HomeMy WebLinkAbout236 16TH ST - Building Permits •
CITY OF COSTA MESA
r BUILDING DIVISION
). : :;,, a DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
1.�1a ± PERMIT B05-01334
(714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.cpMIIUINI' FERMI I 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 236 E 16TH ST Status: ISSUED
Suite: A Applied: 08/08/2005
Vicinity: HOUSE AND GARAGE ROOF, BLDG A Issued: 08/08/2005
Primary Occ: R3 Dwellings/Cong Res<10 Type of Construction: V-N
Parcel Number: 42520115 Zoning:
Applicant: TIM MC CARL •
Address: 126 COMMERCIAL WY 1/1N
Phone: 949-548-5569 ISSUED BY: �/�(
COSTA MESA,CA Zip: 92627
Owner DENDEL, GERALD F TR
Address 236 E 16TH ST
Phone:
COSTA MESA,CA Zip: 92627
Contractor: G L R ENTERPRISES INC/DBA CRANK BROTHERS ROOFING
Address: 126 COMMERCIAL WY
Phone: 949-548-5569
COSTA MESA,CA
Zip: 92627 License: 828379
Arch : Eng:
Address: Address:
Phone: - Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF EXISTING FLAT ROOF MATERIAL AND REPLACE WITH CLASS A FELT AND HOTMOP WITH GRAVEL ON SFD ATTACHED HOUSE
AND GARAGE.REPAIR AND REPLACE SHEATHING AS NEEDED.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $8,140.00
. Permit: $167.25 Claim Valuation: $8,140.00
SMIP Res: $0.81
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $168.06
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
0 I have and will maintain a certificate of consent to self-Insure for workers'coMpensation,as provided for by section 3700 of the Labor Code,for the performance of the
_work for which this permit is issued.
X...;1-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 worker 'co pensatlon Insurance carder and policy number are:
Carner:,.n5 r InA Pdiq,Nugi:rbe 17 2 k 9 9_2 — 2 O
.(This section need not completed 1l the permit is valued at one hundred dollars($100)or less.)
❑ I certify that in the pam. ce o the work for which thiNpermit is Issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation law S . Car • nd a at If I sh become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with t : p •vi -•ns/
Applicent'SlgnattO?CV 4 Dale:"x�. R
WARNING:FAILURE TO S '- WORKERS'COMPENSATION COVERAGE IS UNLAWFUL MD SHALL SUBJECT AN EMPLOYERO CRIMINAL PENALTIE AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(S1•:kg,,IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37W OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensd underuprovisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is In full
force end effec6t Jc# X _moi`)I mar." C7—3 9 os-
-
t
: 9 _, L IOate2 gl $/ bS
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($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement Is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). •
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. 0 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:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal t0 or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes 0 No
(Section 65850.2 of the California Government Code requires that the requested information be fumished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the Information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
V!,at re O al Owner( 5C/c//�Jata C—
CA- •.4 .Auth d&Applicant-
- -- o1D te----'L,
CODE L INSPECTION TYPE 267E NTIUA6a LODES IBSPECT10N TYPE DAB
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
G
200 Final Re-Roof `S'rG I-O'R) ` �-1 q� 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/Occupanby
f •
ti
,4111 CITY OF COSTA MESA
BUILDING DIVISION
>44. DEVELOPMENT SERVICES DEPARTMENT ERMIT NUMBER
PERMIT
�,,�R " B01-00947
0 et
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.usNG PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDIJob Address: 236 E 16TH ST Status: ISSUED
Suite: A Applied: 06/25/2001
Vicinity: HOUSE&ATTACHED GARAGE Issued: 06/25/2001
Parcel Number: 42520115 Zoning:
Applicant: CRANK, JIM ISSUED BY:
Address: 126 COMMERCIAL WAY
Phone: (949)548-5569
COSTA MESA,CA Zip: 92627
Owner DENDEL, GERALD F TR
Address 236 E 16TH ST
Phone:
COSTA MESA,CA Zip: 92627
Contractor: CRANK BROS ROOFING CO INC
Address: 126 COMMERCIAL WAY
Phone: (949)548-5569
COSTA MESA,CA
Zip: 92627 License: 794724
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
REROOF EXISTING SINGLE FAMILY RESIDENCE&ATTACHED GARAGE(15 SQ). INSTALL NEW LAYER OF 30#FELT&
25 YEAR COMPOSITION SHINGLES OVER EXISTING ROOFING.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $2,167.00
Permit: $83.25 Claim Valuation: $2,167.00
SMIP Res: $0.50
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $83.75
• 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 expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
244646(6/00)
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is Issued.
❑ I have and will maintain workers'compensation insurance, required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
,---'My workers'co pensation Insurance- ca(ducand policy nu bar are: �-
Carrier:_ .l z«t- f /C.-4.----'7 Policy Number:
(This section need no be c pie fed if he permit is valued at one dred dollars($100)or less.)
❑ I certify that Int •nuance of the work for 'ch this permit is issued,I shall not employ any person in any manner so to become subject to the workers'
compensation la •• alifornla,and ogre aL I should become subject to the workers'compensation provisions of SgCttloon 3700 of the Labor Code,I shall forthwith
comply with these p -•ns. �—
_Applicant Signefu� _-'S� - e---"L___ ( Date: - S
WARNING:FAILURE TO 5- URE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
'THOUSAND DOLLARE - 00,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
L
LICENSED CONTRACTORS DECLARATION:
I hereby affirm thall am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of,the Business and Pftq a '' ns Code,and my license is in full
force and effect'IC.,, /_ _ - /Class.it -^����—j
Contractor's Signature: ---W---
Contractors / jDate: ' :C — 7 .'.-- C.
t
Ci
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 properly who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such Improvements are not intended or offered for sale.If,however,the building or Improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I.as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑Yes ❑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:
❑ 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 B,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑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? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes IJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
abov:-•ebs�'•.d property for inspection purposes. nnnnccco occupy or allow occupancy of any building authorized by this permit until final inspection.
ei. • />7 Date
� '- a c (
a.Authorized ••+want--'— !Date ,--, i
Co.. INSPECTION TYPF PATE fN1ITIALE CODES fNSPECTION TYPE DALE fNTIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final ..��pp7' /'m� �/ 200 Final Plumbing
200 Final Re-Roof 6 -tf ( it 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
` 9 • CITY OF COSTA MESA
BUILDING DIVISION
vflik
IF ter' DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
PERMIT
„
*hgllraae E02-00731
(714)754-5273 • Fax(714)7544856 • www.ci.costa-mesa.ca.us ELECTRI L 'i RMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 236 E 16TH ST 0 IP 1 Status: FINALED
Suite No Applied: 08/05/2002
Vicinity: Issued: 08/05/2002
Parcel Nunmber: 42520115
Applicant: MALONE, CAROL ISSUED BY: SOK
Address: AUTHORIZED AGENT
Phone: 714-438-1182
Zip
Owner: DENDEL, GERALD F TR •
Address 236 E 16TH ST
Phone:
COSTA MESA,CA Zip: 92627
Contractor: VARDIMAN ELECTRIC
Address: 17150 NEWHOPE ST
SUITE 402 Phone: 714-438-1182
FOUNTAIN VALLEY, CA Zip: 92708
License:658493
SCOPE OF PERMIT
UPGRADE SERVICE TO 200A, 1 BLDG WITH 3 UNITS.
FEE SUMMARY
Quantity Quantity
ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0
Temp service test 50.00 Busway/100 ft $0.00 0
Res.a/c package $0.00 Standing Section $0.00 0
New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0
New Res l3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0
Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0
Lighting Fixts $0.00 0 up to 50 kva/kw $0.00 0
Recept Outlets $0.00 0 up to 100 kva/kw $0.00 0
Switches $0.00 0 over 100 kva/kw $0.00 0
Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0
Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord. No.92-28,§ 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(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 i1 the permit is valued at one hundred dollars($100)or less.)
❑ I certify that in the performance of the work for which this permit is issuedNhallhot employ any person in any manner so as to become subject to the workers'
compensation laws of California,and agree that If I should become subject too4tha workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions. , f
Applicant Signature: - +? ?j' �TjR GD e:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALLSUBJECT in
CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(8100,000),IN ADDITION TO THE MST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 31t$OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.# Class#
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: _ Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
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 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑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 apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 0 No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
6 (If"yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signature Of Legal Owner(s) Data
And/Or Authorized Applicant Date
CODE 0 INSPECTION TYPE PATE INTRULS CODEC INSPECTION TYPE PEE INTIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical 410/10
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
i
Service to 200a 530.50 1 Misc. Conduit $0.00 0
Service to 1000a $0.00 0 Misc. Conductor $0.00 0
Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0
Motors to 1 hp $0.00 0 Circus (mech ride or lights) $0.00 0
Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0
Motors to 50hp $0.00 0 Fireworks Stand $0.00 0
Motors to 100hp $0.00 0 Other Electrical Fee $0.00
Motors over 100hp $0.00 0 Communication
drops $0.00 0 Investigation Fee $0.00
Sub panel to 200a $0.00 0 Plan Check Fee $0.00
Pole Light Pkg $0.00 0 Reinspection Fee $0.00
Sign Circuits $0.00 0 •
Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $54.00
Intermed Pole $0.00 0
COMMENTS/ SPECIAL CONDITIONS
`y111 M - 'CITY OX COSTA MESA •
< BUILDING DIVISION
>. DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
F 1 �..7ar ' PERMIT
4, E02-00731
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 236 E 16TH ST Status: ISSUED
Suite No Applied: 08/05/2002
Vicinity: Issued: 08/05/2002
Parcel Nunmber: 42520115
Applicant: MALONE, CAROL ISSUED BY:
Address: AUTHORIZED AGENT
Phone: 714-438-1182
Zip:
7D
Owner: DENDEL, GERALD F TR EX i�� 1�/,i
Address 236 E 16TH ST ane. f - , II
Phone: L+�
COSTA MESA.CA Zip: 92627
Contractor: VARDIMAN ELECTRIC
Address: 17150 NEWHOPE ST
SUITE 402 Phone: 714-438-1182
FOUNTAIN VALLEY,CA Zip: 92708
License: 658493
SCOPE OF PERMIT
UPGRADE SERVICE TO 200A, 1 BLDG WITH 3 UNITS.
• FEE SUMMARY
Quantity Quantity
ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0
Temp service test $0.00 Busway/100 ft $0.00 0
Res.a/c package $0.00 Standing Section $0.00 0
New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0
New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0
Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0
Lighting Fixts $0.00 0 up to 50 kva/kw $0.00 0
Recept Outlets $0.00 0 up to 100 kva/kw $0.00 0
Switches $0.00 0 over 100 kva/kw $0.00 0
Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0
Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0
Service to 200a $30.50 1 Misc.Conduit $0.00 0
Service to 1000a $0.00 0 Misc.Conductor $0.00 0
Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0
Motors to 1hp $0.00 0 Circus(mech ride or lights) $0.00 0
Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0
Motors to 50hp $0.00 0 Fireworks Stand $0.00 0
Motors to 100hp $0.00 0 Other Electrical Fee $0.00
Motors over 100hp $0.00 0
Communication drops $0.00 0 Investigation Fee $0.00
Sub panel to 200a 50.00 0 Plan Check Fee $0.00
Pole Light Pkg $0.00 0 Reinspection Fee $0.00
Sign Circuits $0.00 0
Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $54.00
Intermed Pole $0.00 0
COMMENTS/SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§ 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626 .
2446.46(WOO)
DECLARATIONS r' . ..
I
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.
c1.1fr-`Fbave and will maintain workers'compen lion Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is 144ired.
My w e compensat n 1 ranee oar' r and policy number are: \1
Car-de-let" \1 p�(.• Policy Num ��`\V1�1- �Q
(Thiseection need nnet be completed if the permit/s valued at one hundred dollars($100)or less)
❑ I certify that in the performance of the work for which this permit Is issued,I shall not employ any person In any manner so as to become subject to the workers'
compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with the rovislons.t1 �l� �j /�
App nLSlgnature: CSrc-A. \\ SIN cYCS. JDatB1 O - —OC7`-.
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST.AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affiml.that I am.lt used under rovi to hapter 9(commencing with Section 7000)of Division 3 of the Businese\ind Professions Code,and my license is In full
force and effecHJc74— � Class d\ �`__
Colt s Signature: —L Nk �Si �A-'t D� ci -0 ..
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($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. 0 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:
❑ I hereby certify that no excavation five(5)or more feet In depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 W III tho applicant or present or future building occupant need to file and certify a Business Plan for emergency rosponse to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure). _ - _
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application aermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes 0 No
(Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Cade).
_...._ bySafety ..._...._ .. r th.._
7 application,If a permit-Ire; the South Coast res Qualitycri ed Management Californiais Healtheal or anddhSr airtpollution coon 4l district3 or aadecy is required far the work which is the subject of this
have all of the disclosures prescribed Celifomia Sefe Code Section 42303 been made? 0 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 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
cored.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I
agreegr( not to occupy or allow occupancy of any building authorized by this permit until final inspection.
nature Of_Ifagel App s) ' �,� R 06-- 5!\,�
z `�\___i-- -•Y. ``� rr--Date--5
-
CODE r INSPECTION TYPC Oa M .5 cQDEk grSPEcT10N TYPE PATE ICA.LS
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
.. • , ,,
. .
COUNTY OF ORANGE Application For Building Permh..
BUILDING DEPT. Permit No 27// (`'44/
636 No.Broadway AND FOR A
Santa Ana,California
Phone:KI 2-6211 Certificate of Use and Occupancy
• Date. S C ? -t
/
1. OWNER'S NAME --....).0 V-- 'D\= 0 s) G. L., PHONE•
MAILING ADDRESS 2.21- 0 • k (c, fl-k . %+- CITY CO SNA.
Name --C.c,,Xi \--C\ ..... ...... Name 0..W ki.g. P- •
(Accratc-ct.ot-Engineer) (Contractor)
Address LV)A1t•:7;A .......... Address
city Cw..0. ..77 lE\ sc`i\ ,..5 er • City
StateState
Lic. No Phone ... coay‘--AA. Lic. No Phone C.17.1.I-vu
PROPOSED USE:. \,..t...S C) Q......\t/.-.. c'.. kA.0 P •
2. JOB LOCATION 7-2....).... l Co I \et,. SA-. Co -r"Ps. tela%14 •
(House No.) (Name of Street) (Town or School District)
NAME OF AND DIRECTION FROM NEAREST CROSS STREET.....o.R.A.NG.E. - \41...).W.,..S.T......
.3.,i LEGAL DESCRIPTION: Lot Block Tract
-.A. (Metes and Bounds Description-Use reverse side of form)
4. CORNER LOT ( ) INTERIOR LOT ( ‘.....-ar THROUGH LOT ( ) SLOPE OF LOT (V € \.1 e.I
5. SIZE OF BLDG.:h l--Y- Cs' AREA 42.7.14-' SIZE OFLOT:Sri 1 31/2".......AREA•
c. , „
6. HEIGHT OF BLDG • 7 a CEILING HEIGHT- 2 1 NO. OF STORIES /
7. NO. FAMILIES Size of Smallest Bedroom- Size of Kitchen
8. EXTERIOR WALL CONSTRUCTION- FRA.M..E INTERIOR WALL COVERING Darn/9i. 4_
(Frame,Stucco, Etc.) (Plaster-Drywall, Etc.)
ROOFING COVERING cam...pos.471.o. IQ ,
9. STATE HOW MANY BUILDINGS NOW ON LOT AND GIVE USE OF EACH Win A/ E
10. SETBACKS: Front Yard From Center Line of Street I
- r
Nearest Side Yard s5Rear Yard S Distance in Feet Between Bldgs. on Same Lot
(Property Line) (Property Line)
11. A COMPLETE PLOT PLAN IS REQUIRED, SHOWING ALL STRUCTURES AND USE OF EACH.
I.,12. (a) Footing: Width if..:: Depth in Ground I Q " Width of Wall----------
(b)
(b) Size of Studs:,.:.2..X.V Spacing / 6i-, "CC Material of Floor Slaek COX Ceit....
(c) Size of Floor Joists' - Spacing "CC
1 re
(d) Size of Rafters' ax c, . Spacing -47-Se "CC
13. VALUATION OF PROPOSED WORK: Including all labor, plumbing, electrical wiring, heating, fire sprinklers, painting and
sewage disposal $ tan
14. I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION IN THIS
APPLICATION IS CORRECT AND THAT THE CONSTRUCTION WORK WILL CONFORM TO ALL LAWS OF
THE COUNTY OF ORANGE AND THE STATE OF CALIFORNIA APPLICABLE THERETO.
Signed-
(Owner)
Plans Filed' 9-/Q -6-•"1- ..
By• ./..2. a...ve ?Re )fract-,
(Authorized Agent)
FOR DEPARTMENTAL USE ONLY
FEES: . CHECKING BY
" oil
Bldg. Permit - $.. ‘1... .. GROUP.,,J. . APPLICATION ,W3 HEALTH
/ 6 Ci
Plan Check • $ TYPE -..V---• ZONING L.------ FIRE
cL....____
Total - • • $ ,.`---5- "--"---- DIST. ,.--,
Receipt No. nil 7 'y i? ---59.• MAP `-----
. R iii • PLANS AND MARSHAL
SPEC'S STATE
Paid to • - ...-59 • SHEET NO --. • CORRECTIONS ENGINEER
Date 4 -2 --c7 VERIFIED CAL
. . .
PERPL. "'PIP '4 ' 'di If, "Urr_13UTOLR1)1
DATE 9- / ;) - __,-,:, -----,--' A.-
5000-7-52 ) I 1 NI
i ..-.....- _____
--,
METES AND BOUNDS DFSCRIPi. 4 '
•
_ gin. . _ . .. ., . zlo •
'o� o 510 610
de
=MUM MEMO
SOMMEMOMMOMMENIMMEMEEMMENEMEMMEMEMOMEMMEMEEMOMMOMM
_
•
•
4` MF A 4 ', CITY OF COSTA MESA '
oft
BUILDING DIVISION
� , DEVELOPMENT SERVICES DEPARTMENT PER IT NUMBER
Ft t
PERMIT
00-01322
Sbab•ourixfr
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesaDING PERMIT ar 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 236 E 16TH ST Status: ISSUED
Suite: C Applied: 08/29/2000
Vicinity: MIDDLE SECTION OF RESIDENCE ONLY. Issued: 08/29/2000
Parcel Number: 42520113 Zoning:
Applicant: CRANK, JIM ISSUED BY:WY
"!�
Address: 126 COMMERCIAL l/
Phone: (949)548-5569
COSTA MESA,CA Zip: 92627
Owner: DENDEL, GERALD F TR
Address 236 E 16TH ST
Phone:
COSTA MESA,CA Zip: 92627
Contractor: CRANK BROTHERS ROOFING CO
Address: 126 COMMERCIAL WY
Phone: (949)548-5569
COSTA MESA,CA
Zip: 92627 License: 408677
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
REROOF:T/O, INSTALL B.U.R.(MIDDLE SECTION OF BLDG ONLY).
1400 SO FT. k C
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $3,991.00
Permit: $97.25 Claim Valuation: $3,991.00
SMIP Res: $0.50
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $97.75
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 expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
244S-48 WOO)
DECLARATIONS` t'
WORKERS'COMPENSATION DECLARATION: •
I hereby affirm under penalty of perjury one of the following declarations:
0 I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
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'compensati�n Insurance carrier and policy number are: 14.-/
r7
carrier: 4,/44- ?Limey fru y 79A3736 Policy Number: '(-2U 7 S37}
(This section need not be completed if the permit is valued at one hundred dollars(S f00)or less.)
❑ I certify that in tLormance 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 o ••Ifomia,and agree that I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these pro isio c •� p
—/--"
Applicant Signature: /J_ — _ Date: ' 2c o
WARNING:FAILURE •S URE WORKERS'COMPENSATION COVERAGE IS UMAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
• •THOUSAND ••E ••,000),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR COOS.INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am II d under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full
force end effect.Lie.a 1/0 5 C `' 7 Class a G — 3 `)
Contractor's Signature: Date: if--t-2. y—CC)
CONSTRUCTION BIG 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,CMI Code).
Lenders 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.It however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ 1 am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. 0 Yes 0 No Driver's license No. Expires:
Verification of Ownership by(type of document,i.e..property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will bo more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title B,California Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
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
materiel? ❑Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one lime during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or 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? ❑Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this implication apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes IJ 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 0 No
8 (If yes',attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penally of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-descri: roperty for inspection purpos:' agree-;•t to occupy or allow occupancy of any building authorized by this permit until final inspection.
Sign: • L-> I•. '=!(s) Date QC
.,.r • theft:• •plicant Crate
CODE f, INSPECTION TYPE PATE R{j117A45 conn( INSPECTION TYPE QML BMW
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1268 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 1-7-0C (,4.-k.- 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 Buiiding/Occupency
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
P RMIT NO TRACT NO. LOT NO. UNIT NO.
CITY OF COSTA MESA CONSTRUCTION PERMIT I IC o 36, I A.P.# Zone
Project Address 236 E. 16th Street ` t v�lIvs�t��� LI $ Main Building: Accessory Building:
Applicant's Mailing Address 126 Com erc i a I Wa C.M. TYPE OF C6NSTRUCTION U NEW LI ADIXXXi(ALTERATION u REPAIR . E Front Z
I CI CONVERSION CI DEMOLISH CI OTHER T 0
Owner's Name �• '� Phone DESCRIPTION OF WORK/USE OF BLDG.area of 36'x101 : apply
I A Rear -, N
Address 1-281 8 2-111 w, h. a •halt and •r.v- I New meta C R;gnt N
Arch/Eng. License No. TYPE OF PERMIT U GRADING II FOUNDATION II STRUCTURAL
Address ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL S Left R
❑ OTHER I Ping. Ref.# ParkingRe E
Contractor's Name Crank Bros. Roofing Phone 548-5569 q./Provided
Address(mailing) 126 Commercial Way. C.M. 92627 PROJECT DESCRIPTION SQ. FT. 360 OCCUPANCY Planning Notes: Q
City License No. 005993 CONSTRUCTION TYPE VALUATION $ 665.00
T
ZONE GRADING CU.YDS. ACRES $,
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed unger provisions of Charter 9 (commencing Remarks:
with section 7000) of Division 3 of the Business and Professions Code,and
my license is in full force effect. ELECTRICAL FEES
License Class C-39 se No. 408677
Data Signature .F �1 PLUMBING FEES Automatic Washer Transformer D 15-50 KW
i
WORKERS'COMPENSATION 0 ON Bar Sink Showers Construction Pole Sub. ❑ 50+KW
I hereby affirm that I have a certificat consent to self-insure or a certificate _
—';Workers' Compensation lnsuran , or a certified copy thereof (SectionCooking Unit Meter ❑up to 100 amps
10, Lab. C Backflow Preventer Service Sink
silky No. z89/224-89 Company State Fund Backflow Irrigation Sewer Cap _ Dishwasher Meter Dover 100 amps
❑ Certified copy is hereby furnished. / Dryers ❑Gas ❑Electric Sub Panel
(Certified copyIs filed with the city Bu';mss- �-" / Bathtubs Sewer Connection
D• ate-10/ /R9 Applicant ,/tJ/f —r Fan
EXEMPTION FROM WORKERS'C• • PENSA r•" DECLARATION
Clarifiers Solar Collectors Motors❑01 HP 01'A--8
(This).section need not be completed if the pe,' is for one hundred ($100) or Dishwasher Solar Piping F.A.U.
lesInc.Solar ❑9-15 HP 016-15+less).
I certify that in the performance Of the - ork for which this permit is Issued, I - Fixtures
shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Microwave
Workers' Compensation Laws of California. - -
Date Signature _ Floor Drains Swimming Pool w/Spa Device Boxes Pole Light .
NOTICE: If,after making this declaration,you should become subject to the Outlets Range
workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal
comply with such provisions or this permit shall be deemed revoked. -
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Switches Sign
I hereby affirm that there is a construction lending agency for the performance
of the work for which this permit Is Issued (Section 3097 Civ. C.) Interceptors Water Heater Garbage Disposal Standing Sections
Lender's Name - -
Lender's Address Kitchen Sink Water Service iS
Generator 00-5 KW 05.15 KW Trash Compactor .
OWNER BUILDER DECLARATION - / v
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash
following reason (Section 7031.5 Business and Professional Code: Any city or - •
county which requires a permit to construct,alter,improve,demolish or repair P—Trap Laundry Trays
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 Roof Drains
the Contractor's License Law(Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code) or that he/she is exempt Reinspection Fee ! $15 Issue Fee '. $ 3
,refrom and the basis for the alleged exemption. Any violation of Section
31.5 by any applicant for a permit subjects the applicant to a civil
fatty of not more than five hundred dollars($500). DEVELOPMENT SERVICES REQUIREMENTS:
Li I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 Zoning Approved By
compensation, will do the work,and the structure is not intended or offered - Date
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES Building Approved By Dat
License Law does not apply to an owner of a property who builds or improves
thereon, and who does such work himself/herself or through his or her own Hood or Type ❑ ' Application Issued By Dat
employees, provided that such improvements are not Intended or offered for Boiler
sale. If, however, the building or improvement is sold within one year of com- Canopy Type II ❑ SUMMARY4F FEES
pletion,the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Q� ��
prove fGbr the purpose of sale). BUILDING PERMIT $ I _ SMIP $
❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System PLAN CHECK $ PERMIT
tractors to construct the project (Section 7044,Business and Professions Code:
I
Thn pntractor's License Law does not apply to an owner of property who Duct-Ventilating ❑0-100,000 BTU ❑100,000 BTU PLUMBING $ ISSUANCE
r $
Dhnos lb improves thereon.and who contracts for such oroiects with a con-
tractortsl license pursuant to me Contractor's License Law). I am aware that Exhaust System ❑ Multiple 0 System Repair/Alteration PLAN CHECK 25% $ ENERGY P.C. $
proof of their worker's Compensation Insurance should be provided to me. ELECTRICAL $ GRADING $
❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.BIt. ICBO# Fire Dampers
PLAN CHECK 50% $ MICROFILM $
I Date Owner Heating System& Ducting Registers MECHANICAL $ TOTAL FEE $ ( I )�
I hereby certify that I nave read this application and state that the above 00-100,000 BTU 0100,000 BTL
• information Is correct.,••ee to +mply with all city and county ordinances - PLAN CHECK 25% $
and state laws reiatin•/f• •uil•'.- construction, and hereby authorize repre-
sentatives of this c T: son the above-menti.ned property for
inspection purposes 10/2/89
Signature .�. Date _ _
••— - • Reinspection Fee $15 Issue Fee $ 3 - l�- - r•n -'sf•^ 11" t-
Drivers' License or SS# - - r
r 0865-46,rev. 5/88 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor -
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. I// . 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd. �•'
8. Foundation 1/` 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 1- , 60. Backwash Lines, P-Trap, O Undrgrnd.
•
10. Structural Floor System • 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection I' 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:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
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 lo°6
Sinoit6 peT oil .
48. Special Requirements Completed
49. Electric Release to Edison
-
50. Gas Release to Southern California Gas Co
•
51. CERTIFICATE OF OCCUPANCY
No. Date -
OWNER DENDEL, GERALD F. DATE 7-13-79 r� 0
JOB ADDRESS 236 East 16th Street BUILDING PERMIT NO. 48414
GENERAL CONTRACTOR Owner-Builder DESCRIPTION of WORK Room Addition
A'"o. -17-151-21 LOT .. TRACT FIRE ZONE VALUES 10,300.00
II _CTIONS • Signature Date TYPE V GROUP I ZONE R-2
F. SOIL r'--.. gAplllf SUBCONTRACTOR PERMITS ISSUED
"l
GAS Dote Number Signature
WATER
S^UU 1•40,21 Plumbing
ROUGH PLUMBING 1++ 1„4/13 G !/•7L •7
PROP. SWR. LINE I 1 HOUSE CON. ❑ 7/751 n ��
SPRINKLING SYSTEM /MISCELLANEOUS �L�i..�
ROUGH HEATING AND AIR CONDITIONING I t L-110114 •
TEMPORARY SERVICE OR POLE
UNDERGROUND E POWER ® 0 at
ROUGH WIRING 1C CSR C•. /O•anti Heating,/ands Vent. �y n
TRENCHES _, FORMS STEEL REINF. 9.-,42-549
-,z 2 . . (�zitoi 0 /0//179 //CMO
FLOOR SYSTEM 1 9-n-
BOND BEAMJ-I STEEL REINFORCE n
SHEATHING
FRAME AND FLASHING /�
LATHING - IN LCy OUT 7 _2�_�7/
PLASTER. BROWN COAT YLf'Ae
S 'TUBAL. FINAL Electric
F. NG. VENT., REFRIG. AND A.C..,,FINALFII /pH,Ii �ooi.o r Clic c#o I C 7-30"77 L/(4 R2 --
PLUMBING. FINAL AND GAS TEST I� �,%(�''(',(} / /'/, ED
ELECTRIC. FINAL -! •
enn niun ciun� / t..•
uFE4_ 4474 Go. e. C. i0-2Z- 7,
iEl)SLa.( I l5' Qa
„k#852 84.72 TL
COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATIO 6tIE TRUQTBRA1.PERMIT 84.72 TL
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 S”'`
RECEIVED BY PERMIT t�tB 48414
For Applicant to Fill in Completteelly/}— Use
Ink Only N2
1 �7 1�1
BUILDING -� `6 (0 I/ ik c/ G /"fes A.P. NO. t t l — I5 [ D— I
ADDRESS - DJ Vf ^^ '�//�� C _
OWNER OR �( _ /� (� `/�L ADDRESS 23 /6 EF Sr
TENANT ��/�jjj,JJJLNNNt---CCLdC eJ-t`/ UNIT OR
MAILING 3:6 c Up �,Q SPACE NO.
ADDRESS t,p �l.{r�
T'.Ne. LOT Fbreat-C JBLK.
• y
TEL. ��.p� I �-
WI 3
CITY
NO. 5-/ D
CONSTRUCTION NEW •`e/D ALTER REPAIR (MOVING DEMOLISH
LENDER sr
BRANCH
OWNER
ADDRESS `,� USE 2u . 400. VALUES a
ARCHITECT y� n0 TEAL./ �1c 61r \ D���
ADDRESS en t4-n� tPo. OR ENGINEER -,a.,JV �//110�.�1 77P ZONE IQ� TYPE GROUP
D bo er' J �'�^4�MO• W.
r _ h- 1^ Loges'
N s'
APPROVED
/ CONT ��-y0,"�-�>7s.gt 1� e/�s,� Jp�/.. FeAP DATE
• A9QS&BS Car•• WN ` V"4
TEL.
r. CITY NO.
STATE CITY APP OV SETBAC pp //q -/
LIC. NO. LIC, NO. //YT07y1 /,(/1°S.C.17 C7/FL't ei4-1 T70ri
SIZE '1 6 I I / NO.OF BLDGS. .-I (KKKFFFiiFiFFiiiiiiOM C/ TR ) /
CW. OF LOT I �''�I Z ?�I• -- NOW ON LOT I+ FRONT .
Q EUSE OF �/__`
r EXISTING BLDG. R.SIDE EL
12 I Z/
/�
F ` Separate permits are required for L.SIDE FT. O� r
electric,plumbing and heating work. /
iO REAR 0 / _ ,
• USE OF BUILDING AND W TtQ9E PERFOFj1AED PLANNING ACTION
O
r• i{>( / /^ DATE ra7- 1
F //./ ZE- 16. APPROVED y-d
/ APPR(p�V�ED �//� ^7
GLI 52.74:0 .011 i 6 !i[G✓y0o/7, 11711
al
0 I hereby acknowledge that I have read this application and state q _/' /1 1 N
CC r that the above Information is correct and agree to comply with 6h���'�`�1 un
/!�i'S //>>y( jJ cc,
17/'rM y/
L t all laws regulating building construction, and I shall not employ 474 >(/ e /y Cu,/il /es /If j Gc[/1L,sted }
Z any person in violation of the workman's compensation laws of _ e _, _ . .t 2
W7," 4 the State of California. x L. .t
SQ. FT. m N
• I hereby certify that I am properly licensed as a contractor under
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the provisions of the State of California Business VALUATION PERMIT FEE S 5-6Y
and Professions Code,Division 3,Cheater 9. m
Signature of \`\P) PLAN CHECK S Zig%QQ
V n
Jima
U.
Permittee ' �� ' •S /0 3004°TAX S 0.72
Or U
Authorized Agent Date ..).!....... ' / TOTAL PAID S et,67 z
1—
OWNER G. F. Dendell DATE 11-6-58 _
JOB ADDRESS 220 E. 16th Street BUILDING PERMIT NO. 7938
GEN pt CONTRACTOR Owner Builder VALUE $ 38.00
l�'�— X21 LOT TRACT FIRE ZONE DESCRIPTION'OF WORK Fedwood Fence
GROUP TYPE ZONE PLAN NO.
I. ECTIONS DATE SUBCONTRACTOR PERMITS ISSUED
DATE NUMBER
Trenches Forms Steel
Floor System
Steel Reinforce Chimney Re-Rod
Bond Beata
Frame and Flashing
Lathing, In Out
Plaster, brown coat •
Underground soil W/G Pipe Test
Top Out _
Furnace
Gas Vans
Rough Plumbing
Cesspool Septic Tank
Prop. Swr, Line House Con. St. Swr.
Sprinkling System
Heating Final
Plumb;nq Fixtures, Final
Fin as Test
Cnstruction Pole
Underground Power
Rough Wiring
Fixtures, Pinal •
OCCUPANCY c94
Form 210-5M-1-57T
7938
COSTA MESA BUILDING DEPARTMENT '
P. O. BOX 317 ��(�_����® I 9938
COSTA MESA CALIFORNIA ci �J 1
1i 1S• i , ` FOR APPLICANT TO FILL IN
C.L.• OF STREET------ ���C it tan BUILDING ADDRESS n- 0 f bSi'
� �` a '(A
// � __„_...-PROP LINE _ ('Ai C la Owner i' . ^ �n._ ,t1 .�
ry --~ -- {�12 FT. 61N. FOR -f \ i �r_ e ✓ l
10 FT. FOR 60 FT. STREET-I-
TREET[ 50 FT. STREET I Mail Address
n ,
City ( ..-. -Cr . t''t+' -.*', Ph. No. I-P 1; 4 d l r.
' � • Contractor 0 LO k e r Ph. No. y
' � I Address
50 FTI IF FRONT City Lic. No. State Lic. No.
I J OF PROP. I- - / /-
150 FT m Size of Lot 7 X j'3 rIi SAP No. j�/,7y- F ( � /¢
w Z N Setbacks: C/L Street 5 A ' R r J
z - m a Side Yard - Right r Left
N r ('T��--� a p o Type of Fencei w c o £ - C. 3P
ALLEY OR PR•P LINE\In n cs
•o.
N.
-I CO tti._ in w NI -1 V
I hereby acknowledge that I have read this application and state
that the above is correct and agree to comply with all City Ord-
ti _ 1 2 a inances and State Laws regulating building construction.
, 0 . c `i
\ �- S p n F Signatureft \Q,\J (� —
di' in Z J n 10 of Permittee �, tQ
il .r U - FT Agent
37 6 I N. .- 2 ' i- • FOR OFFICE USE ONLY
FT ta -, F' a. m a 40
ZV N a FT 1
Z — G Pra�§)
o m
d _ pgt 60 FT ST. Received by Date Received Date Issued
50 FT. ST r P i 6� 34i/ t F I /�/ //- 6 -S P /i - G -S d7
PROLINE tP t` -V _ VALUATION -72ti O-O
Permit Fee $
L � 3dY ° —
$ Plan Check $
C.L. OF STREETS jpir . 6-0
TOTAL FEE •$
MAXIMUM 4 FT. FENCE MAY BE PLACED ON DOTTED LINES -- - ---
MAXIMUM 6 PT. FENCE MAY BE PLACED ON SOLID LINES USE REVERSE SIDE FOR DETAILS
Costa Mesa Building Department / /APPLICATION FOR PERMIT
111 EAST 20th STREET IMO BUILDING - 1
COSTA MESA, CALIFORNIA - ---- - '
FOR OFFICE USE ONLY I
FOR APPLICANT TO FILL IN ceipt No. Permit No. ,
Building • : //o//-7 - 9It '
Address 222 E&St 16th at. .: "T t� / / a;,
Recei (f led'by ' Date ec'd. Date Issued 1
Costa Mesa, California
Nearest I'lestminigter
Cross St. Building
Address ,
Owner Mr_ anti M.rs.. .I..e.nripl ' Costa Mesa, California
Mail 220 East 16th st.
Address Nearest I '
Tel. Liberty Cross St.
City (Ina 1;a Maria Cal - No. P-13119 Zone ,r.),/ I No.of I Type I Group J.
Architect or Lic. does no A� 7' Plans •
Engineer pippin (Owner) No. Approved
apply by ' • Date .
P "rens CORRECTIONS
city Licaces •
t.on }�
tractor py (Owner) No. .
t,ol, apply
Address _®'. •. �`_l, •
Legal Lot X1/1 ._ _ '.._ - l; j '` t •
Description I No. 53 I Block 1, rac{ - �- ( t,
7 ,�f
(Attach Metes and Bounds /,/. $. /� _ /C/_,2( -- R F •
75x737.5 I Nowo?doitwo 1955 i
Size of Lot .- - - --- - - 0
Use off nobby shop and' ksnie I No.of Ct OF Q A
Existing Bldg. Families 1 Rooms5 ��////ttQ 41
Setback Line fromA1'aB'a Rear Yard -• - -et)STA_-E[p - - - - —
Center of Street 'aO I Side Yard ry/CCJJ� y
DESCRIPTION OF WORK1 ���i1��
�, � � r
New X I - I Alteration I I Addition I 6_;.:- : r_Sy
_Repair I I Moving I I Demolish
; Building No.of
Sire Rooms Stories
' rior Wall Roof
L. .ringBue df New i - C vering APPROVALS
-GO C3 fie.
Building garden wHll Foundation Materials,
.Insp c or0/51(
Forms,Materials, 111/,µ/-Under-Pinning
�r2a or Frame: Fire Stops,
X_�ti , !¢-t - _- Bracing,Bolts b dJ
J/ Lath. Int. .tj'(J)t.-
I hereby acknowledge that I have read this Application
and state that the above is correct and agree to comply Lath.Ext. L C44 a
with all City Ordinances and State ws re Mating
building constrruu¢jon. Plaster, Int. cr2Cr
Signature of v,• �
Permittee _ .
Plaster, Ext. / 6/Z4-2'
Authorized Agt. �Gp/y �/; /
�. Masonry Reinforced '"'''++''moi -j
Valuation p V Permit Fee $ y7 Q 0 "i ��/�j
'54 6.7
GI. Plan Check $ • Bond Beam
$ TotalQ Q //
� FINAL �1 ' —�J.,
dervi Fee $ �t,n. c_rr ,M ,o_ci /
: if` le / 5J'J 17.,, ccot., „ 6i.
sl IpCdUtItit `I eh
11
c c oa 35 bh C Q tlrtap
ci
CJi
all ^43 a
a �I
It
•
Jno •
•
rotity p°=td L16
1
1
f(pthStreet
PLOT PLAN
Show location and distances from
property line and between buildings.
;As\
•
tz. qse,
CITY OF COSTA MESA `
"' BUILDING DIVISION
F� 77 FAIR DRIVE, COSTA MESA, CA 92626 •(774) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
°. � FOR INSPECTIONS CALL: (714) 754-5626
�.o,m,m•��
� PERMIT NUMBER: B07-00865
PERMIT TYPE B_ROOF2 O�
APN: 42520115 �
JOB ADDRESS: 236 E 16TH ST CM
Vicinity: RESIDENCE AND ATfACHED GARAGE
Squares: 2600 � ,
STATUS:
DATEISSUED:
ISSUED BY:
Suite/Unit:.
Valuation:
ISSUED
07/20/2007
BJK
$10,000.00
SCOPE OF WORK: REROOF RE$ & ATTACHED CARPORT: T/O 4 SQ CAP SHEET ON CARPORT; REROOF OVER EXIST RES ROOF WITH
1 BASE SHEET, 1 PLY, 1-72# CAP SNEET 8 HOT MOP. 26 SQ
OWNER: DENDEL, GER4LD F TR
PHONE:
Address: 236 E 16TH ST
CirylState/Zip: COSTA MESA, CA
Unit:
APPLICANT: FLORES, JACOBO Address: 29222 RANCHO VIEJO RD Unit: :SUITE 127
PHONE: 949-542-7265 � City/State/Zip: SAN JUAN CAPISTRANO, CA
CONTRACTOR: CRANK BROTHERS CONSTRUCTION INC License No. 458773
Address: 29222 RANCHO VIEJO R6Unit: � SUITE 127 � PHONE: 949-542-7265
City/State/Zip: SAN JUAN CAPISTRANO, CA � 92675 CELL:
ARCHITECT:
ENGINEER:
FEE SUMMARY
Reroof Plan Check:
Reroof Permit Fee:
Reinspection Fee:
Bldg Std Admin Fund
TOTALFEES
$0.00
$181.25
$0.00
??
$187.25
License No.
License No.
PHONE:
PHONE:
NOTICE: The vrork authonzed by thig permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21.g2)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
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 8nal approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of Nis permit.
0� INSpEClIONTYPE p1/ � INTIi11L5 CODE� INSPECTIONTYPE DATE INiliL1L5
1616 Fixed System Final Fire Prevention 206 Final Mechanical
7288 Pool Spa Final 208 Final Plumbing
200 Final Re-Rool 2 0 � 210 Final Electrical
201 Final Block/ReWining Wall � 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 FinalSign 222 Final Site ��
204 Final Demolition 250 Final Building/Occupancy � �
WORKERS' COMPENSATION DECLARATION:
I hereby affrm untler penalty of perjury one ol the following tleclarations:
❑ I have and will maintain a certificate of consent to selFlnsure for workers'
compensation, as provided for by section 3700 0! the Labor Code, for the
peAormance of the work for which this permit is issued.
❑ I have and will maintain v.nrkers' compensation insurance, as required by
seclion 3700 of Ihe Labor Code. (or the peAortnance of the work fw which this
permit is issued. My vrorkers' wmpensation Insurance cartier antl policy
number are:
Cartiec
(itis sttltn nee0 nof be mrriyete0/Ihe pertrN is vahretl af ma �vidred cdars (St00) a less )
Policy Number:
❑ I certify that in the peAortnance of Ihe work !or which this permil is
issued, I shall not employ any person in any manner so as to become suDject
to the vrorkers' compensation laws of California, and agree that il I should
become subject to the vrorkers' compensatlon provisions of Section 3700 of
Ihe Labor Code. I shall lorthwith tomply with Ihese provisions.
Appliranl's Signa�ure Daie
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION CAVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CNIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,OW), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm that I am licensed under pmvisions of Chapter 9(commencing
with Section 7000) ol Division 3 of the Business antl Professions CoOe, antl
my license is in full force and effect.
Lic. # Class #
Comraclor's Signalure Date
CONSTRUCTION LENDING AGENCY:
❑ I hereby aKrtn that there is a construction lending agency tor the
pertortnance of the wurk for wfiich this pertnit is asued. (Sec. 3097, Civil Cotle�.
Lenders Name:
Lender's AtlOress:
SignaWre Date
OW NER-BUILDER DECLARATIONS:
I hereby aKrm ihat under penalry of perjury that 1 am EXEMP7 FROM THE
CONTRACTORS LICENSE LAW for the follOwing fea5on (SeC. 7031.5,
Business and Professions Code: Any city or wunty whith requires a permit to
wnsWct, alter, impmve, tlemolish, or repair any structure, pnor to its
issuance, also requires the applicant for such permit to file a signed statement
that he or she is licensed purSuaM to the provisions of the CoNrectors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business and Professions Cotle) or that he or she is exempt therefrom and
the basis for the allegetl exemption. Any violation of Section 7031.5 by any
applicant for a permit subjects ihe applicant ro a civil penalry of not more than
five hundred dollars (5500).):
❑ I, as owner of Ihe property, or my employees with vrdges as lheir sola
compensation, WILL DO THE WORK, and t�e structure is not intended or
ottered (or sale (Sec. 7044, Business and Professions Code: The Contractors
License Law tloes not apply co an ovmer of property who builtls or improves
thereon, and vfio does such wurk himself or herself or through his or her own
employees, provided that such improvements are not intendetl or offeretl tor
sale. If, however, the building or improvement is sold within one year of
completion, the ovmer-builder will have the burden of pmving that he or she
did noLbuild or improve for purpose of sale.).
❑ I, as ovmer ot the property, am E%CLUSIVELY CONTRACTING WI7H
LICENSED CONTRACTORS to const�uct the project (Sec. 7044, Business and
Pmtessbns Code: The contractors License Law tice's not apply to an owner of
property who builds or improves thereon, and who coniracts for such project with
a cmt2cta�s) license pursuant to the Contractors License Lav+s.j.
❑ I am exempt under sec.
Business and Professions Code for this reason:
SignaWre
�(IS]L6(3/0])
Owner ID verifed by tlriver'S license. ❑ Yes ❑ No
Driver'S License No. Expires:
Veri(cation of Ownership by (rype of document, i.e. - propetly taz bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
I hereby certify that no excavalion frve (5) w more leet in depth into wi�ich a
pe to tlescen4 will be made in connection vrith work authorized
by t budding struclure, scaf(dtling, falsework, a demolition
or an �e�ore1than thitly-six (36) feet high. (Chap. 32. Grp
2, , Sec. , le B, lilomia Atlministrative Code�.
/
❑ As ovmer- w Wlll�.n employ anyone to do work which would
require a permil lrom the Diws n of Intluslrial Safety, as notetl above, unless
such person has a permil lo do such work from the tlivision.
Appimm's Sipnalure Date
Division ot Industrial Safely Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will Ihe applicant or present or luture building occupant need to file and
certify a Business Plan tor emergency response lo release or threatenetl
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the Califomia Health and Safery Code requires, with some
exceptions, Ihat a Business Plan be fled wilh the Costa Mesa Fire
Department by every business which has at any one time during a reported
year a quantiry ot hazartlous matenals equal to or greater than a vreight of
500 pountls, or a volume ol 55 gallons, or 200 cubic leet of wmpressed gas
at slantlartl temperaNre anC pressure).
2. Dces or will the applicant or present or future builtling occupant need to file
a registration form tor acutely hazardous materials7 ❑ Yes ❑ No
(Section 25533 0( the Cali(omia Health and Safety Cotle, with some
exceptions, requires regisiration with ihe Costa Mesa Fire Department by
each business which at any one time has on hand a quantity of acutely
hazartlous materials equal to or greater than a vreighl of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compresseE gas at standard
temperaWre 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
hazartlous materials)? ❑ Yes ❑ No
(Section 25534 of Ihe Califomia Health and Safery Code provitles Ihat the
Costa Mesa Fire Departmenl may require the preparation, certification and
filing with Ihe Fi�e Department of an RMPP by businesses which are required
lo register acutely hazardous matedals with the Fire Department.
4. I! an RMPP is presenly required, has Section 25534 of the Calilornia
Health and Safety Code been tully complied with? ❑ Yes ❑ No
5. Does or will �he applicanl or presenl or fuWre building occupaN require for
the work which is tha subject o( this appliwtion a permit for such con5truclion
or motlifcation from the South Coast Air Qualiry Management DisMct or trom
any other air pollution control tlistricl or agencyl ❑ ves ❑ No
(Sectbn 65850.2 0l ihe Cali(omia Govemment Cotle requires thal the requested
information be fumishetl on aDPlications fa non-resitlential building pertnils).
6. Will any pah of Ihe facilily to be conslructed under Ihis permit be vrithin
1000 feet lrom the ouler 6oundaries of a school7 ❑ Yes ❑ No
Qf yes", Ihe lacilily must meet the requiremenl of Sections 25534 and 42303
of Ihe Calilomia Health and Salely Code�.
7. If a permit from the Soulh Coast Air �ualiy Management Districl or other
air pollution control district or agency is required for the work which is the
subject of this application, have all of Ihe disclosures prescribed by Calitomia
Health and Safery Code Section 42303 been matle? ❑ Yes ❑ No
8. (It yes", atlach certifcate of compliance Imm the appropriate air polWtion
contml oKcer�.
CERTIFICATE OF COMPLIANCE: I certify thal under penalty of perjury the
information given above is correcl. I agree to comply with all state laws antl
city ordinances regardinq Hazartlous Materials and Emissions.
Signatvre Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
cenify under penalry o! perjury that I have read this application and state that
the information given is correct. I aqree to comply with all state laws antl ciry
ordinances relaling to building conslruction, and authonze represenUtives ot
the City of Costa Mesa to enter upon the above-descnbed property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspection.
SignaWre o! Legal Ovmer(s)
Mplw AutM1orrzeO AOW���� Date