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Home My WebLink About478 20TH ST - Building PermitsJ � CITY OF COSTA MESA ��p~Fq BlIILDING DIVISION i�� 77 FAIR DRNE. COSTA MESA. CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • wvnv.ci.costa-mesa.ca.us : � � FOR INSPECTIONS CALL: (714) 754-5626 Ry�o �` PERMIT NUMBER: P09-00114 PERMIT TYPE PLUM APN: 42625201 JOB ADDRESS: 478 E 20TH ST CM Vicinity: METHODIST CHURCH OF CM STATUS: DATE ISSUED: ISSUED BY: Suite/Unit: ISSUED 09I01 /2009 BJK SCOPE OF WORK: WATER HEATER CHANGE-OUT AT THE "COMMUNITY METHODIST CHURCH OF COSTA MESA" NO OTHER WORK AUTHORIZED WITH THIS PERMIT. OWNER: CHURCH, COMMUNITY METH OF COSTA MESA PHONE: APPLICANT: BLOCK, ROBERT PHONE: 909-532-9506 Address: CHURCH, FIRST METH COSTA MESA, CA City/Stale/Zip: 420 W 19TH ST Address: Ciry/State/zZip: CONTRACTOR: ALL STAR WATER HEATERS INC License No. 812894 Adtlress: 30300 PUERTO VALLERTA PHONE: 800-727-0977 City/State: MENIFEE, CA ZipCode: 92584 CELL: ARCHITECT: License No. PHONE: ENGINEER: License No. PHONE: PLUMBING PERMIT FEE SUMMARY PLAN CHECK FEE: PERMIT FEE: TOTAL FEES: $0.00 $35.80 $35.80 NOTICE: The work authonzed by this permit shall wmply with all applicable handicap access requirements under Califomia statutes and relaled regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authonzed 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 fnal approval will result in the expiration of this pertnit. CODE/. INSPEC710NTYPE RTE INTRULS COOEf INSPECiIONTYPE � INTlnus 1616 Fized Sys�em Final Fire Prevention 206 Final MeChanical � 1266 Pool Spa Final 208 Final Plumbing G � 200 Final Re-Root 270 Final Electnwl 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 Builtling/Occupancy WORKERS' COMPENSATION DECLARATION: I hereby atfrm untler penalry of perjury one of the (ollowing declarations: ❑ I have and will maintain a certifcate o( consent to self-Insure (or workers' compensation, as pmvided for by section 3700 0! �he Labor Cotle. for the ' pgAormance of the work for which this permi� is i55ue0. � ,L, �LL � have and will maintain workers' compensation insurance, as required by � section 3700 of the Labor Cotle, for the peAortnance of the work for which this pertnit is issued. My vrorkeys compensation Insurance carrier and policy number are� � �c /y� j/{/'//J �J _ Carrier. .�/� li�{� "i ��`�'�' � � "�'"� - (inis section need iro/16+e wmpelentl a rne permrt is valu/ed� ar one nunMcd IXYlors (St00) a kss ) PolicyNumber. l � /' ��V� � ❑ I certify Ihat in �he peAormance of Ihe vrork for which this permit is issuetl, I shall not employ any person in any manner so as to become subject to the vrorkers' compensation laws of California, and agree that if I should become subject t he ikers' compensation provisions of Section 3700 of the Labor Cod ,� a� witl7 ly " ese p�o�/' O� � qp0lipnYSSig Wre Dale, WARNI G: FAII.URE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affrm that I am licensetl under provisions o( Chapter 9(commencing with Sec�ion 7000) of Division 3 of the Business and Pmfessions Code, and my license is in full (orce and eftect. �Lic. # �' . � Class #_ — � �� Contra s Signalure Dale CONSTRUCTION LENDING AGENCY: ❑ I hereby aHirtn that ihere is a conslructbn lending agency for ihe peAormance o( the work ta which Ihis pertnit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Adtlress: Dale OWNER-BUILDER DECLARATIONS: I hereby aKrm that under penalty of perjury ihat I am EREMPT FROM THE CONTRAC70R5 LICENSE LAW for the follovnng reason (Sec. 7037.5, Business antl Professions Cotle: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any sWcture, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or sha is licensetl pursuant to the provisions of the Contractors License Law (Chapter 9(commencing with Section 7000) of Division 3 of Ihe Business and Professions Code) or that he or she is exempt therefrom an0 the basis for lhe alleged exemption. Any violalion of Section 7037.5 by any applicanl /or a permit subjecls the applicant to a civil penalry of not more than 6ve hundred dollars (5500).): � I, as ovmer of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the slructure is not intended or oHered for sale (Sec. 7044, Business antl Prolessions Cotle: The Contractors License Law does not apply to an ovmer ot propeAy who builds or improves [hereon, and who does such work himself or herself or through his or her ovm employees, provided that such improvements are not intentled or oHered for sale. If, however, the building or improvement is soltl vrithin one year of completion, the owner-builder will �ave the burtlen of proving thal he or she ditl not build or improve for purpose of sale.). � I, as owner of the property, am EXCLUSIVELY CONTRACTING WI7H LICENSED CONTRACTORS to wnslruct the project (Sec. 7044, Business and Professbns Code: The conlractors License Law tices not apply to an ovmer of property wfio builds or improves thereon, and who contracts for such project with a contracta(s) license pursuant tothe Contractors License Laws.). ❑ I am exempt under sec. Business and Pro(essions Code (or this reason: SignaWre �aie 305]�46 (J/0]) Owner ID verifietl by tlriver s license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (rype of documenl, i.e. - propeny tax bill or deed): OIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certify that no ezcavation frve (5) or more feet in tlepth in[o which a person is required to descend, will be made in connect'an with v.ork authonzed by Ihis permil, antl that no building slrucWre, scaffdding, (alsework, or demolition or dismantling thereo(, will be more than thirly-six (36) teet high. (Chap. 32, Grp 2, Art 2, Sea 341, Title 8, Califomia Atlminist2tive Code�. ❑ As owner-builder, I will not employ anyone ro do work which vrould iequire a permit lrom the Division of Industnal Safety, as noted above, unless such person has a permit to do such vrork fmm the division. Appli W nCs SIB^alure Division of Industrial Sa(ety Permit Number: _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or future building occupant need to fle and certify a Business Plan for emergency response to release or Ihreatened release o( a hazardous material? ❑ Yes ❑ No (Section 25505 of Ihe Califomia Health and Safery Code requires, wiM some exceptions, Iha� a Business Plan be fled wi�h �he Costa Mesa Fire Departmenl by every business which has at any one Iime dunng a reported year a quantity of hazardous materials equal lo or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperaNre and pressure). 2. Does or will the applicant or present or fuWre builtling occupant need ro file a regislration form (or acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Cotle, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hantl a quan[ity of acutely hazardous materials equalto or greater Ihan a weight of 500 pounds, or a volume o( 55 gallons, or 200 cubic fee� of compressed gas at standard temperature and pressure). 3. �oes or will the applicant or present or (uture building occupant need to prepare an RMPP (Risk Management and Prevention Program (or acutety hazardous malerials)? ❑ Ves ❑ No (Section 25534 of the Calitornia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certifcation and fling with the Fire Department of an RMPP by businesses which are required to register acutely hazar0ous matenals vrith the Fire Departmen[. 4. If an RMPP is presently requiretl, has Section 25534 of lhe Califomia Health and Safety Code been fully complie0 wiih? ❑ Yes ❑ No 5. Does or will Ihe applicanl or presenl or fuNre building occupant require for the vrork which is the subjec� of this application a permit for such construction or modilcation from the SouN Coasl Air Quality ManagemeN Dis[rict or frOm any other air polWtion contml district or a9ency? ❑ Ves ❑ No (Sec�an 658502 0! the Califomia Govemment Code requires that the requested inlortnation be fumished on applications for nomresidential buildin9 pertnits). 6. Will any part ot the facility lo be constructed under this pertnil be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No Qf yes", Ihe facility must meet Ihe requirement o( Sections 25534 and 42303 o( the Califomia Health and Sa(ery Code). � 7. If a permit fmm lhe South Coast Air Quality Management DisMct or other air polWtion control disMct or agency is required for the v.ork which is the subject of this application, have all of the disclosures prescnbed by Calitomia Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. Qf yes', a[tach certificate of compliance trom the appropriate air polWtion contr0l oKcer�. CERTIFICATE OF COMPLIANCE: I certify that under penalry of perjury the information given above is correcL I agree ro comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Date CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application antl state that the information given is correct I agree to comply wilh all state lavrs and city ordinances relating �o builtling consWction, and authorize represen[atives of the City of Costa Mesa to enter upon the above-describetl propeny for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this pertnit until fnal inspection. Wr Le L s) Date �r�i �-0� �'/ AnElorAulbonzeaAppLtanl � Date (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.�.�LDING PERMIT T/ FAIR ORIVE, COSTA MESA, CA 92626 Job Address: 47$ E 20TH ST Suite: Vicinity: PARSONAGE BUILDING Parcel Number: 42625201 Applicant: BRESLIN, BILL Address: Zoning: Phone: 2ip: owner. CHURCH, COMMUNITY METH OF COSTA MESA Address CHURCH, FIRST METH COSTA MESA, CA Phone: 420 W 19TH ST Zip: 92627-2026 Convactor. 21ST CENTURY ROOFING INC Address: 1835 WHITTIER AV UNIT F72 Phone: 800.7&4-8787 COSTA MESA, CA Zip: 92627 License: 807430 Arch : Address: Eng: Address: Status: ISSUED Applied: 0&13/2003 Issued: 0&13I2003 ISSUED BY: � Phone: Phone: Zip: � License: License: SCOPE OF PERMIT TEAR OFF EXISTING ROOF. INSTALL SHEATHING, FELT AND 30 YEAR COMP SHINGLES. PARSONAGE BUILDING. Plan Check: $0.00 Permit: $125.25 SMIP Res: $0.00 SMIP Com: $1.25 Other: $0.00 Inspection: $0.00 Total: $126.50 SETBACKS MAIN STRUCTURE Front 0. 0 ACCESSORY �Front 0-0 PARKING Existinq: 0 NOTES: Rear 0. 0 Rear 0- 0 Required: 0 FEE SUMMARY PLANNING & ZONING Left 0- 0 Left 0- 0 Pr000sed: 0 Calc Valuation: Claim Valuation: Right 0- 0 Right 0- 0 $5,925.00 ss,s25.00 NOTICE: The work authorized by this permit shall compty with all applicable handicap access requirements under Califomia 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 withln 180 days, or it work is suspended or abarWoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must eomply with all applicable codes, arW all requlred Inepeclione end final epproval must be obtained. Failure to obtain Inspections and tlnal approval will result in ihe expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 t448d8 (8�00) WORKERS'COMPENSATON DECLARAnON: I hereby atfirm under penelty af perjury one oi the following declaretions: / ..� � I heve end will maintain a certificate ol consenl to self-Insure for workers' compansatlon, es provided lor by sectlon 3700 0l the Labor Code, lar the pertormence of Ihe wo k for whlch ihis permit is issuetl. ve antl will meintain workers' compensatlon Inwrenca, es requiretl by sectim 3700 of Ihe Lebor Cotle, for Ihe peAortnence ot ihe work for whkh this pertnit is Issuetl. My workers' wmpensetion Insurence carder entl pollcy number are: Cartier. Policy Numbec (TfJs secNon neetl not Oe completed i! fhe perrttil ls veluetl et one hundred ddlars (3100) or Iess.J ❑ I certlty I�et in Ihe peAortnance of the work lor w�lU Ihis pertnit is issueA, 1 shall not amploy eny person in eny manner so as to become sub�ed to the workers' compensatlon laws of Calilo end a ee Iha houlC be�pj^e sub�ect to the workere' compensetion provisions of Section 3/7pp, of Ne�/y Dor Code, I shell fonhwith Comply wllh Ihese provisio �� /�` // �— Date: �� //-)/ v� ApPlicaN�SlgnaWre:. . � �� b 5 6 -�c WARNINO: FAILURE TO SECURE ORI(ERS' COMPENSATION CWEM�E IS UNUWFUL PND SHALL SUBIEGT rW EMPIOYER TO CRIMINAL PE ilES AND CNII FlN OONE HUNORED TMOUSPND OOLLARE (5100,000). IN nDDfiION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTIqJ �1O80F THE IABOfi CADE, INTEREST, AND ATTORNE`fS FEES. LICENSED CONTRACTORS DECLARATION: I hereby eflirm t�ei l em Ilcensetl und r provisions ol Ch er 9(com ncing with Section 7000) ol Dlvislon 3 ot Ihe Business entl Prolessions CaAe, entl my Iicensa Is in full force end eMecL Lic. q .� c A /7 � �� Class M ConlrectotrSigneWre: � s�r /c' i • �t„� Dete: %Y.z - [ �� o��— CONSTRULTION LENDING AGENCY: ❑ I horeby eMirtn thet Ihere is a construction Ientllnp egency br ihe Oedormance of the work Por which this pertnit is issued. (Sec. 3097, Civil Coda). Lenders Name: Lendors Address: Siqneture: Da�e: OWNER-BUILDER DECLARATIONS: I hereby eNirm thet under penalry of perjury thet 1 em E%EMP7 FROM THE CONTRACTORS LICENSE LAW tor lhe following reeson (Sec. 7031.5, Business end Pmfessions CoCe: Any ciry or wunry whic� requires e permit to wnslruct, elter, improve, demolish, or repair any swcWro, prior to its issuance, elso requires the applicant for such pertnit to flle e slgnetl stetement thet he or she Is licensed pursuent ro the provislons ot the Goniractors License Lew (Chapter 9(commenGng with Sectlon 7000) ot Division 3 of Ihe Business and Pwfessions Code) or t�at he ot She i9 exempt iherefrwn and the basl9 for Ihe allegad exemptlon. Any vlolation oi Sectlon 7031.5 Dy eny epplicant for e pertnit sublecis ihe appllcant to e civil penalry of nat more than five hundred dollars (3500).): ❑ I, es owner ot t�e property, or my employees with weges es t�eir sole compensetion, WILL DO TNE WORK, antl ihe struciure Is not intended or ottered far sale (Sec. 7044, Business entl Professions Code: The Contrectors License Lew tloes not epply Io an owner of property who 6uilds or improves Ihereon, end who dces such work himself or herself or throuqh his or her own employaes, provided that such improvemenis ere not intended or oHered tor sale. If, however, ihe building or improvement is soltl within one year of compietion, ihe ownoo-builder will have.tha burtlen ot provinq ��at he or she did not 6uild or impmve for purpose of sele.). � ❑ I, as owner of Iha properry, am E%CLUSIVELV CONTRACTNG WITH LICENSED CONTRACTORS to construct the projeci (Sac. 704a, Business end Professions Code: The cantrectors License Lew tloes noI appy to en owner of property who builds or improves Ihereon, and who contracts lor such prqecl with e contractor(s) license pursuant to �he Contractors License Lews.). ❑ I em exempt unCer sec. Busineu antl Professions Code for ihis reason: Signeture: Date: Owner ID veniietl by tlriver's license. ❑ Yes ❑ No Drivers License No. Vedficatian oi Ownership by (type ol daument, I.e. - pmpeny tez bill or tleetl): Expires: DIVISION OF INDUSTRIAL SAFETY PERMI7 CERTIFICA710N: ❑ I hereby cehify ihat no excavation Ilve (5) or more feel in depth imo which a person is requiretl �o Oescentl, wlll be made In connectlon with work euthorizetl by this permit, end ihat no builtling strucWre, scaHoltling, lalsework, or demolition ar dismentling thereof, will be moro than Ihirty-siz (38) leet high. (Chep. 32, Grp 2, Ar12, Sec. 341, Tltle B, Celltomia Administretive Catle). ❑ As owner-builder, I will noi employ enyone to do work which would require a pertnil Irom Ihe DlNsion of Industriel Satery, es noteC eDove, unless such person has e permil Io Go suc� work trom the Civision. Signature: Date: Division ol Intlusirial Sefely Permil Numbet: CERTIFlCATE OF COMPLIANCE AND AllfHOR¢A710N OF ENiTiY: I certify untler penalty of perjury that 1 �ave read th�.s application and steta thet the information given is correct. I egree m Comply with all state laws anC Gry ordinances relating to building construction, antl euthorize representetives of t�e Clry ol Costa Mesa ta enter upon the ebove�descnbed property br inspectian purpoaes. I agreo not to acupy or allow occupency ol any building euthorizetl by t�is pertnit until final inspection. LODE �. INSVEC110N7VPE 1618 Fixetl System Final Fire Preventlon 1288 Pool Spe Final 200 Flnel Re-Roof 201 Finel BIocWRetelning Well 202 Final Fectory Fire Place 203 Finel Sign 204 Final Domolition Cp 3 O�e �ate COOE I INSVECTION TYPE 206 Flnal Mechanical 20B Finel Plumbing 210 Final Electdwl 212 Finel Fire Prevantion 220 Final Plenning Approval 222 Finel Site 250 Final BuilAing/Occupancy ueg �s L OWNER COM3•'lUD1ITY NIETHODIST CHURCH DATE 5_29_58 JOB ADDRESS (��8 East 20th Street BUILDING PERMIT NO. (7Q�yj GEN �C�.B=T,RACTOR COUT"bIIeV C. Platt VALUE $� 19�70�.00 �� AP. No. LOT 9 TRACT2SjC� FIRE ZONE j DESCRIPTION OF WORK R25id2nCe w/att �ar, GROLIP I Ac J TYPF.� V ZONE R�i Pi,AN NO. (iA)i3 I� 'ECTIONS G PERMITS ISSUED DATE gUBCON7RACTOR DATE NUMBER � �:. �. . _ ss4s COSTA MESA BUILDING DEPARTMENT P. O. BO% 31] COSTA MESA. CALIFORNIA FOR APPLICANT TO FILL IN '� 7$ � � o .�C' f.,L�,' COSTA MESA. CALIFORNIA MAIL ADDRE55 CITY �y� ARCHITECT OR ENGINEE AODRES LEGRL LOT DESCRIPtION NO. A.P. NO. SIZE e � OF LOT O S USE OF E%ISTIN� SETB�Ctt LINE FROM r �0:1 / �ys � 1 LIG �. NO. LG7T[t�4 �� 9v� y NO. TNo L/1'IB4�6 J 3 � r � !' p � , � No. oF e�o��. v NOW ON LOT CENTEN OF STNEET ��/ REAR YAR�L NEW REPAIR BUILDING SIZE EXTERIOR RIGHT� � / DESCRIPTION OF WORK ALTERATION AODITION MOVING DEMOLISH �.a/ NO. OF p �9 7Q'�j • �� ROOMS p STORIES LL�Eo/ ROOF i� O' CO V ER i NG ,f�'%^G.+�qil 72. . _o , ;o� ��i�l�� s_a9-�'� v�- FIIVANCE DEPT. G�1Y �� r,oSTR MESA APPLICATION FOR PERMIT BUILDING FOR OFFICE USE ONLY flECEIPi NO. pEjM11]�Ni /• a y c ECEIVED BY OATE RECEIVED /D� I55 I 1\ AA �� 7A _ i� Q (J �% � COSTA MESA. CALIFORNIA CORRECTIONS PL '< T� y�� e� � yyo �' - ��- 1 HEREBY /.CI(NOWLEOGE TH�T I H�VE FE.�O THIS 4PPLIC�TION iND ST/�TE TNAT THE ABOVE IS CORRECT ANO 4GREE TO COMPIY WITH ALL CITY ORDINRNCES >ND STATE L�WS REGULRTING B111L�ING CONSTRUC� rion. VALUATION SIGNATURE OF� � PERM�T FEE 3 PERMITTEE '.J /(� �O? {/� PLAN CHECK S S / cJ AUTHORIZED AGENT J TOTAL FEE 8 � �err