HomeMy WebLinkAbout219 16TH ST - Building Permits ,5� ' CITY OF COSTA MESA
4 BUILDING DIVISION
Ir„„:.,1 DEVELOPMENT SERVICES DEPARTMENT PER NUMBER
o1grvoe PERMIT
-"*>o.�m� B01-00512
(714)754-5273 • Fax(714)754-4856 • www.ci-costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 219 E 16TH ST Status: ISSUED
Suite: Applied: 04/17/2001
Vicinity: EXISTING DUPLEX Issued: 04/17/2001
Parcel Number 42533409 Zoning:
Applicant: CEFALIA, JOSEPH ISSUED BY:
Address: 818 W BALBOA BLVD
Phone: (949)675-7130
NEWPORT BEACH,CA Zip: 92661
Owner: CEFALIA, JOSEPH & MARGIE
Address 818 W BALBOA BLVD
Phone: (949)675-7130
NEWPORT BEACH,CA Zip: 92661
Contractor: OWNER-BUILDER
Address:
Phone:
Zip: License: 0
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
DEMO EXISTING DUPLEX(1574 SQ FT& 1079 SQ FT).
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $5,000.00
Permit: $111.25 Claim Valuation: 55,000.00
SMIP Res: $0.00
SMIP Corn: $0.00
Other $0.00
Inspection: $0.00
Total: $111.25
PLANNING &ZONING /
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right' 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTES:
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes„and all
required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiratiortof this permit:
FOR INSPECTIONS CALL: (714)754-5626
2446-46(9'00)
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑ I have and w0 maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued.
My workers'compensation Insurance carrier and policy number are:
Cartier: Policy Number:
(This section need not be completed if the permit is valued of one hundred dollars($f 00)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(S100,000),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.4 Class 4
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 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(5500).):
❑ 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
Xsold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors Li apse Laws.).
❑ I am exempt 4.er s: . / if Business and Professions Code for this reason: .--
Signature: - 1 -- rr,,..C–f Date:
Owner ID ve I :• . driver`-license. ❑Yes 0 No Drivers License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):-- --
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
O I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
O As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
1 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 feel of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No
present
ant ._ _. ...
5 Does or willo the applicant Aor(Duality
a or emen building occupant at requirer for the work which is the subject of this application a permit for such construction or modification
from the South Coast Air Oualiry Management District or from any other air pollution control district or agency? Yes L_I No
(Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air duality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If yes',attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION.OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given Is
correct. I agree to comply with all state la s and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described perry for ins ction est agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
/q�Jry[� CO � /
/ / ignature Ot.Leg er(s) y/—Date�
,(2.5.
And/Or Authorized Applicant Date
EOM t INSPECTION TYPF PAIS' MALS SODS( INSPECTION TYPE Ddu ILIMALS
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 2/17/Y t 250 Final Building/Occupancy
:::. • SO' i COAST AIR QUALITY MANAGEMENT DP MT
wwialiirarl h.,,IFICATION OF DEMOLITION OR ASBESTOS REAI-VAL
. .;q CAM ti t 21855 E. Cap ay Drive, DiM0110 Bar,CA 91785-4182 (PULL:
909) �= pppO
. SAL FORM ANC FEE TO SCAM%ASSESTOB MOTEICATIONY,FLE 03241, ANGELES CA 9007461 t1
ASO OBE DNLY . Est
RECEIVED -- POSTMARK
ITi I : NOTSICATIONa
COMPLETED BY 5czs./�� yr: r, coaIPANY
P .pre •DATE / S 7 0
- - , ECI(0 0 - FEES 96 PRO.E 0
NOTECAT10N TYPE CrooK4i • REvsot DAYEs Remo,OTHER(hiGrAP+r) C+Nc uarrN
PROJECT TYPE r, •.un0r) Orem Ciboria' RtaorAncH(setrow0)
RocriAL RAMO Rao(w nnt
SITE INFORMATION SITE NAME
WE ADDRESS 2/S aJ 120.k2LCId /9 4 •
J y�__/,�tSitr. •
,• BT T 62/7a c i
(:n(:n [Kan C fa �etca STATE CCP /^ ZP co . i
DESCRIBE WORK AND LOCATION £rnl a 4 /7,2, S
I BUILDMG yawns t, colt ,-,. : (YEA
'n - BUILDING AGE RS) '.1>f N9iIB4i.GF DWELLING UNITS
It
M M PRIOR T PRESENT USE Cawr�a/u crti, *awe gnat arra Roue t etc¢` Irma. Se (anuCc u s
SITE°ANSI TS O S c9A C f 4 /i 4 JDOS$ �''i k' G!/ / AGR A.•
VA
1TY i ATE DP tag P40NE/y 9
C
Il1'u� Olt�t'�3��` �f1 . �l.�l�J co .�� G. 4 7 s- 7130
REQUIRED OUBDONG ASBESTOS ASBESTOS ASBESTOS 4�,, ''• i. BUG MHG TO BE (YES NO
INFORMATION • PRESENT? •) 9
SURVEY? /Q iia AEMOVE0. • DEMOLISHED?
PROJECT DATES START S— / .0/ EO . 6-0/ WORK SI ®sl9.nipAt
1i
ASBESTOS AMOUNT TO BE �FRIABI.EF. 1 CUSS I CLASS II • I T�AMOUNT(atl�
RfMOV®M equate feet) Qom,y� -i �?i Syy I l
AYAESI #REMOVAL FROM SURFACES PIPES xMPONENTS
AMOUNT OF EACH TYPE OF ACOUSTIC MING UNCLEUM INSULATION FIRE PROOFING a S?UC.A rasnc
ASSEYTOS On awn I0011 ,
FLOOR TILES(VAT) DRY'NALL PLASTER TRAN51IE •011130FlNG OTHER /
r
(d.Qma)
CONIRACTOR INFORMATION CSB LICENSE t OSHA REG$ 41
AOIIfl ID s
M
z'
ME ADDRESS ii
II
CITY STATE VP SITE SUPVR iI PHONE
is 1
WASTE TRANLSPOR'TERS* / A.
•. , , , LANORLL j 7 a r.4. r a ' c - / , <
rffIrarllgWAIRINIIIIIM ADDRESS
•CItY STATE ..29 CITY S STATE z'P—.
i
• Asbestos surveys are required prior to Dernorttion and Renovattn i 1
Fonts.Instructions,and the Rule 1403 can to ob'ained horn AQMD web site httpJtwww.acynd.tV Pale 1 or 2 Fum REV 2ace,o
}
1 : . i - --,
•
• SCAOMD NOTE ._ATION OF DEMOLITION OR ASBESTOS REMOV •
MAIL ORIGINAL TO SCAQim,ASBESTOS NOTIFICATIONS,FILE 0 55441,LOS ANGELES 744641
WASTE TRANSPORTER 02 WASTE STORAGE SITE
I
ADDRESS ADDRESS
WY ;CfA7E Z>P CITY iSTATE ZIP
CONTROLS: DESCRIBE WORK rtescncca ANU CONTROLS TO BE USED AT THE RENOVATION AND DEMITE Procedure t I.2,3,4.5 a Other.
Fry asbestos nn»vds orbs the axtbineaa+d Rim 1403 pyres used. Procedure 4 are 5 surd 7latn be Ca;rovel.
�ETECTION PROCEDURE: CIRCLE THE PROCEDURES MID ANALYTICAL METHODS USED TO '4 ASBESTOS IN THE BUILDING:Ssmpa ncpaaiat.Survey,P.M.PCM,TEM.Asa it ed a Attestor,Describe Od1er:FOR DE65OUT10N8 GIVE THE COMPANY NAME AND DATES OF THE ASBESTOS REMOVAL 0cum1
FOR CROP-RIM DEMOLITION SEND A COPY OF THE ORDER AND GIVE THE AGENCY NAME 8 PHONES S
AUTHOPoZtHG PERSON: TITLE -
GATE OF ORDER I CATE ORDERED TO BEG'N:
FOR EMERGENCY ASBESTOS REMOVAL GIVE THE NAME AND PHONE NUMBER OF THE PERSON DECARING/ATHCR LNG rre EMERGENCY. GTE ANG HOUR OF
EiE GENCY NO DESCREE THE%MOEN.UE7n£CTED EVENT' 1
MAIN —L �MAINIOW THE EVENT WOULD C.U15E UNSAFE CONONTICNB,EQUIPMENT DAMAGE CR UNRFASONABIE FINANCIAL ia1l�:
a
CINTaNGEDNCY PLAN:DESCRIBE ACTION'S ANC PROCEDURES TO BE FOLLOW®IF t)j CTED ASIESS7OS S F:YAO ANC DasOUTION OR NOIFRfA9tE
*SEEMS KATERIM.BECOME CRUMBLE,PULVIINQFD.CR REDUCED TO P7W09t
F
1
TRAINING CERTIFICATION::c ty dsst an idividsal eared d n is pryers s d regldy6on AOMD Rube 1403 and R'E'SHIP wW be on sir&rim tat irlIni and
atoms diet the npuired trite ha bean accomplished by this pen will be meads Lar inmeaion during normal Puska hairs.
;i
CdlDany Nero Pr runs d ortett cr Sdgniese d cernertopern Pawl awevwpmamc Date
i.
INFORMATION CERTIFICATE00t I certify that/s above tnloms�n ie correct and I have enclosed retired adsaimit.
.3aS reA CC fa Lit '1
OaltpatY Nems Pt nine d awrterbool'etnr rtel ia oec:eraooerapt Dam
Ncafiatees an n t bs as e0md*tout te tecaseed ins(AOMD Rude 301). roveen s tam m100samos ap^y��aa rodCz ion ata ier�
?Wase mese dada pasta to'SCAQMD'. Fees we per ndtllatoL nd iaa..and Vat=lyi g c1 is proyea sUil Fees re aspec
DEMOLITION OR ASBESTOS REMOVAL PROCEDURE 4 OR 5 PLAN $302 53
FROM 100 TO 1.003 SQUARE FEET $ 2656 SPECAL HANDING FEE $?5.73
PROM 1,701 TO 5.000 SQUAREFEr: $ 2242 R_NI&ON OF NOTIFICATION )'t S :0.91
FROM 3,001 TO 10.000 SQUARE rots SI 4,293 RET1RVED CHECK CHARGE I, S 26.75
MORE THAN 10,000 SQUARE FEET in 57 CANCaLATION OF NOTiFICAI)GN S 0.0
DEMOLITION OF LESS THAN 100 SO FT S 25.96 RESIDENTIAL ASBESTOS 4E14 VAL ' S 26;6
ONar lied.single-trait d ax
ATTENTION: Keep a copy of year no4fcatlon. State at reouiro tar you provide a copy Ste demdiion ndfirttian 2uiItirg and Silty beam iisua ce d a
Stitl:r,pent Fa cua:tons aI ZS-3962336. For your convener a was mad the brrn and fee art cc ncI hand arty It ACMD.
I
, i
MAL FORM AND FEE TO:SCAQIDMS,FLE 155641,LOS ANGEL..cS CA StOC74.564t :
MD,ASBESTOS NOTIFICATIONS, ' 1
TELEPHONE_ (80.9)356-2136 FAX (lAs)396.3342 . Farm REV 200610 i Page 2 cf 2
FORMS,INSTRUCTIONS,AND THE RULE 1403 CAN BE.OBTAINED FROM AOMD WEB SITE AT HTTPI/W W WAQ Sd,GOV
1 +
• I
401 Pus APR 10 '01 12: 1G •
•AD
DEMOLITION INSPECTION REPORT NO. S-4584B
219 & 219 1/2 16th Street
ASBESTOS DETECTION, INC.
12862 Garden Grove Blvd., Suite 220
Garden Grove,CA 92843
(714)530.1922
I. CLIENT: Joe Cefalia
818 W. Balboa Blvd.
Newport Beach CA 92661
II. Project address: 219 & 219 1/2 16th St.
Costa Mesa, CA
III. Date of survey: Wednesday, April 4, 2001
Iv. ' Inspector: Charles Ay, Certified Asbestos Consultant No. 93-1030
V. Structure/service requested: The subject lot contains two, one-story,
single family residences . A detached garage is shared by the two units. The
client reports that all structures on the lot are to be cemolished.
The demolition contractor should be aware of the possiiility that presently
inaccessible suspect materials may be uncovered as renovation proceeds. If such
suspect materials are discovered, the suspect material ssould be sampled and
analyzed prior to its disturbance. Similarly, where carpeting was noted, ADCI
lifted a small corner of the carpet in representative a:yeas to determine if
suspect materials are under the carpet . However, th contractor should
carefully remove carpeting to determine if suspect materia' is present under the
carpet which was not readily accessible at the time of tbs survey.
VI . Systems/products surveyed: The term "none observed" refers jointly to the
219 and 219 1/2 residential structures and to the detache3 garage. All other
comments in this section refer to the specific structure ,referenced.
A. Acoustical ceiling material: None observed.
B. Textured wall surfacing: None observed.
C. Pipe/boiler insulation: None observed.
D. Attic insulation: None observed. The attic areas in the two residences
were not insulated.
E. HVAC duct system insulation: The 219 unit has a floor furnace; the 219
1/2 unit has a wall heater. No suspect, accessible materials were noted on the
heaters .
E. Ceiling tiles: None observed.
481 FC6 HFR 10 '01 13: 1E
•
Report No. 5-4584B
Page 2 of narrative
219 & 219 1/2 16th St .
H. Flooring: The majority of the living areas in b+3th residential units
are carpeted.
The 219 1/2 unit has one pattern of suspect vinyl fi.Doring on the surface
of the kitchen and the bathroom. Two layers of suspe,:t vinyl flooring is
present in the living room and bedroom.
The 219 unit has one pattern of suspect vinyl floor::.ng on the surface of
the kitchen and bathroom, Another suspect vinyl floori.7.g material was noted
under the carpet in the south bedroom. No suspect mater',.als were noted under
the carpet in the living room and north bedroom.
The detached garage has an uncovered cement floor .
Samply # Location A kustos present
21 219 1/2 kitchen/bath lino Nor
22A 219 1/2 living room/bedroom Non.;,
(bottom layer)
22B Adhesive on sample no. 22A Non:
22C 219 1/2 living room/bedroom None
(top layer)
22D Adhesive on sample no. 22C None
28 219 lino under carpet in S bedroom None
29 219 kitchen/bathroom lino None
I. Exterior stucco: Stucco was observed on the 219 and 219 1/2 units, as
well as the detached garage .
amine # Location &sbetitos_Present
25 219 1/2 N side None
26 Detached garage None
27 219 - N side None
3, Exterior siding: None observed.
K. Interior wall materials: The interior walls in the both units are of
plaster construction.
The interior of the detached garage is not improved .
Sample.. Location Asbe„tos present
23 219 1/2 living room None
30 219 S bedroom None
L. Exterior roofing materials: Each of the two resid3ntial units and the
detached garage have suspect , composition shingle roof surfaces, with the garage
material deemed to be homogeneous with the 219 unit roof .
Approximately 3-5 square feet of suspect mastic is noted on the roof
surfaces on each of the 219 and 219 1/2 units . No suspect mastic was noted on
the surface of the garage roof .
Due to the age of the structures, the suspect roof mastic is assumed to be
ACM .
Sample 4 Location Ag gtos present
24 219 1/2 roofing None
31 219 roofing None
M. Exhaust/flue piping: No suspect materials observed in 219 1/2 . Two
e+ c•.•enf Fl ++o ^4nmr 'ann. nhc•mr.rmri •rmnrinn .+cp 1+M, ')10 £1 ^•.n+^
l:eport No. 5-4584B
Page 3 of narrative
; 19 & 219 1/2 16th St .
heater. These pipes (a total of 16' -20' long) are the type commonly referred
to as "transite" which can be assumed to contain asbestos without the necessity
of sampling and analysis .
VIZ . Laboratory analysis: Laboratory results are summarized in section VI ,
above . Refer to the attached laboratory report sheets for specifics . Analysis
was performed by polarized microscopy (PLM) utilizing the method described in
40 C. F .R. Chapter I (1-8-87 edition) Part 763 , Subpart F, Appendix A pages 293-
299 . The ENVIRONMENTAL HAZARD SERVICES, INC. laboratory is accredited in this
method under the National Voluntary Laboratory Accreditation Program
administered by the National Institute of Standards and Technology, United
States Department of Commerce (#101882-0) , and by the Department of Health
Services of the State of California (#2319) ,
VIII. Conclusions: The limited building survey protocol , and subsequent bulk
sample laboratory analysis as reported herein, lead to the following
conclusions :
1 . Friable materials: (E.P.A. definition of friable is that "the
material, when dry, may be crumbled, pulverized, or reduced to powder by hand
pressure . " A.H.E .R.A. section 763 . 83 . The term "friable' does not
necessarily indicate that any present damage, deterioration or health hazard
exists . )
Friable asbestos was identified in these constructi,:.n materials :
No Friable ACM was identified in the 219 or 219 1/2 units, or in the
detached garage
2 . Non-friable materials:
Non-friable asbestos was identified in these construction materials :
A. Flue pipes off heat unit and water heater in the 2:1-9 unit (assumed ACM)
B. Mastic on roof surfaces of the 219 and 219 1/2 units
Note: Tne total surface area of all asbestos-< ontairing materials
identified in this survey report was visually estimated to be 19-25 square feet
in the 219 unit , and 3-5 square feet in the 219 1/2 unit . Pb ACM was identified
in the detached garage .
ALL VISUAL ESTIMATES OF THE SURFACE AREA OF IDENTIFIED ACM ARE FOR THE
CONVENIENCE OF THE CLIENT ONLY. THESE ESTIMATES SHOULD NOT BE RELIED UPON OR
UTILIZED FOR BIDDING OR NOTIFICATION PURPOSES .
If applicable, the client may incorporate this report: or its conclusions
into a notice pursuant to the State of California Health anc Safety Code Section
25915 et seq. or into notification pursuant to S . C.A.Q.M.D. Rule 1403 .
S .C.A.Q .M,D. Rule 1403 mandates that, where a renovation will involve 100
square feet or more of asbestos-containing materials, of in any demolition
activity, the property owner or renovation/demolition contractor shall provide
written notice of said activity to S .C.A.Q.M.D. ten days prior to the
commencement of the renovation/demolition.
DATE: April 6, 2001 ASBESTOS DETECTIOI' CO. , INC .
• CITY OF COSTA MESA A
44„ ►9 BUILDING DIVISION
>w- U :1r DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER
F t I �a r PERMIT
J,.y�R"111 •
'gao0m000' P01-00231
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 219 E 16TH ST Status: ISSUED
Suite No Applied: 04/17/2001
Issued: 04/17/2001
Vicinity:
Parcel Nunmber: 42533409 ISSUED BY:
Applicant: CEFALIA, JOSEPH ,
Address: 818 W BALBOA BLVD
Phone: (949)675-7130
NEWPORT BEACH,CA Zip: 92661
Owner: CEFALIA, JOSEPH & MARGIE
Address 818 W BALBOA BLVD -
Phone: (949)675-7130
NEWPORT BEACH,CA Zip: 92661
Contractor: OWNER-BUILDER
Address:
Phone:
Zip:
License: 0
Arch/ Eng: -
Address:
Phone:
Zip:
License:
SCOPE OF PERMIT
PLUMBING PERMIT FOR SEWER CAP FOR DEMO OF EXISTING DUPLEX.
REF: B01-00512 -
•
FEE SUMMARY
AMT QTY AMT QTY - ' AMT QTY
ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Bump 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 $0.00 0
Dishwasher $0.00 0 Sewer Cap for Demo $9.80 1 " Wash Basin Set $0.00 0
Drain,Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0
Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0
Drain,Roof $0.00 0 Shower "$0.00 0 Water Heater/vent $0.00 0
Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0
Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0
Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0
Gas(1-4 outlets) $0.00 0 Sink,kitchen $0.00 0 Water Softener $0.00 0
Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00
Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00
Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00
Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0
Interceptors(Sand Auto) $0.00 0
TOTAL CALCULATED FEES: $33.30
1..UMMtN I b I bVtL.IAL I.UNUI I IUNJ
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. e
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 pem /
FOR INSPECTIONS CALL: (714)754-5626
244646(WOO)
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 is valued at one hundred dollars($100)or less.)
O 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($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.a Class F
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)Or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
74 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 ex pt u der c. Business and Professions Code for this reason:
Signa ut re. ' f. Date: P 9/110 "in/
Owner rifled b river's license, 0 Yes 0 No Drivers License No.-- • ' — r Expires:/,--/f-.?DO,j
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
O I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
O As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑Yes ❑No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a gpermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disClosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑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 stale laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZAT1ON.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 to laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-des 'bed property Jons ion purposes.I agree not to occupy or allow occupancy of any building authorized by t s permit final IV� �C Signature Of Legal Owner(s) ;- Date .
And/Or Authorized Applicant Date
CODE/ yISPFCTION TYPE PATE INTRIALS CODE INSPECTIONTYPL LAM )NTRIALS
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
PROJECT ADDRESS: 219 E 16TH ST UNIT: 0 CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 047962
OWNER'SNAME: MR, WILK
ADDRESS: 459 LYNWOOD CIRCLE PERMIT NO; B 047962 PLAN CHECK NO: N GOVT: N SUPP : N
COSTA MESA, CA.
CONSTRUCTION TYPE; PERMIT TYPE; SIR PURPOSE: ALT
714 /646-2087
ARG/ENGINEER: REG.NO.: JOB DESCRIPTION : REROOF WITH CLASS A SHINGLES SQ FT; 1 , 300
ADDRESS: UNIT:
CLAIM VALUE: 1 , 300 . 00 CALL—VALUE; 1 , 300 .00 GROUP OCC: R-3 /
PERMITTEE: FERRARA ROOFING ( 714 )642-8233
ADDRESS: 3013 GARFIELD AVE. COMMENTS: *
COSTA MESA CA 92626 *******************************************************************************
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licens-•/nder provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code,and my lice..'/ in fall force and effect. SETBACKS
CITYuc 0 F79 ,rTEUG.:342740 /D : C-39
• Date: V a Signature:_ l./ MAIN BUILDING ACCESSORY BUILDING
WORKE COMP! TION DECLARATION: Iherebyaffir tI have a certificate of... -• to self-insure or a certificate of Workers' FRNT : FT IN REAR; FT IN FRNT: FT IN REAR: FT IN
Compenationlnsu ceoracertifiedcopythereof( n, ,Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POUCYNO.: 732492-90 / P.DATE: 07 /01/1'
COMPANY: STATE FUND PARKING REQ: PROV; PARCEL : 42533409 ZNE: REF NO:
�3 Certified copy i ereby furnished. ® Certified copy is they, /ci . ilding Division. PLANNING NOTES>
' // >
.4: . Applicant: A // . , **********************************************************************;(********
EmEM' • FROM WORKERS'COMPENSATION DECLARATION: ..I • .not be completed it the permit is for one hundred WOO)cc less). DEVELOPMENTSERVICES REQU IR EMEN S
I certify that in the performance of the work for which this permit' issued.I shall not employ any person in any manner so as to became I
•
subject to the Workers'Compensation Laws of California. ZONING APPROVED BY DATE: :• '
Date: Signature:
NOTICE:If,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE:
Code.you must forthwith comply with such provisions or this permit shag be deemed revoked. /— // a
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: DATE: (O a i(/
which this permit is issued(Section 3097.Civ.C). .;T**
LENDER: *******************************************************************************
ADDRESS: - LEGALIZATION;N F E E SUMMARY STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,after,improve,demolish,or PERMIT 31 . 00 � . 50
repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensedi SMIP/NON—R E S
pursuant to the provisions of the Contractors'State license Law(Chapter 9(commenting with Section 7000)of Division 3 of the Business A' ��
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by PLAN
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500). ISSUE FEE e.,: •'
I as owner of the property or my employees with wages as their sale compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS—---> 31 . 5 0 0 . 00 0 :00 31 . 5 0 31 . 50 . 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through , I
his or her own employees.provided that such improvements are not intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS--> COLRECTED• 31 . 50 OVER/SHORT: . 00
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve 7
for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business
31 . 00 ' - 50
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who blds or Improves thereon .s
and who contracts for such projects with acontractors)license pursuant to theContractors'State License Law).I am aware *************************************Sr**********************w w w w w*w************
that proof of their Worker's Compensation insurance should be provided to me. IND IV I D U A L S :F E E B R E AK DOW N
❑ I am exempt under Section: B.A P.C. `f :0 •
for this reason: TYPE QTY D E S C R I P T I O )N ?° r' UNIT COST TOTAL COST
Date: • OwnerSFR 1300 REROOF BY VALUE RES*DEN?AL NOZONE 1 . 00 1 , 300 . 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533.and END j )F' FEES
25534 and that I or any future building occupant wilUwill not(circle one)need to comply with said state codes and the requirements for a 1
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from . , ^••
these provisions. •.
Date: Applicant: !° '
I hereby certify that I have read this application and state that the above):a�.io "rrect.I agree to comply with all city and county -'
'
ordinancess anid state laws
Urelating to building construction and hereby aa,Ally ep, natives of this city to enter upon the above-mentioned /'
property f`��ction p/ /L
Date: {i- Signature:
Driver's License or Social Security A: 1
184148 White—Building;Green—Code Enforcement; angry—Applicant;Pink—Revenue;Goldenrod—Assessor 01 00064251-00064252 TOT 31.:u
° DATE: 06/29/90 TIME: 11:53
Y CONSTRUCTION AND PLANNING POOL 'A
APPROVALS Permit# •-• `Date Inspector APPROVALS Permit Date Inspector
1. Temporary Electrical Service`or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms •
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings . - 58. Electrical Conduit-Undrgrnd.
8. Foundation ✓; 59. Gas Pipe, O Undrgrnd.,Test
9. Water Pipe-Undrgrnd. ,, ' • _ - 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System / 61. APPROVAL TO DECK .
11. Property Sewer Line & House Connection •/' - 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts,in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank ❑Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing& Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED -
33. Final Electric • Notes: 7- , ,,,.qo - �g�, _s
34. Final Heating & Air Conditioning e/� , '17c -.1"'“*"
7'1��$r
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace �.
38. Final Plumbing j
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING 7-2'10 6al7 L
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
• No. Date
- MAT ADDRESS: 219 E 16TH ST UNIT: 1 /2 CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 047961
OWNER'S NAME: MR, W I LK '
ADDRESs: 459 LYNWOOD CIRCLE PERMIT NO: B 047961 PLAN CHECK NO: N GOVT: N SUPP : N
COSTA MESA, CA,
CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: ALT
714 /646-2087
'ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : REROOF WITH CLASS A SHINGLES SQ FT: 1 , 300
ADDRESS: UNIT:
CLAIM VALUE: 1 , 300 . 00 CALL—VALUE: 1 , 300 . 00 GROUP OCC : R-3 /
PERMITTEE: FERRARA ROOFING ( 714 ) 642-8233
ADDRESS: 3013 GARFIELD AVE. COMMENTS: *
COSTA MESA CA 92626 ******4*********************4*******4***4*4****************************4*******
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licen .,und• •rovisions of Chapter 9(commencing with Section ZONING REQUIREMENTS
7009)of Division 3 of the Business and Professions Code,and my lice • is i II force and effect. SETBACK S
cmuc.: 016798 ATEuc.:342740 i C-39
• MAIN BUILDING ACCESSORY BUILDING
—Date: Signature:— .� FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
WORKERS'C PEN ON DECLARATION: I hereh aaffirm / •rt irate of consent to self-insure or a certificate of Workers'
Compensation Insuran a or a certified copy thereof Section 'n, ab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLICYNO.: 732492-90 DATE: 01 /01 /91
COMPANY: STATE FUND PARKING REQ• PROV: PARCEL : 42533409 ZNE: REF NO:
—Cfurnished ®Certified copy' hereby Certified copy is filed with the city Building Division. PLANNING NOTES>
>
a ,ate: Applicant: **********************************************************************4******** •
i / DEVELOPMENT S ERV IC ES R E U I R E M E N .T, S
EKEMP1ION F WOR RS'COMPENSATION DECLARATION: (This sectile• ed„ d the permit is for one hundred(5100)or less). Q
I certify that in the performance of the work for which this permit Is' rri %� ploy any person in any manner so as to become
subject to the Workers'Compensation Laws of California. / ZONING APPROVED BY DATE: ' ,
Date: Signature: ��_ ��..� BUILDING APPROVED BY
NOTICE:ft.after mald : DATE:ng this declaration,you should 'eco ,bj'c to he Workers'Compensation provisions of the Labor
Code,you must forthwith comply with such provisions ori. permit shall be deemed revoked. -gyp
CONSTRUCTION LENDING AGENCY: I hereby affirm that "re is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: DATE: , 7,/, a
which this permit is issued(Section 3037,Civ.C). **************************************& *()***********************4*. **
UNDER: *********************************************************************#4********
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: My city of county which requires a permit to construct,atter,Improve,demolish,or PERMIT 31 . 00 - J.50
repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business S M I P/NON—RES
PLAN
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.My viotation of Section 7031.5 by ,
any applicant for a permit subjects the applicant to a civil penally of not more than five hundred dollars(5503). ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
Las owner of the property or my employees with wages as their sole compensation, will do the work, and the
❑ structure a not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS————> 31 , 50 0 , 00 0 , 00 3 1 . 5 5 0 31 . 50 . 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through y r
his or her own employees,provided that such improvements are not intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS——> COLI:ECTED • 31 , 50 OVER/SHORT: 00
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve
for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business
31 . 00 :•' $0
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or imprm2s thereon
and who contracts for such projects cith a contractor(s)license pursuant to the Contractors'State License Law).I am aware ***********************************40*******************************************
that proof of their Worker's Compensation Insurance should be provided to me. I N D I V I D U A L • FEE E BREAKDOWN
❑ I am exempt under Section: B.&P.C. . ' e
for this reason: TYPE QTY D E S C R I P T I OIN''- UNIT COST TOTAL COST
Date: Owner
SFR 1300 REROOF BY VALUE REEND' OIAL NOZONE 1 . 00 1 , 300 . 00
I do hereby certify I am aware of and understand thellrequirements(circle
of California Healthwvn and stat Codeand 2eqs,and END• OF FEES
25534 andr that I or any future ifca o occupantm Airia not(arae one)need ri t.Rcomply with said state i codes and thearrequirementse
for a
permit for construction or modification from the Quality Management Distract.Residential construction applications are exempt from
these provisions.
Date: Applicant: //'•i
`' ,
I hereby certify that I have read this application and state that the above I. •:ti• is correct.I agree to comply with all city and county ter
ordinances and state laws ig relating to building construction and hereby / e• " -natives of this city to enter upon the above-mentioned
property fir" .. ,urpoees. x' .e l
• Date: w /� - Signature: // ///er
fl,
Driver's tense or Social Security x: 01 00064253-00064254 TOT T 31.50
164146 White—Building;Green—Code Enforcement:,•:nary—Applicant;Pink—Revenue:Goldenrod—Assessor DATE: 06/29/90 TIME: 11:54 I
r
1 1
CONSTRUCTION AND PLANNING - POOL PA
APPROVALS Permit# Date Inspector APPROVALS Permit# _ Date Inspector
1. Temporary Electrical Service orPole � - 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. • ,""c' - 53. Steel Reinforcement
3. Electrical Conduit Utility-Uridrgrnd. _ 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation - 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. �'�' 60. Backwash Lines, P-Trap, 0 Undrgrnd. 1 �,
10. Structural Floor System ./ ':. '- 61. APPROVAL TO DECK ' v
11. Property Sewer Line & House Connection • % 62. Backwash & Receptor-Final '
12. Sewer Cap - 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing - 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
•
16. Rough Electric Wiring - - 67. Fencing & Access Approval
17. Rough Wiring Sign • 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts,in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing& Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: 7-2_9
34. Final Heating & Air Conditioning 5./10 L /ell. `�P.!
35. Final Gas Pipe-Test �f r-K Kc (%�•�
r
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING 1-2-90 iptt%hC
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co '•/
51. CERTIFICATE OF OCCUPANCY
No Date
t .
. .
' ' • -
COUNTY OF ORANGE ' Application for Building Permit
BUILDING DEPT. Permit No 2/3 373.
636 No.Broadway AND FOR A
. . Santo Ana,California
, Phone:KI 2-6211 • Certificate of Use and Occupancy
Date_.12(.e.e. al /a:a
/
I. OWNER'S NAME Ati--..-441/142- de litnat.-.° PHONE4tel.C.44/.4::±2
MAILING ADDRESS.225,24.26 7-9*72.7-nier CITY cc-vas-27z,-
Name Name
(Architect or'Engineer)
Address , (Contractor)
• Address -4/e -
City City
r (
State State
*-
Lic. No Phone Lic. No hone
PROPOSED USE- le)we-7.- .41ityyzi .....e..‘
tULC9
2. JOB LOCATION ,g_ z. t ,7-6 fz-t--- —
(HouseNo.)No.) (Name of Street) 7:4(Town or School District)
NAME OF AND DIRECTION FROM NEAREST CROSS STREETS/a —(.7.rxe ed-.72-- •
3. LEGAL DESCRIPTION: Lot
-- Tract
(Metes and Bounds Description—Use reverse s(i c of form)
4. CORNER LOT ( ) INTERIOR LOT ( ) THROUGH LOT ( ) SLOPE OF LOT ( ) ,
...-
5. SIZE OF BLDG.i.0'''''''''''''''''''''''/2,d.1'' a - SIZE OF LOT:.
.Z .„..-1-4-.YV. i AREA-Lt'gren? a.
/. d•-•' n ., .
6. HEIGHT OF BLDG.:< ..CEILING HEIGHT- .47 NO. OF STORIES
7. NO. FAMILIES QA Size of Smallest Bedroom:...7 2.z, ::6 ' Size of Kitchen 7.'1'412 /
8. EXTERIOR WALL CONSTRUCTION:sr2 e..cs INTERIOR WALL COVERING./2‘2E4rA'yeetaaen,
(Frame, Stucco, Etc.) (Plaster-Drywall, Etc.)
ROOFING COVERING
9. STATE HOW MANY BUILDINGS NOW ON LOT AND GIVE USE OF EACH.. -
.
...........
,,,,..„,
10. SETBACKS: Front Yard From Center Line of Street. C+/1M.b ...P..0 /-4,34/..te 4547 —/
I
Nearest Side Yard c.f— ' Rear Yard ,9 ef Distance in Feet Between Bldgs. on Same Lott.90
(Property Line) (Property Line)
11. A COMPLETE PLOT PLAN IS REQUIRED, SHOWING ALL STRUCTURES AND USE OF EACH.
,
.
12. (a) Footing: Width /4/ Depth in Ground / Z Width of Wall .6,„
,,,,. n
(b) Size of Studs:-22-3(1.____Spacing /a "CC Material of Floor /./../&” n
„.... -,- (c) Size of Floor Joists• --e..2.6 Spacing ./.‘ " "CC
(d) Size of Rafters• s,e 2..2151 Spacing. ratr ..2 "CC
13. VALUATION OF PROPOSED WORK: IncIeling all labor, plumbing, electrical wiring, heating, fire sprinklers, painting and
sewage disposal $....tentai.T42._ • 257.47 0 -- -
14. I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION IN THIS
APPLICATION IS CORRECT AND THAT THE CONSTRUCTION WORK WILL CONFORM TO ALL LAWS OF
THE COUNTY OF ORANGE AND THE STATE OF CALIFORNIA APPLICABLE THERETO.
Plans FiledSigned:Sikerfatre-Z-442„4,17-K
(Owner)
•
By•
(Authorized Agent)
• FOR DEPARTMENTAL USE ONLY
FEES: „.„.QHECKING BY
Bldg. Permit - tilt Q'0 GROUP 1 .17. . 'APPLICATIONcerS.,4 HEALTH
Plan Check - $ ...3.r..0.....0 TYPE — -
ZONING FIRE
Total - • • s...2- / •• 00 mAMSL.......c2... • ya v
PLANS AN MARSHAL
Receipt No. - I SPEC'S STATE
Paid to - - SHEET NO S CORRECTIONSENGINEER
,
Date VERIFIED /' CAL
,..
o
PERMIT ISSUEDnATT„(1
I2p: ' ' 7
, •
COUNTY BUILDIN
DATE pricroR
5000--7-SU CEPUTY '
---.J..
METES AND BOUNDS DESCRIMtI.. .. Jp� SDI /Ywi� 2 6 E./&�
fr: S wt /3s' 3n0-44" 413
( , P,infly)o'I-��yi' Yr
/t47.7
k
NE . . -. I
' / •
i9 21,03!0 ��o sIo Wa
4- I.a 1 A . -1 lb _ __
• 2-i- Mill .....1 N. mum no Nil_
ql - idiiiimi- lidiiiiiiSlibldbint
en ---eirommemoilirj"-__-
1
iiiiiitraism
1
i ! 1NiHIOIl 'itipuit
-
_01
0 gm n in I m
• 4894 FEE RECEIVED
COSTA MESA BUILDING DEPARTMENT G(�'""4 /g,/7)2- 10
P.O. . FINANCE DEPT.
COSTA MESA.A. CALIFORNIALII yy ��FF mrnee ��__pp����gg��
FOR APPLICANT TO FILL IN APPL7TA'TIO"NT'FIgIkA PERMIT
ADDRESS oY/y e/<'icnAe'6-r BUILDING
COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY
�p /J,/ RECEIPT NO. PERM/T NO
R,
OWNER P ( /%GiPQ/.Art/✓. v
MAIL RECEIVED BY DATE RECEIVED DATE ISSUED
AD DRE5507/p ea "Cf T2 etc'7- - - P-
-/G -f
CITY No.r TA NeseTNELO.L' 62, P/?o BAUDDILRDEIsG
-
ARCHITECT <F40/..41
� pa-,
E SIO. COSTA MESA. CALIFORNIA'
OR ENGINEER 7
FIRE
ADDRESS ZONE
ileaCITY LIC. / ION�.a/�� / PLAINS TYPE '/ GROUP, ////
CONTRACTOR/:P..7- lea,r/4s/6 NO. (J QD•2 .P,doe p V \ (/ G
ADDRESS e.2/9 C/b �.FT.QEe T NO:L/ p ?,/Q( BYPROVED �p[I/�\p�(Q\/�-(}/a'` DATE
LEGAL LOT "� , A Pit V P
ESCRIPTION NO. BLOCK T
A.P. NO. j/77 /y4,-- o9
SIZE a / Nof BLLGDG CITY OF COSTA, MCSA
of LOT K �.� No.W DN OTS. oZ . PLANNING DEPT.
USE OF f'e.cc r,ve r Arr,pa ....ONOO SUBJECT TO R{,f7-0 DEPT. REG.
EXISTING BLDG. ``` ,,,///
ETBACK LINE FROM / / g �`(///'/�
CENTER OF STREET I.Sa / REAR YARD OG J. 8%1 /' /— / DATE '441?"'-5.7
n ( / Y JPLAN Ttc. - /
SIDE YARD RIGHT /2 LEFT S �/(
DESCRIPTION OF WORK 6 tipLL
I
NEW A ALTERATION ADDITION
REPAIR MOVING DEMOLISH 1
BUILDING / A. ✓<J 9p NO.OF
SIZE J ROOMS 7 STORIES
EXTERIOR WALL �� ROOF /� r�P I,j/^
USE
COVERING psi/./U(tC f/." COVERING Y+�+ /J rEsf .
BUILDINGEW /l�(JF,✓E-Wole ( /y 'S/ .A7 .
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL .
CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUC-
TION. / /e VALUATION
SIGNATURE OFM„_ q� / _ _ /iw/ PERMIT FEE $ /� --
PERMITTEE
PERMITTEE YYYfffCCCAAAI S�.x�//VrL-�!!KK
y6PLAN CHECK $
AUTHORIZED AGENT
TOTAL FEE $ /,.--- \P'