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Home My WebLink About369 22ND ST - Building PermitsJobAddress: 369 22ND ST Suite No Vicinity: Parcel Nunmber: 42617120 AppiicanC MCCULLOUGH, DOMINIC Address: P.O. BOX 10714 COSTA MESA, CA Owner: LEISHER, KENNETH R Address 369 E 22ND ST COSTA MESA. CA Contractor. JOHNSON, ERIC A Address: ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+unifs) Pool / Spa Lighting FixLS Recept Outlets Switches Non Res Appl ELECTRICAL PERMIT ISSUED BY Phane: 714 329-0974 Zip: 92627 Phone: Zip: 92627-1800 Phone: Zip: License: 773735 Status: ISSUED Applied: OS/19/2004 Issued: 08/19/2004 SCOPE OF PERMIT REF: B04-00827-CONSTRUCT 1918 SF ADDITION TO THE 2ND F�OOR OF AN EXISTING TWO-STORY SFD. REMODEL 1ST FLOOR INCLUDES DEMOOF EXISTING STAIR AND CONSTRUCTION OF 3 NEW STAIRS; REMODEL EXISTING 2ND FIOOR INCLUDES DEMO OF EXISTING M. BATH, 2 WALK-IN CLOSETS, AND BEDROOM #3 TO CREATE M. BEDROOM SUITE; MOLD REMEDIATION; STUCCO REPAIR; CHANGE-OUT OF 32 WINDOWS, 2 EXTERIOR DOORS, 3 SLIDERS, AND GARAGE FIRE DOOR. DEMO EXISTING 653 SF GARAGE AND BUILD A NEW1205 SF GARAGE. REMOVE AND REPLACE 1ST FLOOR FIREPLACE AND ADD NEW FIREPLACE AT 2ND FLOOR (ICBO #ER5677). TWO BALCONIES WILL BE ADDED: 73 SF AND 250 SF ON THE FRONT AND REAR SIDES OF THE SECOND LEVEL, RESPECTIVELY. THE ADDITION CREATES A 4-BEDROOM, 4-BATH AND 2•HALF BATH DWELLING. ELECT. PERMIT IS FOR 400 AMP SERVICE, TEMP POWER, 110 FIXTURES, 70 OUTLETS & 56 SWITCHES. - $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $87.70 $58.50 $4828 $0.00 FEE SUMMARY Quantity � Temp Disl System / Lighling Busway /100 ft � Standing Section� � 0 Misc Electncal Equipment 0 , Transformers up to 1 kva/kw 0 ................up to 10 kva/kw 110 .................up to 50 kva/kw 70 .................up to 100 kva/kw 56 ..................over 100 kva/kw 0 - Low Voltage Equipment Quantiry $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-27-92) EXPIRATION: This permit shall automatically expire and become void ii work is not commenced within 180 days, or if work is suspended or abandoned for a penod ot 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 Inspectlona and finel approvel must be obtained. Fallure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 2d48d8 (fl�00) WORKERS'COMPENSATON DECLAflATON: 1 hereby affirm untler penelry ot Der�ury one of the lollowing deGarations: ❑ I have end wlll meintein e ceNlicate of consent ro self-Insure tor workers' campensatlon, as proNAed lor 6y sectlon 3700 oi the Lebor Cotle, for lhe pertormence of the �work tor which Ihis pertnil i9 issued. � I have entl will maintein workers' compensetbn insurence, es requiretl by section 3700 ot ihe Lebor Code, for Ihe pertartnance of Ihe work lor which Nis pertnil is issue0. My workers' wmyp9nsa on Insurence er e d policy number are: / . CeRier: r7 1 /{�- � -�� Policy Numher. � �S � OI� I — �Od �-i (rnls secnon need nor ee canp�ered ir fne permi(!s ve�uee er one nundred doners /sioo) or �ess.) ❑ I certify that in the pertortnance at the work tor which thls permit is luued, I s�all not employ eny person in eny menner ao es to become sub�act to the workers' compensatlan laws ai Celitomle, entl egree t�at if I s�oultl bacome sublect to the workers' compenseNon provlslons ot Sectlon 3700 ot Ne LeDor Code, 1 shell torthwith comply with ihese pro �i ( AppllcentSigneWre: � Dete: 7S� � '— � � WARNINO: FAILURE TO SECURE WORKERS' COMPENSATION COVEMOE IS UNIAWFUL AND SHALL SOBIECT Ml EMPLOVER TO CRIMINAL PENALTIES rW0 GVIL FlNES UP TOONE HUNORED THOUSAND OOLURE (5100,000�, IN ADDITION TO THE COST OF COMPENSATION, DAM4GES AS PROVIDED FOR IN SECTION 3)OB OF THE UBOR CAOE. INTEREST, M10 ATTORNEY'S iEES. LICENSED CONTRACTORS DECLARATION: I hereby eHirm ihat I am brce antl eflecL Llc. q_ Cantractofs SlgneWre: 8(commencing wit� Section 7000) o/ Dlvlsion 3 oi the Buslness antl Professlans Cotle, end my Iicense is in tull Cless q � {-1 1 [' Date: CONSTRUCTION LENDING AGENCY: � I hereby ettirtn that there is e construction lentling egenty for the pertortnance of the woAc lor wMch Ihis pertnit is Issued. (Sec. 3097, Ch�il Cotle). Lendefs Name: Lenders Aatlreu: Signature: Date: OWNER•BUILDER DECLARA710NS: I �ereby eMirtn Ihet under Denalry ot per�ury t�et I em E%EMPT FROM TME CONTRACTORS LICENSE LAW lor ihe following reason (Sec. 7031.5, Busineu end Profeulons Code: Any city or wunry which requires e pertnit ta construct, elter, improve, demdish, or repair eny structure, pdar to Its Issuance, elso requires t�e epplicant for such pertnit ta tile e signed stetement thet he or she is Ilcensed pursuant to Ue proNsions of ihe Conirectors Llcense Lew (Chepter 9(mmmendng with Section 7000) ot Division 3 of Na Buslness antl Pmfessions Coda) or Ihet he or sha is exempt therefrom entl Ne Easis for the elleged exemptlon. Any violetlon of Secilon 7031.5 by eny epplicant for a pertnit subjecis ihe applicant to a Civil penelry of not mOre lhan INe hundred dollers (5500).): ❑ I, es owner of the properry, or my amployees wlih weges es their sole compensation, WILL DO THE WORK, end the structure is not Intended or oHered for sele (Sec. 7044, Business and Prolessions Cotle: TTe Contractors License Law does not appty to an owner of pmperty who builds ar Improves thereon, and w�o tloes such work himseN or hersetl or t�mugh his or her own emplqrees, pmvided Nat such imprwements era nm Intended ar oNered lor sale. It, however, Ihe building or Improvement is soltl within one yeer of completlon, the ownerbuilder will have the burden of pmving ihat ha or she tlitl not build or improve tor purpose of saleJ. � ❑ I, es owner of the property, em E%CLUSIVELV CONTRACTINC WITH LICENSED CONTRACTORS to consWct Ne Droject (Sec. 7044, Business antl Pmfessions Cotle: 7Te cnmractors License Lew does not eppty to en owner of property who builtls or improves ihereon, end who comrects for such proJect wit� a contractor(s) license pursuant to the Contractors License Laws.). ❑ I em exempt under sec. Business and Professions Code tor this reeson: Signewra: Date: Owner ID veritietl by Crivers Iicense. ❑ Ves ❑ No Dr'rvets License No. Vedlirstion of Ownership by (rype ol dxumem, i.e. - pmperry tac blll or deed): Expires: DIVISION OF INOUSTRIAL SAFETY PERMIT CERTIFICATON: ❑ I hereby certity thet no excavatlon live (5) ar more leet in depth Into which a person Is required to tlescend, will be mede In connectlon wlih wark euthorized by this permit, entl Ihet no building siructure, scaflolding, lalsework, or demolition or dismantling Ihereaf, will be more than ihirry�six (36) teet high. (Chap. 32, Grp 2, An 2, Sec. 341, Tule B, Celifomle Adminlsiretive Cotle). ❑ As awner-bullder, I will not employ enyane to do work which would require a pertnit irom the Division of Intlustdel Safety, es notetl ebove, unless such pereon has e permit to do such work irom the Elvislon. Signeture: Date: Division of Industnal Safery Pertnit Number. CERTIFlCATE OF COMPLIANCE AND AllTHORIZATION OF ENTAY: I certify untler penelry of perjury thet I have read Ihis application end state that Iha infortnation given is wrrecL I egree to comply with ell stete laws end ciry ordlnences relatlng to building construction, end emhodze representatives ot �he Clry of Cwta Mesa to enter upon ihe ebove-descnbed properry tor inspection purposes. I egree not to occupy or ellow occuoency ol eny builCing authorizotl Cy Ihis Oermit unlil finel inspeclion. CO�E I, INSPEC110NTYYE 1618 Fixetl System Finel Fire Prevention 1288 Pool Spe Flnal 200 Final Re-Roof 201 Final BIacWRetaining Wall 202 Flnel Fectory Firo Place 203 Flnel Sign 204 Final Demolitlon � � It�65 �� ` Dete � Date COpE� INSPECTIONTYPE Q�jE 206 Finel Mechanicel 208 Final PlumDing � 270 Final Elecirlcel 212 Final Flre Prevenlion 220 Final Planning Approval 222 Finel Slle 250 Finel Bullding/Occupanty (�ia) �sa-52�3 • Fax (�ia) �sa-aess • www.ci.costa-mesa.ca.us 77 FAIH UHIVE, GOSIA MESA, GA 92626 .lobAddress: 369 22NDST Suite No Vicinity: ; ` Parcel Number: 42677120 - Applicant: MCCULLOUGH, DOMINIC Address: P.O. BOX 10714 COSTA MESA, CA Owner: LEISHER, KENNETH R Address: 369 E 22ND 5T COSTA MESA, CA Contrador: JOHNSON, ERIC A Address: MECHANICAL PERMIT Phone: 714 32&0974 Zip: 92627 Phone: Zip: 92627-1800 Phone: Zip: License: 773135 � Status: Applied: Issued: ISSUED Bl ISSUED 08/19/2004 08/19/2004 SCOPE OF PERMIT REF: 804-00827-CONSTRUCT 1918 SF ADDITION TO THE 2ND FLOOR OF AN EXISTING TWO-STORY SFD. REMODEL 1ST FLOOR INCLUDES�DEMO OF EXISTING STAIR AND CONSTRUCTION OF 3 NEW STAIRS; REMODEL EXISTING 2ND FLOOR INCLUDES DEMO OF EXISTING M. BATH, 2 WALK-IN CLOSETS, AND BEDROOM #3 TO CREATE M. BEDROOM SUITE; MOLD REMEDIATION; STUCCO REPAIR; CHANGE-OUT OF 32 WINDOWS, 2 EXTERIOR DOORS, 3 SLIDERS, AND GARAGE FIRE DOOR. DEMO EXISTING 653 SF GARAGE AND BUILD A NEW1205 SF GARAGE. REMOVE AND REPLACE iST FLOOR FIREPLACE AND ADD NEW FIREPLACE AT 2ND FLOOR (ICBO #ER5677). 7W0 BALCONIES WILL BE ADDED: 73 SF AND 250 SF ON THE FRONT AND REAR SIDES OF THE SECOND LEVEL, RESPECTIVELY. THE ADDITION CREATES A 4-BEDROOM, 4-BATH AND 2-HALF BATH DWELLING. � MECH. PERMIT IS FOR NEW A/C, 2 FACTORY FIREPLACES, 5 SINGLE DUCT VENT FANS & 6 MISC. APPLIANCES. - � � ISSUE FEE Inst FAU <100 k BTU Inst FAU >100 k BTU , � Repair / Alt Cooling/Heat Inst / Rep. Recess Wall HV Refng Sys <100 k BTU � Refrig Sys >100 k BTU Gas Piping Factory Fireplace Hood w/Mech Exhaust VAV Box Vent Fan ! Single Duct $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $21.30 $0.00 $0.00 $3625 Quantity 0 0 0 0 0 0 0 2 0 0 5 FEE SUMMARY Repair / Alt Absorblion Unit Repair / Alt Refrigeration Unit ' Ventillation System - Evaporative Cooler � Commercial I ncinera tor Domestic Incinerator . Compressars / Absorption Systems � � Up t0 3 hp / 100 k BTU 3To15hp/SOOkBTU 75 To 30 hp / 1,000 k BTU 30 To 50 hp / 1,750 k BTU Over 50 hp / Over 1,750 BTU Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitornia statutes and related regulations. (Ord. No. 92•2B, § 7, 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 1 BO days. INSPECTIONS: In order for ihe work authorized under this permit to be considered legal, such work must comply with all applicabla codes, end all requlred Inspeetiona end final approval must be obtained. Failure to obtain inspections and final approval will result in tha expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 zae�ae �aroo> WORKERS' COMPENSATION DECLARATION: I hereby eMirtn under penalry of perjury one of tha following declaratlans: ❑ I have entl will maintain e cenificete oi consem to sel(-Insure lor workers' campensatlon, es proNded br by sectlon 3700 at the Lebor Cotle, for Ihe paAortnence ot the work tor which �his permi� Is 155ued. ❑ I have and wlll maintain workers' compensaiion insurence, es required by section 3700 of the Lebor Coda, for Ihe peAortnanca oi Ihe work for which Ihis pefmit is issued. My workere' wmpensatl n Insurance r entl po'cy num6er ere: ��^�7 j ^� Cartier. Ci-�'- �V � Policy Number: I h'�I -1 ��- l�/1AJ L.} (Thls secbon ne not be completetl J fhe peimit �s velued at ane huntlretl dollers ($100) oNess.) ❑ I certly thet in the peAormanca of Ihe work for which this pertnit is IssueO, I shall not employ eny person in eny manner sa es to become subject to the workers' compensatlon laws ot Celifomia, entl egrea thet I should become subJect to the workers' compensation proNsions of Section 3700 of tha Labor Code, I shall forthwith Comptywit�these cvican /�, Appllcant Signeture: � Date: �� — � � WMNINO: FAILURE TO SECURE WORKERS' CAMPENSATIUN COVERApE IS UNLAWFUL AND SHALL SUBIEGT AN EMPLOYER TO CFIMINAL PENALTIES AND GVIL FlNES UP TO IXJE HUNORED TFiOUSPND Op1ARE (5100,OW). IN ADDfiION TO TNE COST OF COMPENSATIIXJ, OAMAGES AS PqOVIOED FOR IN $ECfIIXJ 31O60F iHE LABOq COpE, INTEREST, AND ATTORNEI"S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirm that I am licensed under provisions of forte enC eNect. Llc. N �'� �T� Gontractor's Signature:��v /1 (commencing with Section 7000) ot Division 3 of ihe Busines�5,ayd `P.riofj s� ns Code, entl my licensa Is in full cless a LS Data: Q — I �'I — Cll.,� CONS7RUC710N LENDMG AGENCY: ❑ I hereby effirm ihat Ihere Is a construction lending agency for Ihe pedormance ot the work for which this permil is issuetl. (Sec. 3097, Civil Code). � Lendefs Neme: Lender's Address: Signeture: Date: OWNER-BUILDER DECLARATIONS: I hereby eflirtn that under penalry of perjury �het I am EXEMP7 FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business antl Protessions Code: Any ciry or county which requires e pertnit to construct, alter, improve, tlomolish, or repair any structure, pnor to its issuance, also requires the appliwnt for such pertnit to flle e signetl stetement i�et he ar she ISllcensed pursuant to lhe provisions ol tha Contrecmrs License Lew (Chepter 9(commencing with Sectlon 7000) of DlWslon 3 0l t�e Business end Professions Code) or that he or she is exempt theretrom anA Iho besis for the allagetl e:emption. Any violation of Section 7031.5 by eny applicenl for e pertnit sub�ects the eppllcant to a civil penalry ol not more then five hundred dollers ($500).): ❑ I, es owner oi the property, or my employees with wages as thelr sole compensatlon, WILL DO 7HE WORK, antl the structure is not Intended or aHered tor sale (Sec. 7044, Business and Protessions Gode: The Conlractors License Law does not apply to an owner of properry who builds or improves thereon, entl who does such work himself or herself or Ihrou9h his or her own emploYees, provided ihat such improvements are not IntendeC or ottered for sale. If, however, the building or improvement Is sold within one year o� complation, t�e owner-builder will heve Ihe burden of proving that he or she did not builtl or improve tor purpose of sele.). ' ❑ I, as owner at the property, am EXCLUSIVELY GONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business antl ProleSsions Code: The tontractors Llcense Lew tloe5 not eppty to an owner ol property who Duilds or Improves Ihereon, entl who rnnirec(s for such pmject with a cronirector(s) license pursuent to the Contractors License Laws.). ❑ I am exempt under sec. Business entl Protessions Code for ihis reeson: SiqneWre: Date: Owner ID verilietl by tlriver's Ilcense. ❑ Ves ❑ No Drive(s License No. Expires: Verificetlon ot Ownership by (type of document, i.e. - property tex bill or deetl): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certify ihat no exwva�lon fiva (5) or more feet in dapih into which a parson is required to descentl, will be made In connection with work euthorizetl Gy this permii, and that no building stmcWre, sceHolding, taisework, or tlemolition or dismantling thareot, will be more than thirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Titla e, Calitornia Adminisirative Code). ❑ As ownerbuilder, I will no� employ anyone to do work which would requlre a permit from the Division ol Indusinal Sefery, as noted ebove, unless such person hes a permit to do such work trom ihe division. Signature: Date: Divislon oi Intlustrial Satery Pertnit Number: CERTFICATE OF COMPLIANCE AND AUTTIORIZA710N OF ENTAV: I certity under penalty of perjury ihat I have reatl ihis epplicatlon and state thet ihe intormation given is correct. I egree to comply with all stete laws and city ortlinances releting b builtling constmction, entl emhorize representatives of iha Cly of Coste Mesa to enter upon ihe ebove-descnbed pmperty for inspection purposes. I egree not to occupy or allow occuoancy of any building authorized by ihis permit until tinel inspection. COOE 1, INSVECTIONTYPE 1616 Fixed System Final Fire Preventlon 1288 Pool Spe Final 200 Final Re-Roof 201 FInaI BIocWRetaining Well 202 Final Fectory Fire Place 203 Final Sign 204 Final Demolition I»� �—/i-y^O �Date � �7 Date 7I�9L$ S4PEd INSPECTIONTYPE 206 Final Mechenical 20B Finel Plumbing 210 Finel Electrical 212 Flnal Flre Prevention 220 Final Planning Approval 222 Final Site 250 Finel Building/Occupancy �. L 1111: � � (714) 754-5273 • Fex (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 369 22ND ST Suite No Vicinity: Parcel Nunmber: 426�7120 Applicant: MCCULLOUGH, DOMINIC Address: P.O. BOX 10714 COSTA MESA, CA Owner; LEISHER, KENNETH R Address 369 E 22ND ST COSTA MESA, CA Contractor: JOHNSON, ERIC A Address: Arch / Eng : Address: PLUMBING PERMIT ISSUED I Phone: 714 329-0974 Zip: 92627 Phone: Zip: 92627-1800 Phone: Zip: License: 773135 Phone: Zip: License: Status: ISSUED "Applied: 08I191200a Issued: 08/19I2004 SCOPE OF PERMIT REF: 804-00827-CONSTRUCT 1918 SF ADDITION TO THE 2ND FLOOR OF AN EXISTING TWO-STORY SFD. REMODEL 7ST FLOOR INCLUDES DEMO OF EXISTING STAIR AND CONSTRUCTION OF 3 NEw STAIRS; REMODEI EXISTING 2ND FLOOR INCLUDES DEMO OF EXISTING M. BATH, 2 WALK-IN CLOSETS, AND BEDROOM #3 TO CREATE M. BEDROOM SUITE; MOLD REMEDIATION; STUCCO REPAIR; CHANGEAUT OF 32 WINDOWS, 2 EXTERIOR DOORS, 3 SLIDERS, AND GARAGE FIRE DOOR. DEMO EXISTING 653 SF GARAGE AND BUILD A NEW1205 SF GARAGE. REMOVE AND REPLACE �ST FLOOR FIREPLACE AND ADD NEW FIREPLACE AT 2ND FLOOR (ICBO #ER5677). TVJO BALCONIES WILL BE ADDED: 73 SF AND 250 SF ON THE FRONT AND REAR SIDES OF THE SECOND LEVEL, RESPECTIVELY. THE ADDITION CREATES A 4-BEDROOM, 4-BATH AND 2-HALF BATH DWELLING. PLUMBING PERMIT IS FOR: 2 BATHTUBS, 1 DISHWASHER, 1 GAS SYSTEM (1-0 OUTLETS), 1 LAUNDRY TUB, 1 IRRIGATION SYSTEM, 3 SHOWERS, 1 STEAM ROOM/SPA, 2 WASH BASIN SETS, 1 WASTE & VENT SYSTEM, 5 TOILTES, 1 WTR. HTR., WfR REPIPE EXISTING SECTION OF HOUSE, 1 WTR SERVICE 8 1 WATER SOFTNER. AMT QTY FEESUMMARY AMT �TY AMT QTY NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 7, 12-21-92) EXPIRATION: This permN shall automaticalty expire and become void Ii work is not commenced within 180 days, or II work Is suspended or abandoned lor a period of 780 days. INSPEC710NS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, arM aIi requlred Inepeetione and final epproval must be obtained. Failure to obtain inspections and final approval will result in the ezplration ot thls permit. FOR INSPECTIONS CALL: (714) 754-5626 2u&68 (8N0) WORKERS'COMPENSAnON DECIARAnON: I hereby attirm under penalry of perjury ane ot the lollowing dederetions: ❑ 1 have end will malntein e cenificate oi consent to selt-Insure for workers' compenseilon, es D�aWdetl tor by sectlon 3700 of the Lebor Cotle, for the performence ot the work lor whic� t�is permit is luued. ❑ I heve flnd will maintain workers' compensaUan Insurence, a5 required by 5ection 3700 ol the Labor Code, for the peAortnanca ot Ihe work lor whkh Ihis pertnit is issuetl. My workers' compensation Insurance cartler end pollcy number ere: .. ' /65��4i- � Cartier. 7'� if' � �U �t Od • Poliq Number: /rms secnon neea nar be cano�erea u flie peimir �s vemed er one nunorea aoners (81oa) or �eu.) ❑ I certily that in the peAortnance oi tha work lor whic� thls pertnit is issued, I shell not emplay any person In any mennor so es ta becoma subject to Ue workers' compensetlon laws of Califomla, and epree Ihet It I shoultl bemme sub�ect to t�e workers' compensatlon provisions ol Section 3700 of Ihe LeDor Code, I s�ell fonhwlih comply with these provisiau. /� ��7 Applicant Slgnature: �l Date: lS '� Cl ��r WARNINO: FAILURE TO SECURE WORKERS' COMPENSATION COVEMGE IS UMAW FUL M1D SNALL SU&IECf Ml EMPLOYER TO CRIMINAL PENA�TIES AND CML FlNES UP TO ONE HUNDRED T110USAND �OLLAFE (5100,000�, IN ADDfT10N TO7HE CQST OF CaMPENS4T10N, DNMGES A4 PRONOED FOR IN SEGfION 3)OB OF THE LABOR ODOE.INfEREST, AND ATTpVJEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby eHirm I�et I em Ilcansetl untler provisions of Chapter 8(commonUnp with Soctlon 7000) ol Divislon 3 at Ihe Business untl Prolaulons Catla, end my license ISIn tull torca and eflect. Lic. p �_�. (?i �'J C�ass p � H l C ContrectorsSigneture: v��— Date: c?— i�—(� l� CONSTRUCTION LENDING AGENCY: ❑ I herehy attirtn Ihat there is e construcilon lending egenry tor the peAormance ol t�e work tor wNch t�is pertnit is issued. (Sec. 3097, CFriI Code). Lendera Neme: Lendefs Address: Signature: OWNER•BUILDER DECLARATIONS: Dete: I hereby effirm that untler penalry of perjury thei 1 em EXEMPT FROM TME CONTRACTORS LICENSE LAW lor Ihe lollowing reason (Sec. 7031.5, Business enC Professions Cotle: Any ciry or counry which requires e pertnit to construct, elter, improva, demolis4 or repair any strucWre, prior to its issuence, elso requires ihe applicant for such pertnit to Iile a signed stetement Ihet he or she is licensed pursuent co Ihe proNsions ai the ContractoB License Lew (C�ap�er 9(commendng wlih Sectlon 7000) ot Dlvisian 3 of the Busineu en0 Protessians Cade) ar that he or she is ezempt therelrom entl the basis lor Ne ellegatl exemptlon. Any Wolatlon of Secuon 7031.5 by eny eppliwnt for a permit sub�eas the epplicant to e civil penalry of nat mare ihan frve hundred dollars (5500)J: ❑ I, es owner o1 Ihe property, or my employees with wages as their sWe compensatlon, WILL DO THE WORK, end Iha struaure is not intendeE or oNered tor sale (Sec. 7044, Business and Professions Code: The Cammctors License Lew tloes not apply to en owner oi property who builds or Improves theraoq and who does such work himself or hersetl ar through his or her awn employees, providetl thai such improvements ere nat intended or ottered lor sale. If, however, the building or improvement is soltl within one year of completion, Ihe ownerbuilder will heve the burtlen ot Omving ihet he or she ditl not Ouild or improve tor purposa at sele.). � ❑ I, es owner ol the property, em E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS Io consiruct the pr0lect (Sec. 7044, Busineu and Professions Code: 71�e contracbrs Llcense Lew tloes not appry ro en owner of property who builds or impmves Nereon, end who comrects for such project wit� a contractor(s) license pursuant to the Contractors License Lews.). ❑ I em ezempt under sec. Business ana Professions Code lor Ihis reason: Signatura: Date: Owner ID verified by dnvefs licen5e. ❑ Y85 ❑ No DnveYs License No. Vedilcatlon ot Ownership by (rype ol documam, I.e. - proparty tex blll or deetl): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: Expires: ❑ I hereby certily thet na excavetion five (5) or mora teet in deplh imo which e person Is requiretl �o tlescend, wlll be made in connection with work authodzed by this pertnit, entl that no Cullding strucWre, sceHoltling, talsework, or tlemolition or dismentling thereoi, will be more ihan Ihirty-six (36) leet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Tltle B, Cellfomia Administretiva Cade). ❑ As ownerbuiltler, I wlll not employ enyone to do work which would requlre e permit from Ihe Division of Intlustdel Sefery, es noretl ebove, unless such person has e pertnit to do such work Irom Ne division. Signeture: Dete: Division of Indusirial Salety Permit Number: CEH7IFlCATE OF COMVLIANCE AND AUTHOROA710N OF EMRY: I cenity under penelry ot perjury t�at I have reatl Ihis application antl sWte that Ne inlortnation given is correct. I agree to wmply wilh all stele lews end ciry ortlinances relating to huiltling construction, end euthodze rapresentatives ot the Ciry of Cwta Mesa ro enter upon the ehove-descdDed O�oPerty br Inspection purposes. I agree nat to accupy or ellav occuDancy ot any builtling euthorizetl by t�is permit until final inspaction. 40DE t. INSPECTIONTYYE 1616 Fixetl Sysiem Final Flre Preven�ion 1288 Pool Spa Finel 200 Finel Re-Rool 201 FIneI BIocWReloining Well 202 Final Fac�ory Flro Place 203 Finel Sign 204 Finel Dort �� O� ua�e Date Qdjj ��$ FQQ� INSPECTIONTYVE 206 Finel Mechenical 208 Final Plumbing 210 Final Electdcel 212 Final Fire Prevention 220 Finel Planning Approval 222 Final Slle 250 Finel Bullding/Occupancy PAg I�l� . � �► June 17, 2004 CITY OF COSTA MESA P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628-1200 DEVELOPMENTSERVICES DEPARTMENT Kieran Treacy 1940 Orange Avenue Costa Mesa, CA 92627 RE: ZONING APPLICATION ZA-04-40 369 22ntl STREET, COSTA MESA Dear Mr. Treacy: The zoning application for the above-referenced property has been completed. The application has been approved, based on the following background, project description, and findings, subject to the conditions set forth below: BACKGROUND The City of Costa Mesa annexed the subject property from the County of Orange in November of 2003. The existing residence was originally constructed under County jurisdiction and presently does not meet all current City standards. PROJECT DESCRIPTION The applicant proposes to enlarge the first floor to create a new, 1,205 sq. ft., three-car garage and to add 1,977 sq. ft. to the second floor. The existing two- story structure has a 4-foot, left side, setback with minimal articulation provided along the rear and side elevations. The existing first and second floors are on the same building plane, and consequently, appear massive and boxy. The applicant proposes to extend the first and second floor toward the front of the property, while maintaining the same 4-foot, left side, setback and architectural style. A minor modification is required to extend a nonconforming setback. Staff supports extending the 4-foot setback because the building additions will not encroach further than the existing structure. Additionally, the 60-foot wide property is constrained by a 20-foot wide easement on the right side; and with a 5- foot side setback requirement, the building pad would be restricted to 35 feet in width. Building Division (71a) 754-5273 • CoOe EnforCemeN (71a) 7Y1-5623 • Planning Division (714) 754-5245 FAX (774) 75a�aB56 • TDD p74) 754-STda • wv.w.ci.costa-mesa.ca.us zp,-oa-ao June 17,2004 Page 2 � A minor design review is required because the proposed second story will resuit in a 4.5-foot average, left side, setback with a second-to-first floor ratio of 88%; whereas, the City's residential design guidelines suggest a minimurn 10-foot average side setback and a maximum 80% second-to-first floor ratio. Without significantly compromising the character of the existing residence, 16.5 lineal feet of the proposed second floor will be set back 7 feet from the left property line. Sta1f supports the 4.5-foot average setback because the second floor addicion is articulated with differing building and roof planes. Although the articulation is minimal, it provides some relief to the building mass along the left etevation and is an improvement to the existing residence. Staff also supports the 88% second-to-first floor ratio because the proposed first and second floor additions provide additional architectural relief with varied building planes and roof forms to the front, rear, and right elevations, enhancing the visual interest of the existing structure. The front elevation consists of a one-story garage roof that provides a smooth transition from the first to second floor. A chimney and a trellis-covered balcony relieve the building mass of the rear elevation. A second story balcony at the south end of the residence, an entrance tower at the center, and portion of a shed roof at the �orth e�d, relieve the right elevation. A minor conditional use permit is required for the garage to exceed 700 sq. ft. The purpose of requiring a minor conditional use permit is to prevent the garage from being used in such a way that may be detrimental to surrounding persons or properties. The proposed 1,205 sq. ft., 3-car garage will not be detrirnental to surrounding persons or properties, because the excess area cannot easily be converted into a dwelling unit, and will provide additional on-site parking. The garage is one open area with no partition or fixture that could accomrnodate a different kind of use. A condition has been included prohibiting installation of any toilet and/or bathtub/shower without proper approval from the City. Privacy of the adjoining properties will not be significantly impacted because the proposed second story windows and balconies are located at least 24 feet from the right property line, 25 feet from the rear property line, and 20 feet from the front property line. Although the new windows and balconies on the left elevation are only 4 feet from the left property tine, they are located toward ihe front and rear of the property, providing views into the back yard and garage of the residence to the left. As shown on the attached Planning Application Summary, the site does not comply with the minimum 40% open space requirement. A variance is not necessary because the project will provide greater open space than currently exists, bringing the property into greater conformity with current standards. ZA-04-40 June 17, 2004 Page 3 FINDINGS � A. The information presented complies with Costa Mesa Municipal Code Section 13-291g1161 in that the project will not be materially detrimental to the health, safety, and general welfare of persons residing or working within the immediate vicinity of the project or to property and improvements wi[hin the neighborhood. Specifically, the proposed additions will extend the nonconforming, 4.5-foot, left side setback toward the front of the property. The proposed improvements are compatible with the existing structure and will not encroach further than the existing building line. B. The information presented complies with Costa Mesa Municipal Code Section 13-29(g)114) in that the project meets the purpose and intent of the Residential Design Guidelines, which are intended to promote design excellence in new residential construction, with consideration being given to compatibility with the established residential community. This minor design review includes site planning, preservation of overall open space, landscaping, appearance, mass and scale of structures, location of windows, varied roof forms and roof plane breaks, and any other applicable design features. Specifically, although the second-to-first floor ratio is 88% and the left side setback averages 4.5 feet, the proposed additions enhance the elevations of the existing structure with balconies and differing building planes and roof forms. Privacy of the adjoining neighbors will not be impacted because the new second story windows and balconies will have views into the neighboring rear yard and garage. C. The information presented substantially complies with Costa Mesa Municipal Code section 13-291g►12) in that the proposed 1,205 sq. ft. attached, 3-car garage is compatible with developments in the same general area. Granting the minor conditional use permit will not be detrimental to the health, safety and general weifare oi the public or other properties or improvements within the immediate vicinity. Specifically, the garage is one open area, with no partition or plumbing fixture. Additionally, a condition is included limiting plumbing in the garage to make it more difficult to convert the garage into a dwelling unit. Granting the minor conditional use permit will not allow a use, density, or intensity that is not in accordance with the general plan designation for the property. D. The project has been reviewed for compliance with the California Environmental Quatity Act ICEQAI, the CEQA Guidelines, and the City environmental procedures, and has been found to be exempt from CEQA. E. The project is exempt from Chapter XII, Article 3, Transportation System Management, of Title 13 of the Costa Mesa Municipai Code. ZA-04-40 June 17, 2004 Pac�e 4 CONDITIONS OF APPROVAL C, � Ping. 1. No partition, toilet, and/or bathtub/shower is permitted in the garage without proper approval from the City. 2. Construction, grading, materials delivery, equipment operation or other noise-generating activity shall be timited to between the hours of 7 a.m. and 8 p.m., Monday through Friday, and between the hours of 8 a.m. and 6 p.m. on Saturday. Noise-generating activity shall not be allowed on Sunday or Federal holidays. Exceptions may be made for activities that will not generate noise audible from off-site, such as painting and other quiet interior work. 3. The conditions of approval and ordinance or code provisions and special district requirements of Minor Design Review ZA-04-40 shall be blueprinted on the face of the site plan. 4. The appficant shall contact the Planning Division to arrange for an inspection of the site prior to the release of utilities. This inspection is to confirm that the conditions of approval and code requirements have been satisfied. Eng. 5. Maintain the public right-of-way in a"wet-down" condition to prevent excessive dust and remove any spillage from the public righi-of-way by sweeping or sprinkling. CODE REQUIREMENTS The following list of federal, state and local laws applicable to the project has been compiled by staff for the applicant's reference. Any reference to "City" pertains to the City oi Costa Mesa. Ping. 1. All contractors and subcontractors must have valid business licenses to do business in the City of Costa Mesa. Final inspections, final occupancy and utility releases will not be granted until all such iicenses have been obtained. 2. Approval of the zoning action is valid for one (1) year and wiil expire at the end of that period unless building permits are obtained and construction commences, or the applicant applies for and is granted an extension of time. A written request for an extension of time must be received by Planning staff prior to the expiration of the zoning action. 3. Development shali comply with all requirements of Title 13 of the Costa Mesa Municipal relating to development standards for single- family residential projects. 4. Any new mechanical equipment such as air-conditioning equipment and duct work shall be screened from view in a manner approved by the Planning Division. All roof-mounted equipment is prohibited. Any air conditioning units shall be placed a minimum of 5 feet away from any property line. � ZA-04-40 June 17, 2004 Page 5 5. Street addresses shall be visible from the public street and may be displayed either on the front door, on the fascia adjacent to the main entrance, or on another prominent location. When the property has alley access, address numerals shall be displayed in a prominent location visible from the alley. Address numerals shall be a rninimum 6" in height with not less than Yz" stroke and shall contrast sharply with the background. Bldg. 6. The two required exits from the second tloor shall be separated per the California Building Code Section 1004.2.4. 7. Comply with the requirements of the California Code of Regulations, Title 24, also known as the California Building Standards Code, as amended by the City of Costa Mesa. 8. Prior to or concurrent with ihe submittal of plans for gradingl6uilding( plan check/submittal of final subdivision map for engineering plan check, the applicant shall prepare and submit documentation for compliance with the State Water Resources Control Board (SWRCBI Water Quality Order 99-08-DWQ; National Pollutant Discharge Elimination System (NPDES) Permit No. CAS000002 for Storm Water Discharges Associated with Construction Activity (General Permitl; the California Regional Water Quality Control Board (RWQCB) Santa Ana Region Order No. R8- 2002-0010 and NPDES Permit No. CAS618030; and, the City of Costa Mesa Ordinance No. 97-20 for compliance with NPDES Permit for the City of Costa Mesa. Such documentation shall include a Storm Water Pollution Prevention Plan if over 1 acre (if over 5 acres if submitted prior to March 10, 2003) and a Water Quality Management Plan (WQMP1 identifying and detailing the implementation of the applicable Best Management Practices IBMPsI. Fire 9. Provide approved smoke detectors to be installed in accordance with the 2000 Edition of the Uniform Fire Code. Eng. 10. At the time of development submit for approval an off-site pian to the Engineering Division and grading plan to the Building Division that shows sewer, water, existing parkway improvements and the limits of work on the site, both prepared by a civil engineer or architect. Construction access approval must be obtained prior to building or engineering permits being issued by the City of Costa Mesa. Pay offsite plan check fee to the Engineering Division. An approved offsite plan and fee shall be required prior to engineering/utility permits being issued by the City. 11 . A site access permit and deposit of 5350.00 for street sweeping will be required by the Engineering Division prior to the start of any on- or off-site work. ZA-04-40 June 17, 2004 Page 6 ` Trans. 12. Show all parking spaces with dimensions on site plan. All parking shall conforrn with City standards. 13. Provide 25-foot minimum distance from far side drive aisle for all parking spaces to provide adequate space for turning movements. SPECIAL DISTRICT REQUIREMENTS The requirements of the following special districts are hereby forwarded to the applicant: Sani. 1. Applicant shall pay all current Sanitary District sewer connection charges. Contact Sanitary District at (714) 754-5307 for information. CDFA 2. Comply with the requirements of the California Department of Food and Agriculture (CDFA) to determine if red imported fire ants exist on the property prior to any soil movement or excavation. Call CDFA at (714) 708-1910 for information. Upon receipt of this letter, your project has been approved. A copy of the conceptually-approved plans are enclosed. The decision will become final at 5 p.m. on June 24, 2004, unless appealed by an affecied party (including filing of the necessary application and payment of the appropriate fee) or by a member of the Planning Commission or City Council. If you have any questions regarding this letter, please feel free to contact the project planner, Hanh Tran, at (714) 754-5640, between 8 a.m. and 12 noon, Monday through Friday. Sincerely, �V �` � � Perry L. V lantine Zoning Administrator Enclosure: Conceptuaily-approved plans cc: Engineering Fire Protection Analyst Water District Building Division Ken Leisher 369 22ntl Street Costa Mesa, CA 92627 PLANNING APPLICATION SUMMARY tocation: 369 22nd Street Application: ZA-04-40 Request: Minor Design Review to add 1 977 sq. ft. to the 2nd floor with a minor conditional use permit to allow a new, 1,205 sauare-foot, 3-car qarage. SUBJECT PROPERTY: SURROUNDING PROPERTV: DEVELOPMENT S7ANDARD COMPARISON Development Standard Required/Allowed Proposed/Provided 'Legal Nonconforming "Residential design guidelines CEQA Status Exempt Class 1 Final Action Zoning Administrator JobAddress: 369 22NDST Suite No Viciniry: Parcel Nunmber: Applicant: Address: Owner: Address 42617120 KIEGGO, KIER,4N P.O. BOX 10714 COSTA MESA, CA LEISHER, KENNETH R 369 E 22ND ST COSTA MESA, CA ELECTRICAL PERMIT Convactor: KIEGGO CONSTRUCTION INC Address: P.O. BOX 10714 ISSUE FEE Temp service test Res. a/c package New Res (7-2 units) New Res (3+units) Pool / Spa Lighting Fixts Recept Outlets Switches Non Res Appl Res Appl � Service to 200a Service to t000a Service over 1000a Motors l0 7 hp Motors to 10hp Motors to SOhp Motors to 100hp Motors over 100hp Communicalion drops COSTA MESA, CA Phone: (949) 294-0902 Zip: 92627 Phone: Zip: 92627-1800 Phone: (949)294-0902 Zip: 92627 License: 773135 ISSUED BY: Status: ISSUED Applied: OS/042004 Issued: OS/04/2004 SCOPE OF PERMIT TEMP POWER POLE IN CONJUNCTION WITH THE CONSTRUCTION OF A 1977 SF ADDITION TO THE 2ND FLOOR OF AN EXISTING TWO-STORY SFD WITH A 552 SF EXPANSION OF THE EXISTING GARAGE. REF: 604-00827 $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 30.00 50.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Quantiry 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FEE SUMMARY Temp Dist System / Lighting Busway /100 ft Standing Section Misc Electrical Equipment Transformers up to 1 kva/kw ................up to 10 kva/kw .................up to 50 kva/kw .................up to 100 kva/kw ..................over 100 kvalkw Low Volfage Equipment Low Volt Wiring System / Ckt Misa Conduit Misc. Conductor Circus ( gen or ride) Cirws (mech ride or lights) Christmas Tree Stand Fireworks Slantl Other ElecVical Fee Investigation Fee Quantity $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 7, 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 considared legal, such work must comply with all applicable Codes, and all requlred Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration ot this permit. FOR INSPECTIONS CALL: (714) 7545626 24a64fi (5100) WORKERS' COMPENSATION DECLARATION: I hereby attirm untler penalry oi perjury one ol the lollowing tleclarations: ❑ I have entl wiil maintain e cerlificate of conseN to seli-Insure for workers' compensetion, es pmvided for by section 3700 of the Labor Code, for the pertormance of the work for w�ich this permit Is issued. 6i I have end will meimain workers' compensation insurence, es requiretl by section 3700 of the Labor Code, for the peRormance ot ihe work br which this permit is issued. �/�FAy workers' comp nsation/Insurence cerrier end policy number ere: [ �/, I Carrier: �� TI.I�Q POIItyNumber: I US�trry (T�is secfion need nof be compleled il fhe permi( is veluetl et ane huntlretl dollers ($100) or /ess J ❑ I certify that in tha pedormance of the work for which this permit is issued, I shall not employ any person in eny manner so as to become su6ject to ihe workors' compensetlon lews of Calitoml , antl egree thet If I should becoma subject to the workers' compensation provisions of Section 3700 of the Lebor Code, I shell lorthwtlh comply with thesa i Appliwnt Signawre: Date: O.S' O�{— - C1� WARNING: FAILURE TO SE E WORKERS' COMPENSATION COVEMGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAI. PENALTIES AND CIVIL FINES UP TOONE HUNORED T110USAND OOILARE (E100.000�, IN AODITION TO THE COST OF CqMPENSATION, DAM4GE5 AS PROVIDE� FOR IN SEGTION 3]O60F THE IABOR WDE, IMEPEST. AND ATTOWJEV'S FEES. LICENSED CONTRACTORS DECLARATION: 1 herehy aflirtn t�at I em licensetl er provislons force end ettect. Lic. x� Contreaors Signa�ure: (commencing with Section 7000) of Dlvislon 3 ot the Business and Professions Code, anA my license is in full Class # �pz_ . _ _ Date: .,�- 04-' OLf-- CONSTRUCTION LENDING AGENCY: ❑ I hereby attirm that fhere is e constmction lending egency br the pedormance of ihe work for which this permit is issued. (Sec. 3097, Civil Cotle). Lenders Name: Lentler's Adtlress: Signeture: Date: OWNER-BUILDER DECLARATIONS: I hereby aNirtn that unde� penalry ot perjury Ihet I am E%EMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business antl Professions Cotle: Any ciry or county which requires e permit to construct, elter, improve, demolish, or repair any sWcture, pnor to its issuance, also requires Ne applicant for such parmit m file e signed statement that he or she is Iicensetl pursuant to the pmvislons ot the Contractoro License Lew (Chapier 9(commencing with Section 7000) of Divislon 3 ot the Business and PrOfe55ions Cotle) or ihat he ar she is exempt therelrom end the basis for the allegetl exemplion. Any vidation of Saclion 7031.5 by eny eppliwnt for a pertnit subjects tha ap0licant to e civil penelry of not more than five huntlretl tlollars (5500).): ❑ I, as owner of the property, or my employees wlth weges es l�eir sole compensation, WILI DO THE WORK, and the siructure is not intended or oHeretl tor sale (Sec. 70d4, Business and Professions Cotle: The Contractors License Lew does not appty to an owner of properry who builds or improves thereon, and who does such work himselt or herself or throug� his or her own employees, provided that such improvements ere not intendetl or ottered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have ihe burtlen ot Droving ihel he or she did not build or improve tor purpose ol sale.). ❑ I, as owner ol the property, am EXCLUSIVELV CONTRACTING WITH LICENSED LONTRACTORS to consiruct the projeci (Sec. 7044, Business antl Professions Code: The contractors License Lew tloes not epply to en owner ol property who builds or improves thereon, and who wniracis for such projed with e coniractar(s) license pursuant to �he Con�rectors License Lews.). ❑ I am exempt under sec. Business antl Protessions CoOe for this reason: SiqnaWre: Date: Owner ID verilied by dnvar's licensa. ❑ Ves ❑ No Drivefs License No. Venfication ol Ownership by (rypa of tlocument, i.e. - propeny tex bill or deed): Evpires: DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certify ihat no exwvation five (5) or more feet in depih imo which e person is required to descenq will he matle in connec�ion with work aut�orizetl by Ihis pertnit, antl �hat no building structure, scaflolding, talsework, or demoli�ion or dismantlinp ihereof, will be more ihan Ihirty-six (36) feet hiqh. (Chap. 32, Grp 2, An 2, Sec. 341, Title 8, Celilornia Adminlsiretive Cotle). ❑ As owner-builder, I will not employ enyone to do work which would require e permit Irom the Division ol Industnal Sefery, es notetl ebove, unless such person hes a permi� to tlo such work fmm the division. Signature: Dale: DiviSion of Indusinal Setety Parmit Number: CERTIFlCATE OP COMPLIANCE AND AUTHORVATION OF ENTRY: I cenify under penalry of perjury that 1 have read this application and state that ihe infortnatlon given is correct. I agree to wmpry with ell stata lews end ciry ordinances relating to building construction, and authorize representatives of the Ciry ol Costa Mesa to enter upon the above-described properry tor inspection purpases. I egrea not to occupy or allow occupancy of any building authorized by this pertni� until final inspection. COpE t. INSFECTIONTYPE Q�, II�LS 1616 FixeC System Final Fire Preven�ian 1266 Pool SOe Final 200 Finel Re-Rooi 201 Final Blxk/Retaining Well 202 Final Factory Fire Place 203 Finel Sign 204 Final Demolition OE� INSPECTONTYPE 206 Final Mechanical 208 Final PlumDing 210 Final Electrical 272 Final Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupency OSDaa�F' O�- Date �� (714) 754-5273 • Fax (714) 754-4856 • www.ci.cosla-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT JobAddress: 369 22NDST Suite: Vicinity: 2ND FLOOR AND GARAGE Parcel Number: 42617120 Applicant: TREACY, KIERAN Address: Owner: LEISHER, KENNETH R Address %389 E 22ND ST COSTA MESA, CA Contracror. KIEGGO CONSTRUCTION INC Address: P.O. BOX 10714 Arch : Address: Zip: Zoning: ISSUED BY: Phone: 949-642-1046 Zip: Phane: Zip: 92627-1800 Phone: (949)294-0902 COSTA MESA, CA Zip: 92627 License: 773135 Phone: License: Eng: Address: Status: ISSUED Applied: 04/30/2004 Issued: OB/09/2004 D DAILEY Phone: License: 39489 SCOPE OF PERMIT CONSTRUCT 1918 SF ADDITION TO THE 2ND FLOOR OF AN EXISTING TWO-STORY SFD. REMODEL 1 ST FLOOR INCLUDES DEMO OF EXISTING STAIR AND CONSTRUCTION OF 3 NEW STAIRS; REMODEL EXISTING 2ND FLOOR INCLUDES DEMO OF EXISTING M. BATH, 2 WALK-IN CLOSETS, AND BEDROOM #3 TO CREATE M. BEDROOM SUITE; MOLD REMEDIATION; STUCCO REPAIR; CHANGE-OUT OF 32 WINDOWS, 2 EXTERIOR DOORS, 3 SLIDERS, AND GARAGE FIRE DOOR. DEMO EXISTING 653 SF GARAGE AND BUI�D A NEW1205 SF GARAGE. REMOVE AND REPLACE 1ST FLOOR FIREPLACE AND ADD NEW FIREPLACE AT 2ND FLOOR (ICBO #ER5677). TWO BALCONIES WILL BE ADDED: 73 SF AND 250 SF ON THE FRONT AND REAR SIDES OF THE SECOND LEVEL, RESPECTIVELY. THE ADDITION CREATES A 4- BEDROOM, 4-BATH AND 2-HALF BATH - DWELLING. REF:ZA-04-00 PLNG: IT WAS PLANNING'S OVERSIGHT TO ALLOW AN EXTERIOR ACCESS TO THE SECOND FLOOR AT THE FRONT ENTRANCE; THEREFORE, ALLOWING AN EXTERIOR STAIRWAY FOR THE REAR BALCONY WOULD NOT MAKE A DIFFERENCE. FEESUMMARY Plan Check: $1,330.26 Permit: $2,046.55 SMIP Res: $28.70 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $3,405.51 Calc Valuation: Claim Valuation: ; i $2e�,osa.as so.00 NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92•28, § 1, 72-21-92) EXPIRATION: This permit shall automatically expire and become void ii work is not commenced within 180 days, or if work is suspended or abandoned for a period of 780 days. j/ INSPECTIONS: In order tor the work authorized under this permit to be considered legal, such work must comply with all applicable codes,�and all required inspeetlona and finel approval must be obtainad. Failure to obtain inspections and final approval will result in the expiration of this•permit. FOR INSPECTIONS CALL: (714) 7545626 // 2aw-ae lvoo� WORKERS'COMPENSATON DECLARAnON: I hereby aHirm under penelty ol perjury one of the lollowing tleclarations: � ❑ I heve end will meintaln e certificete of consent to sell-Inwra for workers' compansation, es provitled for by section 3700 0l the Lebor Code, for �he peAarmence ot the work fo� which this permit is issued. ��I heve flntl will meintaln workers' compensa�on insurence, as required by sectlon 3700 ot the Lehor Cotle, tor the peAortnance oi the work tw which Ihls permll is lssued. ----My workers' campensetion Insuran e cerder end policy number are: Certiar.`; STKiT� �l.lN(i ` � � � %S � CY�-� � PVry�Number: • ❑ I certify that in the peAortnance oi th work for which this pertnit is issued, I shall not employ eny person in any manner so es to become subject to the workers' compensetion lews of Celito le, e�r� egree that It I should become sub�ed to Ihe workers' compensetion provisions of Sectian 3700 of Ihe Labar Code, I s�ell forthwith comply with these pro ' on . ApplltariESignaWre: � Oete: ng'f7�� ' _' WAqNINCi:'FAILURE TO SECUPE WORNERS' COMPENSATION COVERAGE IS UNLAWFUL PND SHALL SUBIECT AN EMPIOVER TO CRIMINAL PENALTIES PND GVIL FlNES UP TOONE HUNDREO TTIOUSMID DOLLARE (5100,000), IN ADDITIIXJ TO THE COST OF CAMPENSATIIXJ, DAMAGES AS PROVIOED FOR IN SECiION 3]O60F TME LABOR COOE, INTEREST, M!D ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: t�at I em licensed under provisions ol Chapter 9(commencing wilh Section 7000) of Division 3 0l Ihe Business and Pmfessions Code, end my license Is in full i. uc. a'� ?-1 313.� rciess n� CONSTRUCTION IENDING AGENCY: ❑ I hereby eHirtn thel ihere is a construction lending agency tor Ihe pedortnance of the work for which t�is pertnit is issued. (Sec. 3097, Civil Code). Lentlels Name: Lendels AtlAress: Signeture: Date: OWNER-BUILDER DECLARATIONS: I hereby eHirtn that under penalry ot perjury thai 1 em EXEMPT FROM THE CONTRACTORS LICENSE LAW far the following reason (Sec. 703L5, 8usiness entl Professions Code: Any ciry or counry whic� requires a pertnit to canstruc6 alter, improve, demolish, or repair eny structure, pnor to its issuance, elso requires the eppliwnt for such permit to file e signed statement Ihet he or she is Ilcensed pur5uent to Ihe provlsion5 0l the Contrectors License Law (Chapter 9(commencing with Seclion 7000) oi DlNslon 3 oi the Business and Pmfeulons Cotle) or t�at he or sha Is eaempt therefrom and lhe besis for the allegetl esamption. Any violation af Sectlon 7037.5 by any appllcant for e permit sublecis the epplicant to a ciWl penelry ot not more then live hundred dollars ($500).): ❑ I, es owner ot Ihe properry, or my employees with wages as their sole compensation, WILL DO THE WORK, and t�e siructure Is not intendetl or oHered for sale (Sec. 7044, Business and Professions Cotle: The Con�ractors License Lew 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, providetl thet suc� Improvements ere not Intended or oflered for sele. If, however, the builtling or improvement is sold within one year oi completion, the owner-builder will heve ihe burden ol proving ihat he or she tlitl not build or improve for purpose ot sale.). ' ❑ I, as owner of the property, am EXCLUSIVELV CONTRACTINC WITM LICENSED CONTRACTORS to construct the projeCt (Sec. 7044, Business end Professions Catle: The contrectors Licensa Lew tloes not epply to an ownar oi pmperty who bullds or improves thereon, end who contracts for such pmject wlih e contractor(s) license pursuant to the Conireclors Licanse Lews.). � I em exempt under sec. Business and Professions Code for this reason: Slgnature: Date: Owner ID venfied 6y dnveYs Iicense. ❑ Ves ❑ No Drivers License No. Vetlficelian at Ownership by (type of tlocument, i.e. - propeny tex bill or deed): Expires: DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certity ihat no ezcavetion five (5) or more feat In depih into w�ich e person Is required to descend, will be made in connectlon with work authorized by this permit, ana that no building siructure, scalloltling, felsework, or demolition or tlismantling thereol, wlll be more than Ihirty-six (36) leet high. (Chep. 32, Grp 2, Art 2, Sec. 341, Ttle 8, Cellfomia Atlminisirative Cotle). ❑ As owner-builder, I wlll not employ anyone to tlo work w�ich would require a pertnit from the Division of Industrial Safery, es noted ebove, unless such person has e permit to do such work Irom the diWsion. Signeture: Date: Division of Intlustnal Safery Permi� Number: CEF7IFlCATE OF COMPLIANCE AND AUTHORVJITION OF ENTRY: I cenify under penalry of Oerjury that I �ave reatl ihis epplication and state thet the inlortnation given is conect I agree to compy with ell state laws entl city ordinences rela�ing to Ouiltling wnsWction, and euthodze representatives of the Ciry of Caste Mesa to enter upon the ehove-described property tor inspection purposes. I agree not to occupy or ellow occupancy of eny 6uilding authorized by this pertnil until final inspaction. COOE t. INSPECTONTYPE p� UIIIIIBLS 1616 Fixed System Final Fire Prevention 1268 Pool Spa Finel 200 Finel Re-Roof 207 Finel BIaWRetaining Well 202 Final Factory Fire Place 203 Final Sign 204 Final �emolition COOE� INSPEC710NTYPE 206 Final Mechanical 20B Final Plumbing 210 Pinel ElecMcal 212 Final Fire Preventlon 220 finel Planning Approvel 222 FinalSite 250 Final BulltlinryOccupency Date Q�]F INfiiIALS . �� (714) 754-5273 • Fax (714) 754-4656 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT JobAddress: 369 22NDST Suite: Vicinity: GARAGE Parcel Number: 42617120 Applicant: KIEGGO, KIERAN Address: P.O. BOX 10714 COSTA MESA, CA Owner: LEISHER, KENNETH R Address 369 E 22ND ST COSTA MESA, CA Contractor. KIEGGO CONSTRUCTION INC Address: P.O. BOX 10714 COSTA MESA, CA Zip; 92627 Arch : Address: Zoning: Phone: (949)294-0902 Zip: 92627 Phone: Zip: 92627-1800 Phone: (949) 294-0902 License: 773135 Eng: Address: Phone: Status: ISSUED Applied: 05/04/2004 Issued: OS/04/2004 ISSUED BY: Phone: Zip: License: License: SCOPE OF PERMIT DEMOLITION OF A 650 SF OF AN ATTACHED GARAGE IN CONJUNCTION WITH THE CONSTRUCTION OF A 1977 SF ADDITION TO THE 2ND FLOOR OF AN EXISTING TWO-STORY SFD WITH A 552 SF EXPANSION OF THE EXISTING GARAGE. REF: B04-90-827 APPLICANT HAS BEEN ADVISED TO NOTIFY A�MD. Plan Check: Permit: SMIP Res: SMIP Com: Other: Inspection: Total $0.00 $153.25 $0.00 $0.00 $0.00 $0.00 $153.25 SETBACKS MAINSTRUCTURE Front 0-0 ACCESSORY Front 0- 0 PARKING Existinq: p Rear 0- 0 Rear 0- 0 Required: 0 FEE SUMMARY PLANNING & ZONING Lefl 0- 0 Left 0- 0 Proposed: 0 Calc Valuation: Claim Valuation: Right 0- 0 Right 0- 0 $8,000.00 $8,000.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related regulations. (Ord. No. 92-28, § t, 1247-g2) EXPIRA710N: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspeetions and final approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permit. FOFi tNSPECTIONS CALL: (714) 7545626 zaas-as �woo� WORKERS' COMPENSA710N DECLARATION: I hereby attirm under penalty of perjury one of the following declarations: ❑ I have end will maintain a cehificata ot consent to seN-Insure for workers' compensation, as provided for by section 3700 oi the Labor Code, for the pedormance of the work for which ihi5 permit is issued. � I have entl will maintain workere' compensation insurance, es requiretl by section 3700 oF the Labor Code, For the pedormanca ot the work for which this permit is issuetl. My workers' competsatLion Insuren carner antl policy numbar ere: I OS7 �!yy Cerner: 1-�- "1 Q,\�' ��Y.i Policy Number (This sectian neetl nof be crompleted il theOertnif is valued at one hundred dallers ($ f00) or less J ° ❑ I cenify Ihat in the peAortnance of t o c for which this permit is issued, I shall not employ any pareon in eny manner so as to become sublect to the workere' compensation laws of Calito i e 4 e Ihat it I shoultl become subject Io ihe workers' compensation pmvisions ot Section 3700 ot the Labor Code, I shall fotlhwiih comply with ihese provision . ApplicaniSignature: Date: �`S �� - WARNING: FAILURE TO SECURE W ' COM �NSATION COVERAGE IS UNL4WFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDPED THOUSAND OO�LARE ($100,000), IN ADOITION TO THE CAST OP CAMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3]O60F THE LABOR CODE, INTEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby eHirtn that I am torce antl eXect. Lic. s_ Comracrors SignaWre: 9(commencing with Section 7000) of Division 3 of the Business�d Professions Code, and my license is in full class a Date: DS- o�-P • O�c CONSTRUCTION LENDWG AGENCV: i ❑ I here6y a%irm that ihere is a consimclion lentling agency for ihe pertormance of Ihe work for whic� this permit is issuetl. (Sec. 3097, Civil Code). Lentler's Name: Lender's Address: SignaWre: Date: OWNER-BUILDER DECLARATONS: I hereby effirm that untler penalry of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business entl Profe55ions Code: Any city or county which requires e permit to consiruct, alter, impmva, demolish, or repair any strucWre, pnor to its issuance, also requires Ihe applicant for such permit to file e signed statement that ha or she Is Iicensed pursuant to the pmvisions of Ihe Contractore License Lew (Chapter 9(commencing with Section 7000) of Division 3 of the Business end Professions Code) or thet he or she is exempt therafrom and ihe besis for the allegetl exemption. Any violation of Section 7031.5 by eny applicant for a pertnit sublects Ihe applicent to a civil penelty of noi more �han fiva hundred dollers ($500J.): ❑ I, as owner ot ihe propeny, or my amployees with wages as their sole compensation, WILL DO THE WORK, and Ihe strucNre is not imentletl or otteretl for sale (Sec. 7044, Business and Professions Coda: The Coniractors License Law tloes not apply to an ownar of property who builds or improves theraon, antl who does such work himself or herseH or through his or he� own employees, provided that such improvemenis ere not intended or oHered for sale. If, howevar, the building or improvemem is so�d within one year oi completion, the owneo-builder will have ihe burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of ihe property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consimct ihe project (Sec. 7044, Business and Protessions Cotle: The contractors License Law does not epply �o an owner of propetly who builds or Improves thereon, end who conlrecis for such projact with a coniractor(s) license pursuant to the Contractors License Laws.). ❑ I am eaempl under set. Signa�ure: Owner ID verified by dnvefs license. ❑ Yes ❑ No Business and Professions Code tor this reason: Verilication of Ownership by (type of tlocument, I.e. - pmperry tat hill or d6ed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: Driver's License No. Date: Expires: ❑ I hereby certify that no excavation five (5) or more feet in depth imo which e person is required to descenq will be made in connection with work authonzed by this permit, and that no buiiding sUucture, scaHolding, falsework, or demolition or dismantling ihereot, will be more ihan ihirty-six (3fi) teat high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title B, Califomla Administretive Gode). ❑ As owner-builder, I will not employ anyone to tlo work which would require e permit from the Division of Industnal Safety, as noted ebove, unless such person has e permit to do such work trom ihe tlivision. Signature: Date: Division oi Intlusinal Safery Permit Number: CER7IFICATE OF COMPLIANCE AND AUTHORIZATiON OF EN7AY: I certity untler penalty of perjury that I have reatl this application antl state thet ihe information given is correct. I agree to comply with ell stata laws end ciry ortlinances relating to building constmction, and euthorize representatives ot ihe City of Costa Mesa to enter upon the ebove-describetl property tor inspection purp�s. I agree not to occupy or ellow occupancy of any buildinq authorized by this permit until finel inspection. CODE�. INSVELTIONTYPE QAjE INTRIRLS 7616 Fized System Final Fire Prevemion 1266 Pool Spa Final 200 Final Re-Rooi 201 Final BIocWRetaining Wall 202 Final Factory Fira Place 203 Final Sign 204 Final Demoli�ion oate a5- o�l-� oc f'. Date CODE� INSPECTIONTYPE 206 Final Mechanical 20B 210 212 220 Final Plumbing Final Electncal Final Flre Preven�ion Final Planning Approval POIE INTITULS 222 Final Sita 250 Final Building/Occupancy �� MIDGET A Professronal lnspection Servrce � (760) 757-0556 Cell: (949) 370-7922 I HEREBV CERTIFV THAT I HAVE INSPECTED ALL OF THE ABOVE REPORTED WORK, UNLESS OTHERWISE NOTED, AND TO THE BEST OF MV ABILITY, I HAVE FOUND THIS WORK TO COMPLV WITH THE APPROVED PLANS, SPECIFICATIONS, 8 APPLICA84E BUILDING LAWS. c hG�G� s � /��- 2-- C',�---z� -------� SIGNATURE OR REGISTERED INSPECTOR ,i�- i� -� 4 �� a s z DATE OF REPORT REGISTER NUMBER INSULATION CER,,�'ICATE � IC-1 Site Address � Permit Number � O�{-- 00 g��' 3 6� a� r� St Co st� m e s� �t� ��s� Number and Street �ry County Description of Installation I. ROOF Material Thickness (inches) Subdivision Lot Number Brand Name Thermal Resistance (R-Value) — 9 CEILING Batt or Blanke[ Type BN�s Brand Name Thickness (inches) Thermal Resistance (R-Value) �2 — 3 0 Loose Fill Type Brand Contractor's min installed weight/ft' Ib Minimum thickness inches Manufacturcr's installed weight per square foot to achicve Thertnal Resistance (R-Value) 3. EXTERIOR WALL Frame Type A. Cavity Insula[ion Material Thickness (inches) _ B . Exterior Foam Shcathing Material Thickness (inches) 4. RAISED FLOOR Material Thickness (inches) 5. SLAB FLOOR/PERIMETER Material Thickness (inches) Perimeter Insulation Depth (inches) 6. FOUNDATION WALL Material Thickness (inches)_ Declaration Brand Name Thermal Resistance (R-Value) -- 3 Brand Name Thermal Resistance (R-Value) Brand Name Thermal Resistance (R-Value) Brand Name Thermal Resistance (R-Value) Brand Name Thermal Resistance (R-Value) [ hereby certi(y that the above insulation was installed in the building at [he above location in conformance with the curtent Energy EJficiencv Smndards for residential buildings (Tide 24, Part 6, California Code of Regulations) as indicated on the Certificate of Compliance, where applicable. a.��°� K�e9yo �Kst�uc��on ih� I[em #s igna te Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner Item #s Itcm #s Signature, Datc Signature, Date Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner Installing Subcontractor (Co. Name) OR General Contractor (Co. Name) OR Owner Compliance Forms August 2001 A36 � r'1 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT JobAddress: 369 22ND ST Suite No Vicinity: Parcel Nunmber: 42617120 npplicant: KIEGGO CONSTRUCTION Address: P.O. BOX 10714 COSTA MESA, CA Owner; LEISHER, KENNETH R Address 369 E 22ND ST COSTA MESA, CA Contractoc KIEGGO CONSTRUCTION Address: P.O. BOX 10714 ISSUE FEE Temp service test Res. a/c package New Res (1-2 units) New Res (3+units) Pool / Spa Lighting Fixts Recept Outlets Switches Non Res Appl Res Appl Service to 200a Service to 1000a Service over 7000a Motors to 1hp Motors to tOhp Motors to SOhp Mo[ors to 100hp Motors over'IOOhp Communication drops Sub panel to 200a COSTA MESA, CA Phone: (949)294-0902 Zip: 92627 Phone: Zip: 92627-1800 Phone: (949)294-0902 Zip: 92627 License: 773135 Status: ISSUED Applied: 04/07/2003 Issued: 04/07/2003 ISSUED BY: SCOPE OF PERMIT REMODEL EXISTING KITCHEN AND TWO BATHROOMS IN AN EXISTING SFR. ELECTRICAL TO INCLUDE: 12 LIGHT FIXTURES, 10 OUTLETS, B SWITCHES. $23.50 $0.00 $0.00 50.00 50.00 50.00 $13.20 $71.00 38.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $O.00 so.00 50.00 Quantity 0 0 0 12 10 8 0 0 0 0 0 0 0 0 0 0 0 0 FEE SUMMARY Temp Dist System / Lighting Busway /100 ft Standing Section Misc Electncal Equipment Transformers up to 1 kva/kw ................up l0 10 kva/kw .................up to 50 kva/kw .................up to 100 kva/kw ..................over 100 kvalkw Low Voltage Equipment Low Volt Wiring System / Ckt Misc. Conduit Misa Conductor Cirws ( gen or ride) Circus (mech ride ar lights) Christmas Tree Stand Fireworks Stand Other Eleclncal Fee Investigation Fee Plan Check Fee Quantity $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 50.00 50.00 $0.00 NO710E: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitomia staNtes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void il work Is not commenced withln 180 days, or ii work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, and all required Inepeetlons end final approval must be obtained. Fallure to obtain inspections and tinal approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 zaae�ae �aroo� WORKERS' COMPENSA710N DEClARA710N: . I hereby eHirtn un0er penalry of perjury one of the following tleclaratlons: I heve end wlll maintain e certificata of consent to self-Insure for workers' compensetion, es pmvided tor by section 3700 0l Ihe Labor Cotle, for Ihe peAormence of the rk for which t�is permit is issuad. I heve entl will maintain workers' compensation Insurance, es required by section 3700 0l Ihe Lebor Code, for ihe pertortnance of the work for which �his pertnit is issuetl. My workers' compensatlon Insurence carrier and policy number are: Cerrier: Policy Number. (This section need not 6e campleted i/ the permit is veluetl af one hundred dollars ($700) or less.) ❑ I certity t�et in the peAormence ol ih ork }or w�ich Ihis pertnit is Issued, I shall not employ any person In eny menner so es to 6e me subject to the workers' compensetlon laws ot Calilornia, e a .lhetiFl-shoottl-become sub�ect to the workars' compensetlon provisions of Settion 370�ot Ihd la�e, I shell torthwlih comply with t�ese pr�� / / Applicant Signewre: Date: � � / ( WARNINO: FAILURE T03ECtlREWOHI' S' WMPENSATION COVERAGE IS UNLAWFUL ANO SHALL SIIBJECT AN EMPLOYER TO CRIMINAL PENPLTIES AND CIVIL FlNES UP TOONE HUNORED i/%HISAND OOLLARE (5100,000). IN ADIXTION TO7HE CQST OF COMPENSATION, DMUGES AS PROVIDED FOR IN SECfIIXJ 31O80F THE UBOR CODE, INTEREST, AND ATTORNE`f5 FEES. LICENSED CONTRACTORS DECLARATION: I hereby eHirm that I am licensea under rovisions ot Chapler 9(commencing with Saction 7000) af Division 3 0l the Business and Professlons Code, entl my Ilcense Is In tull io�oe ana exea. uo. « 7 73f �S" ' ciess a coNrectorssignaWre: __ _ oate: ��, T CONSTRUCTION LENDING AGENCY: ❑ I here6y affirtn Ihat there is e construction lentling aqenty tor Ihe pertortnanca ol �he work for which Ihis permit is issued. (Sec. 3097, Civil Code). Lentler'S Name: Lentler'S Adtlress: Signalure: OWNER•BUILDER DECLARATIONS: Date: I hereby elfirtn Ihat under penalry ol perjury Ihet I am EXEMPT FROM TME CON7RAC70R5 LICENSE LAW tor Ihe following reason (Sec. 7031.5. Business entl Professions Code: Any.ciry or counry which requires a pertnit to construct, elter, improve, demolish, or repair any structure, prior to its issuanca, elso requires the applicant (or such permit to Ille e slgnetl statement thet he or she is licensed pursuant to the prodsions of ihe Contractors License Law (Chapter 9(commencing with Sectlon 7000) ot Division 3 of the Businass and P.rofessions Code) or that he or she is exempt therefrom end ihe basis for Ihe alleged exemption. Any violetion ol Section 7031.5 by eny epplicant for a pertnit sublects �he a0P��4eM'�o'a'civil.penalry oi not more Ihan five hundretl Aollars (5500).): ❑ I, as owner oYthe'propei7y �or my employees wtlh wages as Iheir sole compensation, WILL DO T1E WORK, end Ihe siructure is not Intended o� oNered for sale (Sec. 7044, Business and ProfessionsLode: The Contractors License Law does not apply to an owner ot property who builds or improves thereon, and who does such work himself or herself or througA tiis'or her own employees, provided ihat such improvements are not intendetl or oHered lor sale. It, however, the building or Improvement is sold within one year of completion, the ownar-6uilder will have the burden of proving ihat �e or she did not build or improve for purpose of sale.). ' ❑ I, as owner oi the property,''am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to constmct the project (Sec. 7046, Business and Professi0ns Code: The contractors Licensa Law does not appty to an owner ol properry who builtls or Improves iheraon, antl w�o coniracts tor such pmject wiih a contractor(s) license pursuant to the Contrectors License LawsJ. ❑ I am e:empt under sec. Signalure: Owner ID verifietl by driver's license. ❑ Yes ❑ No Business antl Professions Code for lhis raeson: Venfication of Ownership by (rype oi daument, i.e. - property ta< bill ar deed): DriveYSLicense No. Date: Expires: DIVISION OF INDUSTRI,4L SAFETY PERMR CERTFICA710N: ❑ I hereby cenity that no excavation five (5) or more teet in tlepth into which a pereon is requiretl to tlescentl, will be made in connection with work authonzed by this pertnit, and that no building siruciure, scattolding, felsework, or demoli�ion or tlismantling ihereof, will be more ihan ihirty-six (36) faet hiqh. (Chep. 32, Grp 2, Art 2, Sec. 341, Ttle B, Califomla Atlminisirative Code). ❑ As owner-builder, I will not employ en}rone to do work which would require e pertnit Irom tha Division ol Indusiriel Sefery, as noted ebova, unless such person has e pertnit to do such work Irom the division. Signeture: Date: Division ot Industnal Satery Pertnit Number. CERTFlCATE OF COMPLIANCE AND AUTHORIZATON OF ENTFiY: I cenity under penalry ot perjury Ihet I have read Ihis application end state iha� tha information given is correcL I agree to comply with all state laws and ciry ordinences rela�ing to bullding construction, end authotlze re0resentetives of the City ot Casta Mesa to enter upon ihe ebove-described property lor inspectian purposes. I agree not to occupy or ellow occupency of any tuilding emhorized by this pertnit until finel inspection. CODE �. MSPEC110NTYPE Qdg 1[�IdLS 1616 Fixea System Final Fire Prevention 12fi6 200 201 202 203 Pool Spa Finel Final Re-Roof Final Block/Retaining Wall Finel Fectory Fire Plece Finel Sign 204 Final Demolition �QQ� INSVECTIONTYPE 206 Flnel Mechenicel 208 Finel Plumbing 210 Final Electrical 212 Flnel Fire Prevention 220 Finel Plenning Approvel 222 Finel Site 250 Finel Building/Occupency •: : / fr. PAg 1�6$ I ,-�. (714) 754•5273 • Fex (774) 754-4856 • www.cl.costa-mesa.��LDING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626 JabAddress: 369 22NDST Suite: Vicinity: Parcel Number: 42617120 Applicant: KIEGGO CONSTRUCTION Address: P.O. BOX 10714 COSTA MESA, CA Owner: LEISHER, KENNETH R Address 369 E 22ND ST . COSTA MESA, CA Contractor: KIEGGO CONSTRUCTION Address: P.O. BOX 10714 COSTA MESA, CA Zip: 92627 Arch : Adtlress: Zoning: Phone: (949)294-0902 Zip: 92627 Phone: Zip: 92627-1800 Phone: (949)294-0902 License: 773135 Eng: Address: Status: ISSUED Applied: 04I07I2003 Issued: O4I07I2003 ISSUED BY: Phone: � Phone: Zip: License: License: SCOPE OF PERMIT REMODEL EXISTING KITCHEN AND TWO BATHROOMS IN AN EXISTING SFR. MISC DRYWALL, CREATE ARCHES IN TVJO EXISTING DOORWAYS LEADING TO KITCHEN. Plan Check: $0.00 Permit: $321.25 SMIP Res: $2.00 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $323.25 SETBACKS MAINSTRUCTURE Front 0-0 ACCESSORY Front 0-0 PARKING Existinq: 0 Rear 0- 0 Rear 0- 0 Required: 0 FEE SUMMARY PLANNING & ZONING Left 0- 0 Left 0- 0 Proposed: 0 Calc Valuation: Claim Valuation: Right 0• 0 Right 0- 0 s2o,000.00 $20,000.00 NOTICE: The work authorized by this permit shall compty with all applirable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12•21•92) EXPIRATION: This permit shail automaticalty expire and become void if work is not commenced within 180 days, or II vrork is suspended or abandoned for a period of 780 days. INSPECTIONS: In ortler lor the work authorized under ihis permit to be considered legal, such work must comply with all applicable codes, antl all required Ins{rntione and final approval must be obtained. Failure to obtain inspections and final approval vnll result in ihe expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5628 !nas.te lerool WORKERS'COMPENSAnON DECLANAnON: I hereby eHirm untler penalry of perjury one of �he follawing dedarations: ❑ I heve end will maimain e certificate ol wnsem to setl-Insure for workers' compenseNon, es provided for by section 3700 of the Lebor Code, fo� the pertormenca ai the work for whlch t�is permit is Issued. ave and will maintain workers' compensatlon Insurance, es requiretl by sectlon 3700 0l the Lebor Cotle, lor the perfoRnance of the work tor which lhLs pertnit Is issued. My workdre' compensation I�ura�e csMer entl policy number are: Certier. Policy Number. (Thls secNon need nol be compleled i! Ne pertNf !s valued et one hundred dd/ers ($100) or IesSJ ❑ I cartity t�at in ��e Dertorman e work lor which t�is pertnit is issued, I shell not omploy eny person in eny menner so as to become subject to the workers' compengetlon laws of Calito ntl e�BA ��1q�p.1 should become sub�ect to t�e workers' compensatlon pmNsions of Sectl� 7� t�Labor Cotle, 1 sheli torthwlt� complY wich these p � � ApPlicant StgnaWre: Dete: I U� � J WARNINO: FAI�URE TO S RE WORf(ERS' COMPENSnTION CpVEMGE IS UNUW FUL M'D SHALL SUBIEC� rW EMPLOYER TO CRIMINAL PENALTES AND GVIL FlNES UP TO ONE HUNDRED T/10USAN0 OOU-ARE (5100.000), IN ADIXiIq! TO THE WST OF COMPENSATION, DAAi4GE5 AS PROVIDED FOR IN SECfION 3]OB OF THE UBOF CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CtlNTRACTORS DECLARATION: I hareby eNirm ihat I em licensetl untler provislo mrce end enect. uc. a `773( �S ContrectofsSigneWre: m i��- Chepter 9(commencing with Soction 7000) of Division 3 of the Businass nntl Pmfessions Code, entl my license Is In full CIes9 M Dele: _ ---i .'1—, CONSTRUCTON LENDING AGENCY: ❑ I hereby 811�rm that there is e constmction lentling egency for ihe peAormance W IDe work for which Ihis permiUs issue0. iSec. 3097, CiW Cotle). Lendels Name: LentleYs Address: signecure: Date: OWNER-BUILPER OECLARATIONSi f;� � �/. �/( �,Y. I hereby efllrm that under penatly at perjurydhet.l em�EXEMPT FROM THE CONTRACTORS LICENSE LAW tor the following reason (Sec. 7031.5, Business end Proteulons Cotle: Any city or counry which requires 8 permiftacon"sMuct, alter, imprave, tlemolish, or repair eny structure, prlor ta ils Issuence, elso requires the epplicant for such permit to tile e signed stetement thet he or ahe is IlcenseB'pursianl ta tha proNsions ol the Contractors License Lew (Chapter B(wmmencing with Section 7000) of DlWsion 3 ot the Buslness end Fra�essians Catle) or thet he ar she Is exempt therefrom antl the basls tor the ellegad ezemption. Any vialation of Section 7031.5 by any appllcant lor a pertnit sub�ects the epplicent to e civil penelry of not moreihen five huntlretl dollars ($500).): .• n ❑ I, as owne� oi Ihe D�operty, or my employees with wages as their sole compensation, WILL DO 7ME WORK, entl t�e siructure is not intendetl o� oMered lor sale (Sec. 7044, BuSiness antl Professions Code: The Contrectors License Law tloes not appty to an owner of property who builds or improves Ihereon, antl who does such work hlmself o! herselt or through his or her own employees, pmvided lhat such Improvements ere not imendetl or oHered lor sele. If, however, ihe bulitling or imprwement is soltl wii�in one year ot complation, ihe ov.•ner-builder will have ihe burden ol proving that he or she did not build or improva tor purpose ot sale.). ' ❑ I, es ownB� of the properry, am EXCLUSIVELY CONTRACTING WI7H LICENSED COMRACTORS to construct the project (Sec. 7044, Business anC Professions Code: Tha cantractors License Lew does not eppty to an owner ol property who bulltls or improves thareon, antl who wntraas for such project with a comreaoqs) license OUrsuanl to Ihe Gonirectors License Lews.). ❑ I am eiempt under sec. Business end Professions Code for this reason: Signsture: Dato: Owner ID verifiod by tlnver's license. ❑ Ves ❑ No Driver's License No. Expires: Verllication af tlwnership by (rype oi document, i.a. - property ten bill or tleetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certity that no excevetion tive (5) ar more leet In tlepih Into which e person Is required to tlescend, will 6a metle In connection with worN euthodzetl by this permit, entl t�at no Duilding structure, scaHoltling, falsework, or tlemolition or dismaNling lhereol, will �e more Ihen thirry-six (38) teet hiqh. (Chep. 32, Grp 2, Art 2, Sec. 341, Ttle e, Califomia Admini5iretive Cade). ❑ As ownerbuiltler, I will not employ enyone to tlo work which woultl requlre a permit trom t�e Division at Indusidel Salety, es noted ebave, uNess such person hes e permll to do such work irom the division. Signature: Date: Oivision of InduS��el Safery Pertnit Number: CERTIFlCATE OF COMPLIANCE AND AUTHORVATON OF EMRY: I cenity untler penelty of perjury thai I have reed ihis application antl state that lhe inlortnation given is correct I egree to compty wilh ell stale laws end ciry ordinances ralating to building consWction, end emhodze represeNatives ol ihe Giry ol Coste Mese to enter upon the ebove-0escnbed Oroperry tor inspection p�rpaaes. I egree not to occupy or ellow occupancy ot any building euthodzed by Ihis pertnit until tinal inspection. cooe .. ItlSPESL4N.IYE€ PdIE Itf�9Lfl a 7fi18 Fized 5Ystem Finel Fire Preventlon 1288 Pool Spe Final 200 Finel Re-Root 201 FIneI BIocWRetelning Wall 202 Finel Fectory Fire Place 203 Finel Sign 204 Final D6molitian CODE� INSPECTIONTYPE � 206 Final Mochanlcel 208 Finel Plumbing 210 Finel Electdcel 212 Finel Fire Prevention 220 Finel Plenning Appro�el 222 Final Site 250 Finel Building/Occupency /� � Da`�e � It�� i1 � (714) 754-5273 • Fax (714) 754-4856 • www.ci.cosla-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address; 369 22ND ST Suite No Vicinity: Parcel Nunmber: 42617120 Applicant: KIEGGO CONSTRUCTION Address: P.O. BOX 10714 COSTA MESA, CA Owner: LEISHER, KENNETH R Address 369 E 22ND ST COSTA MESA, CA Contractor: KIEGGO CONSTRUCTION Address: P.O. BOX 10714 Arch / Eng : Address: ISSUE FEE BackFlow irrigation BackFlow Preventer BathWb Clarifier System Connect (Ice,Soda,etc) Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank COSTA MESA, CA PLUMBING PERMIT Phone: (949)294-0902 Zip: 92627 Phone: 2ip: 92627-1800 Phone: (949) 294-0902 Zip: 92627 License: 773135 Phone: Zip: Llcense: Status: ISSUED Applied: 04I07I2003 Issued: 04I07I2003 ISSUED BY: SCOPE OF PERMIT REMODEL EXISTING KITCHEN AND TWO BATHROOMS IN AN EXISTING SFR. PLUMBING TO INCLUDE: 1 KITCHEN SINK,1 LAUNDRY SINK, 2 WASH BASINS, 2 TOIIETS. CHANGEOUT EXISTING ONLY. AMT $23.50 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 �TY FEE SUMMARY AMT Laundry Tub / Washer $0.00 Landscape Irrigalion $0.00 P-Trap $0.00 Pressure Regulator $0.00 Process Piping (per 10 ft) $0.00 Receptors $0.00 Septic Tank $0.00 Sewer Cap for Demo $0.00 Sewer Connect $0.00 Sewer Private Line $0.00 Shower 50.00 Sink, bar 50.00 Sink, commercial $0.00 QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr Bkflow(1-4) Vacuum Brkr BkBow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) Waler Heater / vent Water Piping (Insl or Rep.) Water Re-pipe AMT 30.00 $0.00 $0.00 $0.00 50.00 $0.00 $19.60 $0.00 $0.00 $19.60 $0.00 50.00 $0.00 QTY 0 0 0 0 0 0 2 0 0 2 0 0 0 NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulatlons. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: 7his permit shall automatically expire and become void if work is not commenced within 1 BO days, or it work Is suspended or abandoned for a penod of 180 days. INSPECTIONS: In order for the work authorized under this permit �o be conslderetl legal, such work must comply with all appliceble codes, end all required Inepectiona and final approval must be obtained. Failure to obtain inspections and tinal approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 zaaa+s (e�ool WORKEHS' COMpENSATION OECLARATON: ' I hereby effirm und�� penalry of perjury one of the following tledarations: ❑ I have end wiil mainteln e certifiwte at conseN to sell-Insure for workers' compensetion, es provided br by section 3700 of ihe Labor Cotle, for Ihe peAartnance ol t�e wark tor whicn this permit is Issuetl. ve entl wlll malntain workers' cwnpensatlan Insurance, es requlratl by SecGon 3700 of the Labor Code, lor ihe pertormance of the work lor which Nis pertnit is Issued. My workers' compensation Insurenca cerrier and policy number ere: Cerrier: Policy Number: (This secNon neetl nof be canpletetl i/ the pemut ls velued e1 one ��ndred dWlars (5700) or less.) ❑ I cenity Ihat in ��e pedormence oi tha rk fo� whlch t�is permit is luuod, I s�all not employ any person in eny mennor so as to become subject ro the warkers' compenseUon lewa ot Cal wi a a Nat tl I shoultl become suD�ect to che workers compensatlon provisions of SecOon� p ot thg Lebo�l shell fort�wit� comply with tPese pr i o . I� � o AppliCen� SlpnaWre: Dete: WARNINO: FAILURE TO E WORKE0.S' COMPENSATION ODVERAQE IS UMAW FUL AND SHILLL SUBJECT PN EMPLOYER TO CRIMINAL PENALTI AND CML FlNES UP TO ONE HUNDRED THOUSAND DOLUPE (3100.000). IN ADDRION TO THE WST OF COMPENSATION, DAMPGES AS PROVIDED FOH IN SECTION 31080F THE IABOR CODE.IPf�EREST, AND ATTORNEI"S FEES. LICENSED CONTFACTORS DECLARATION: I here6y aMUm ihat I nm Ilcens� under provisic forte end eflect. Llc. M % convectors sianew� . ol Chapter 9(commencinp with Sectlon 70W ) of Olvislon 3 0l the Buslaess and Pmtesslons Cotle, and my Ikense Is In tull CIus9 k Dete: _ --7 I 12 CONSTRUCTION LENDINC AGENCY: ❑ I �eraby eAlrm ihat ihere is e conslrucGon lending egency tor the pertormance ol tha work br which this pormlt Is issuetl. (Sec. 3097, Civil Cotle). Lentlefs Neme: Lentlefs Address: SigneNre: Date: OWNER-BUILDER DECIARATIONS: I hereby eMirtn that untler penalry ol peQury ihet I em EXEMPT FHOM THE CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7037.5, Business and Protesslons Code: Any ciry or cWnry w�ich requiras a permit to cooslrucL elter, improve, tlemolish, or repair eny structum, pdor lo Its Iuuance, also requires Ihe appliwN tor such permit to file e signetl slatement t�at �e or she is licensed pursuant to Ihe provisions ol lhe Contrectors LJcense Lew (Chapter e(commencing with Section 7000) of D'Msion 3 at Ihe Busineu and Prole9sions Cade) or that he or she is exempt Iheretrom end the basis tor tha elleged exempHon. Any violatlon ot SecUon 7037.5 by eny applkant far e pertnit sub�ects the epplicen �� .e civil penelry of not more then Hve �undred dollers ($500)J: ❑ I, es owner ol ihe properry, or my employees with wages es Ihair sole compensation, WILL DO THE WORK, and Ihe siructure is not intendetl or otteretl for sale (Sec. 7044, Business and Professlons Code: The Contractors LJcense Lew tloes not appty to an owner of properry who builtls or improves thereon, antl who does such work himself or her4elf or Ihrough fiis.or her awn emplayees, pmWded that such Impmvemenis are not Intendetl or oflered tor sale. tl, however, Ihe 6uilding or Improvement is soltl wi�hin one Year of comp\elion,�tha ownerbuilder will heve Iha burtlen of proving that he or she did not build or improve lor purpose of sale.). � ❑ I, es owner of lhe property, am E%CWSIVELV CONTRACTING WITH LICENSED CONTRACTORS to constmct ihe project (Sec. 7044, Business antl Professlons Code: The cod�rectors License Lew does �iot apply to en owner ot pmperty who builtls or Improves Ihereon, and who contracis for such prqact wit� a contractor(s) ficense pursua�t to ihe Coniractors liceirse Laws J. ❑ I em exempt u�tler sec. '�+ eusiness antl Professions Cade for this reeson: Signeture: Date: Owner ID verilled by drivefs license. ❑ Ye5 0 No Drivafs LJcense No. Vedlicallon oi Ownership by (type of document, l.e. • property tex 6111 or tleed): Expiraz: DIVISION OF INDUSTRIAI SAFETY PERMR CER7IPICATON: ❑ I hereby ceNty that no excavatlon frve (5) or more leet in Oepth into which a person Is requiretl to descend, wlll be made in connection with work euthonzeO by this permli, antl ihAt no builtling sifucture, scettdding, lalsework, or demolition or tlismantling thereol, wlll be mora than thirry-six (36) teet high. (Chap. 32, Grp 2, An 2, Sec. 341, Title e, CAlllarnia Atlministrative Cotle). ❑ As owner-bullder, I wlll not employ anyone to do work which would reduire e permit irom Ihe Dlvlsion ot Induslriel Selery, es notetl ebove, unless such persan has e pormit to tlo sUch work fmm the division. Slgneture: Dete: Divlsion of Industriel Selety Permit Number: CERTIFlCATE OF COMPLIANCE AND AUfHORPA710N OF EHTAV: I certily untler penalry ot perjury t�at I heva read this epplication antl state ihat Iha infortnatlon gNen is correcL I egree to comply wit� ell state laws end ciry ordinances rela�ing to building construction, end euthodze re0�esonteUves of the City ot Coste Mese to enter upon tha ebove-descnDetl propeny tor inspection purposes. I agree not to oaupy or ellow occupancy of eny building euthorized by Ihis permi� until fnal inspection. CODE 1. INSPECTIONTYPE 1676 Fixetl System Final Fire Prevention 1268 Pod Spe Finel 200 Final Re•Roo� 201 Finel BIocWPetelninp Wall 202 Final Fettory Firo Plete 203 Finel Sign 20a Finel Demotltion Pd1E I[�Lfl � � n : COQE1 INSPECTIONTYVE � 206 Flnal Mechanlcel 208 Finel Plumbinp 210 Finel Electdcel 212 Finel Fire Pravontlon 220 Final Planning Approval 222 Final Site 250 Finel Buliding/Occupancy Pd7E It�t&