓/1--;) (VI � BOND BEAM n STEEL REINFORCE ❑ SHEATHING 4 2- - 7 ' FRAME AND FLASHI 4, h G- /•-2.i LATHING — IN OUT Ca r �P¢7 PLASTER, BROWN COAT e ..t-(-7.3 STRUCTURAL, FINAL Electric HEAT"'G, VENT., REF RIG. AND A.C., FINAL / SG�4-2 M. (g/1,27- ._.. d/ � 3S-3.57— PL �3 j1 PL 4G, FINAL AND GAS TEST n i/'S6 9-73 ELELI RIC, FINAL pi-73 :04 BUILDING, FINAL ,/ / e G-2.2— gyp_ �j✓ n T SPECIAL REQUIREMENTS J / _ 4/1073 Lille. �'I :L. /.LGn /''.✓/ • 35663V -9-7?F PAID,, 279* ****48.89 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APP IC TION FOR BUILDING PERMIT For Applicant to Fill in Completely ��Z ST R /I/I ED Y D�F}FCE7 DA -I $�IE D_� BUILDING CCSS,r//ff // �71/ ADDRESS / �7 0 `] �j n//•1 I (� A.P.NO/11/40-/,e7 cv_ PE OWNER /4>•Tti c:YN•- / m,,,(//e f•-.+( G V MAIL / BUILDING / ��'7 — !' Z ADDRESS /j{. e. „a,? 4 if . /= ADDRES �j (7� �� BLOCK co ui TEL. fGo /yfcavi A."' ee/L U CITY r NO. o/d-RTS LOT01-1•y I-z se Ale, se? 1.4�-1i�� TRACT t Z Q CONSTRUCTION ,ADD ALTER REPAIR MOVING DFMOLLSH O H LENDER ,j J DBRANCH Jfn OWNER 47n ..6--__&22____ „„, Q W . ADDRESS VD 03 J W VALUE z� J m ARCHITECT • TEL.i z r ` /r _ $, /I/ NOR ENGINEER w. . .0A./ ' �i it ' N/�• a 1.ay FIRE w CC ADDRESS .¢4C G/ LgMfnn Ari/ ///f/i. ZONE TYPEEiROUP//' APPROVED / J O CONTRACTOR Own Er I+ BY DATE CO Z J C ADDRESS WW TEL. ZONE� NO.OF oz, USE OF NEW/€4cr 4r% ZF= CITY NO. /c^/ IPLANS CBUILDING GA A6 _ CU O STATE CITY YARDS APPROVED YARDS APPROVED rn CC LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING D 512E NO.OF BLOCS. (FROM C/L STREET) OF LOT CJX el 27,'-, INOW ON LOT -®- FROM 6,ST T. FT. USE OF EXISTING BLDG. R.SIDE 6 FT. FT. I- SIZE OF ` 4 /NO.OF ,4 Z _ . NEW BLDG. �(CO ROOMS EM STORIES i L.SIDE 9 FT. FT. U EXTERIOR WALL Wood.i- ROOF / _ COVERING it/Cc• r, I COVERING f.4rl,eol REAR ca-CD. FT. FT. J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& Cl. a MAIN BLDGS. ACCESS BLDGS. Q VAR.# DATE O Rena S(a C.U.P.# APPROVED F APPROVE U � , —ELYL !y 2 1/ DAT mar 7� FOR SPECIA , L '+ Q '+ 'r'. 5 UI hereby acknowledge that I have read this application and state /r a that the above information is correct and agree to comply with AG _A-L.4 - CC all laws regulating building construction, and I shall not employ TAS( H any person in violation of the workman's compensation laws of (n the State of California. C�) it ,/�j m Z I hereby certify that I am properly licensed as a contractor under ✓v SO. FT.C s� o the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:¢ • am exempt from the provisions of the State of California Business I C VALUATION and Professions Code, Division 3,Chapter19, az / sive PERMIT FEE $ r• O Signature of� m Permittee - p $ /��h,I,r/qPLAN CHECK $ E W ` t�Uv IIID Authorized Agent u_ TOTAL FEE $ ( COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 I PLI xTIONFORBUILDINGPERMIT For Ap�p�li7cant to Fill in Completely qE IVL/y�/BAY --O TTE/j'RECEIVED D/p/TE ISSU D BUADILDINGDRESS j (.9 c",..-7,4 t — ST ll� /I // i/r1 /!—E I Z PEMT NO. OWNER A.P.NO. r C, i MAIL BUILDING 'ISL t , __ Z ADDRESS ADDRESS S47.0r W W TEL. O. Z CITY NO. TRACT I LOT BLOCK ZQ CONSTRUCTION NEW .ADD ALTER[REPAIR (MOVING r1FMOLISH 02 LENDER til R1 ' _I D BRANCH (J En //}y.)� /'I ^.�y�� Q W OWNER �i--FlS-r a.0 r 7` ��./y 03—IADDRESS (�,{�,, /n VALU� (ry J m ARCHITECT TEL. USE 4 r..—(�7"/C, ro!/.i N OR ENGINEER NO. }I T FIRE W W ADDRESS ZONE TV/pE GROUrY-4.7— a_ / W Z APPROVED / r(.^c.„/ I1 , _J 0CONTRACTOR BY ((1 � ({.� DATE I/I co Z fL ADDRESS W W W TEL. ZONE INO.OF USE OF NEW Zr CITY NO. PLANS BUILDING STATE CITY YARDS APPROVED YARDS APPROVED (n2 LIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING D SIZE NO.OF BLDGS. (FROM C/L STREET) OF LOT I NOW ON LOT FRONT FT. FT. USE OF EXISTING BLDG. R.SIDE FT. FT. _ H SIZE OF NO.OF 2 NEW BLDG. . ROOMS STORIES L.SIDE FT. FT.sit EXTERIOR WALL ROOF V COVERING COVERING REAR FT. FT. ��—• J USE OF BUI ING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& Cl- CI- MAIN BLDGS. ACCESS.BLOCS. Q VAR.* DATE O /� (37/0” C.U.P. APPROVED I— T / APPROVED (r) _WY DATE Z 0 UI hereby acknowledge that I have read this application and state that the above Information is correct and agree to comply with CC all laws regulating building construction, and I shell not employ H any person in violation of the workman's compensation laws of C6 the State of California. a1 e 2 I hereby certify that I am properly licensed as a contractor under SO.FT. o the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and that such licenses are In full force and effect,or I THE PURPCSE OF ESTABLISHING A PERMIT F ONLY: 5 CO am exempt from the provisions of the State of California Business and Professions Code,Division 3,Chapter 9. VALUATION Ig h PERMIT FEE $ N Signature of ^ Permittee $ PLAN CHECK $ E o Authorized Agent a a TOTAL FEE