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HomeMy WebLinkAbout227 20TH ST - Building Permits CITY OF COSTA MESA BUILDING DIVISION 41111t'�� 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us /111014, FOR INSPECTIONS CALL: (714)754-5626 PERMIT NUMBER: B08-00160 PERMIT TYPE B_ROOF2 • STATUS: ISSUED APN: 42627312 DATE ISSUED: 05123/2008 ISSUED BY: JOB ADDRESS: 227 E 20TH ST,CM• • . Suite/Unit: Vicinity: _ Squares: 0 Valuation $4,500.00 SCOPE OF WORK: REROOF 5:12 PITCH ROOF;NEW PLYWOOD, NEW FELT AND INSTALL APPROX, 18'SQR'S OF 30 YEAR COMP • SHINGLES.WORK INCLUDES REFRAMING-OF ROOF STRUCTURE AS NOTED ON: REF: BX08-00084 FIRE DAMAGE REPAIR TO,ENTIRE ROOF STRUCTURE AND LEGALIZE 216 SQ.FT..LIVING ROOM ADDN. OWNER: BIES,JAMES L TR - ' Address: - .2310 WESTMINSTER AVE Unit: PHONE: - City/State/Zip: COSTA-MESA';CA • - - APPLICANT: FLORES, BENJAMIN • - ._- - Address: - • Unit: : PHONE: 714651-8172 • City/State/Zip:, • CONTRACTOR: KEVIN'BARRYAND ASSOCIATES INC License No. 779374 Address: 1636 E EDINGER AVUnit: ' - - - SUITE.B `_, ' PHONE: • :949496-2421 • City/State/Zip: SANTA ANA,CA' 92705 • 'r ARCHITECT: - License No. - PHONE:' •' ENGINEER: License No. PHONE: • FEE SUMMARY • Reroof Plan Check: $0.00 • Reroof Permit Fee: Reinspection Fee: $0.00 TOTAL FEES $111.25 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28, §1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. CODE S. INSPECTION TYPE DATE INI1IIALSS CODE1 INSPECTION TYPE - DATE INI1ML$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final /� / {lr�r 208 Final Plumbing Ol 200 Final Re-Roof -/crib /' 7/�+f• FJc 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 WORKERS'COMPENSATION DECLARATION: Owner ID verified by driver's ,e. ❑Yes ❑No I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires O I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed): 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 DIVISION.OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a number are: person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,a demolition Carrier: 24?LC rOtr atea 542 holt 9N4u46ANC-c//772 or dismantling thereof,will be more than thirty-six(36)feet high. (Chap.3.2,Grp (This sedan need not be completed tithe permd is valued at one hundred dollars($100)a'less.) 2,Art 2,Sec.341,Title 8,Califomia Administrative Code). Policy Number: /7 *"7 - zern ❑ As owner-builder, I will not employ anyone to do work which would ❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant's Signature Date '' Z 3—o `! Division of Industrial Safety Permit Number: Applicant's Signature Date HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes ❑ No ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE. INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. 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 LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000) of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license is in full force and effect. a registration form for acutely hazardous materials? ❑Yes 0 No Lie,# 7'79 3 -7 C/ Class# $ (Section 25533 of the California Health and Safety Code, with some 5-23'ro exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely convador'ssignawre Date 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 CONSTRUCTION LENDING AGENCY: temperature and pressure). O I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work far which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? ❑Yes 0 No Lender's Address: (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. Signature Date 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes ❑No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? ❑Yes ❑No issuance,also requires the applicant for such permit to file a signed statement (Section 65850,2 of the Califomia Govemment Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits). 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 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes 0 No applicant for a permit subjects the applicant to a civil penalty of not more than (If yes", the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). • ❑ I, as owner of the property, or my employees with wages as their sole • 7, If a permit from the South Coast Air Quality Management District or other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec.7044, Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by Califomia License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes 0 No thereon,and who does such work himself or herself or through his or her own 8. (If'yes",attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and El I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. ' LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code: The contractors License Law does not apply to an owner of Signature Date. property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that ❑ I am exempt under sec. •- the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: 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) Date Signature Date 3057-46(3/07) And/or Authorized Applicant Date • 2 CITY OF COSTA MESA , aQ BUILDING DIVISION „„ a18 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)7544856 • www.ci.costa-mesa.ca.us J � FOR INSPECTIONS CALL: (714)754-5626 111.. uuummm^ PERMIT NUMBER: BX08-00045 PERMIT TYPE B_MISC STATUS: ISSUED APN: 42627312 DATE ISSUED: 02/13/2008 Zoning: , ISSUED BY: RMD JOB ADDRESS: 227 E 20TH ST CM Suite/Unit: Vicinity: THOUGH OUT HOUSE Primary Occ: Const Type :?? SQ. FT: 0 Valuation: $2,000.00 SCOPE OF WORK: DEMO PERMIT FOR FIRE DAMAGE REPAIR TO UNIT"B"ONLY,THOUGHOUT. OWNER: BIES,JAMES L TR Address:: 2310 WESTMINSTER AVE Unit City/State: COSTA MESA,CA Zip Code: 92627 Phone: APPLICANT: MARTINEZ,TONY Address: 1636 E EDINGER AV Unit: SUITE B City/State: SANTA ANA, CA Zip Code: 92705 Phone: 949-496-2421 CONTRACTOR: KEVIN BARRY AND ASSOCIATES INC License No. 779374 Address: 1636 E EDINGER AV Unit: SUITE B City/State: SANTA ANA, CA Zip Code: 92705 - Phone 949-496-2421 Cell: ARCHITECT: License No. Phone ENGINEER: License No. Phone FEE SUMMARY Building Plan Check: $0.00 Building Permit: $69.25 Electrical Permit: $0.00 SMIP Residential $0.00 SMIP Commercial $0.00• $0.00TOTAL FEES $69.25 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92.28,§1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. CODE#. INSPECTION TYPE DATE INTTALS CODE# INSPECTION TYPE DATE INTOIAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Root 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign Q 222 Final Site 204 Final Demolition Y/( B p 250 Final Building/Occupancy i 1 WORKERS'COMPENSATION DECLARATION: Owner ID verified by drive ❑Yes Cl No I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires: ❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed): 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a number are:Cartier: p person is required to descend,will be made in connection with work autflorized f{4 f L 6t./ -4l fir g7rq^'O2 by this permit,and that no building structure,scaffolding,falsework,a demolition I or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp (T is seam need not be ed I the penes valued al one hundred dollars($100)or less.) 2.Art 2,Sec.341,Title 8,California Administrative Code). Policy Number: 0 As owner-builder, I will not employ anyone to do work which would O I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California, and agree that if I should become subject to the workers'compensation provisions of Section 3700 of Applicants Signature Date the Labor Code II orthwith comply with these provisions. z--/3"or Division of Industrial Safety Permit Number: A lirant's Signature X10 HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No ($100,000), IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS (Section 25505 of the California Health and Safety Code requires.with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST,AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. 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 LICENSED CONTRACTORS DECLARATION: 500 pounds, or a volume of 55 gallons,or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license is infullforce and effect. a registration form for acutely hazardous materials? 0 Yes 0 No Lic.# / /37r 1 Class# Q (Section 25533 of the California Health and Safety Code, with some �� Z— 7-o f exceptions, requires registration with the Costa Mesa Fire Department by C/•Y l O each business which at any one time has on hand a quantity of acutely Contractor's Signature Date 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 CONSTRUCTION LENDING AGENCY: temperature and pressure). O I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work fa which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? 0 Yes 0 No Lenders Name: (Section 25534 of the California Health and Safety Code provides that the Lender's Address: 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. Signature Date 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish. or repair any structure, prior to its any other air pollution control district or agency? ❑Yes 0 No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Government Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits). 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 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes 0 No applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). ❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation. WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec.7044, Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 No 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 8. (If"yes", attach certificate of compliance from the appropriate air pollution sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code: The contractors License Law does not apply to an owner of Signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contracta(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that ❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: 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. Sign reILee gal Owner(s) 2'/ ate Signature Date ��_ Yr Or 305746 OW) - - Andlor Authorized Applicant Date 1 CITY`OF COSTA MESA SOL BUILDING DIVISION )•• 77 I FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 5 !• FOR INSPECTIONS CALL:(714)754-5626 S4boamso^4. PERMIT NUMBER: BX08-00084 PERMIT TYPE B_MISC STATUS: ISSUED APN: 42627312 DATE ISSUED: 05/02/2008 Zoning: , ISSUED BY: JOB ADDRESS: 227 E 20TH ST CM Suite/Unit: Vicinity: ROOF AND LEGALIZE ROOM ADDITION - - Primary Occ: 7 Const Type '90 SQ.FT: 216 --Valuation: $34,500.00 SCOPE OF WORK: - FIRE DAMAGE REPAIR TO ROOF,STRUCTURE AND LEGALIZE A 216 SF LIVING ROOM ADDITION WITH ELECTRICAL. NO OTHER WORK AUTHORIZED UNDER THIS PERMIT. • x5/23/08- PERMIT SUPPLEMENT TO INCLUDE (9)WINDOW REPLACEMENTS WITH SAME,SIZE/LOCATION THROUGHOUT HOUSE) -OK TO ISSUE PER INPS..GARY HOOK. • OWNER: BIES,JAMES L TR Address:: 2310 WESTMINSTER AVE , Unit City/State: COSTA MESA, CA Zip Code:` "92627 Phone: .1 APPLICANT: TONY MARINEZ -• - Address: Unit: City/State: Zip Code:. 90040 , - Phone: 714-6844111 , — - . CONTRACTOR: KEVIN BARRY AND ASSOCIATES INC License No.`:' 779374 Address: 1636 E EDINGER AV - Unit: SUITE B City/State: SANTA ANA,CA Zip Code: 92705 Phone 949-496-2421 Cell: ARCHITECT: License No. Phone • ENGINEER: License No. Phone _:FEESUMMARY" •• Building Plan Check: $320.29 Building Permit: $492.75 Electrical Permit: $89.20 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: 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 final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. CODE S. INSPECTON TYPE DATE INTnULS CODES INSPECTION TYPE DATE INTTALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing P 200 Final Re-Roof 210 Final Electrical 91)--3 201 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 �P.1F67, ��- WORKERS'COMPENSATION DECLARATION: Owner ID verified by driver's tee. 0 Yes 0 No I hereby affirm under penalty of perjury one of the following declarations: Driver's Lisegse No. Expires: CII have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed): 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: . permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a number are: person is required to descend,will be made in connection with work authorized Cartier:`pT71Q Pompe.?�t#}Yon 1/�Sr7LAN4-' � p 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 (Thisseclat neednl 0ecompleted d thepermM is valued at one hundred dollars($100)or less) 2,Art 2,Sec.341,Title 8,California Administrative Code). Policy Number: /(9ell 7SY ❑ As owner-builder, I will not employ anyone to do work which would ❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of Califomia, and agree that if I should become subject to the workers'compensation provisions of Section 3700 of Applicant's Signature Date the Labor Code,I shall forthwith comply with these provisions. C.23 ,CR Division of Industrial Safety Permit Number: AOWiram's Signature Date HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes 0 No ($100,000), IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST.AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. 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 LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license isin,full force �¢and effect. a registration form for acutely hazardous materials? ❑Yes 0 No Lit.# -in ! 3 7 y Class# ✓ (Section 25533 of the California Health and Safety Code, with some 23 ^ � exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely lontranor's Signature Date 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 CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affum that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097.Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? 0 Yes IDNo (Section 25534 of the Califomia Health and Safety Code provides that the Lender's Address: 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. Signature Date 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes 0 No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes ❑No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Government Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits). 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 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes ❑No applicant for a permit subjects the applicant to a civil penalty of not more than (If'yes', the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). ❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec. 7044, Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes ❑ No thereon,and who does such work himself or herself or through his or her own 8. (If"yes", attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she .CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. CI I, as owner of the • LICENSED CONTRACTORS to construct the project(Sec.7044,Business and -Professions Code: The contractors License Law does not apply to an owner of Signature Dale property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that ID I am exempt under sec. the information given is correct. I agree to comply with all state laws and city • . ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: 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 ermit until final inspection. • Si9natur Owner(s) W Signature Date 305746(3/07) And/or Authorized Applicant Date .,,CITY QF COSTA MESA BUILDING DIVISION f i= .,. � 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us • FOR INSPECTIONS CALL:(714)754-5626 sibiboimna PERMIT NUMBER: BX08-00084 PERMIT TYPE B_MISC STATUS: ISSUED APN: 42627312 DATE ISSUED: 05/02/2008 Zoning: , ISSUED BY: JOB ADDRESS: 227 E 20TH ST CM Suite/Unit: Vicinity: ROOF AND LEGALIZE ROOM ADDITION . Primary Occ: 7 Const Type ?o SQ. FT: 216Valuation: $30,000.00 SCOPE OF WORK: FIRE DAMAGE REPAIR TO ROOF,STRUCTUREAND LEGALIZE A 216 SF LIVING ROOM ADDITION WITH ELECTRICAL. NO OTHER WORK AUTHORIZED_UNDER THIS PERMIT. • OWNER: BIES,JAMES L TR Address:: 2310 WESTMINSTER AVE Unit City/State: COSTA MESA,CA- Zip Code: 92627 • Phone: . APPLICANT: TONY MARINEZ p Address: • • - Unit: • City/State: , Zip Code: 90040 Phone: 714.684.4111 CONTRACTOR: KEVIN BARRY AND ASSOCIATES INC License No. 779374 Address: 1636.E EDINGER AV Unit: SUITE B City/State: SANTA ANA,CA - • Zip Code: 92705 • _. - Phone 949-496-2421 Cell: ARCHITECT: License No. Phone ENGINEER: . License No. Phone - ' FEE SUMMARY - Building Plan Check: - $287.46 Building Permit: - , _ - $442.25 Electrical Permit: - $58.70 ' SMIP Residential $3.00 ; SMIP Commercial - $0.00 TOTAL FEES - $791.41 NOTICE: The work authorized by this permit shall comply with al .pp -ble handicap access requirements under California statutes and rel- ed regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISS OR 'ATE OF LAST INSPECTION. I INSPECTIONS: In order for the work authorized under this permit to .-.,4 nsidered legal, such work must comply with all applicable codes, a d all required inspections and final approval must be obtained. Failure to•.>:' 'nspections and final approval will result in the expiration of this pe t CEEL INSPECTIONTYPE bAh 1n�1111•.1, CODE/ INSPEC11ON TYPE a '\ ,ct ,/ 1616 Fixed System Final Fire Prevention ` SP 206 Final Mechanicalt �6\—/ 1266 Pool Spa Final - \�_ k 208 Final Plumbing \ MIL W. Final Re-Root \�,� 210 Final Electrical ` ' 11 "I T 201 Final Block/Retaining Wall . 212 Final Fire Prevention 202 Final Factory Fire Place alar 220 Final Planning Approval f/G//' ,' / 203 Final Sign !./ 222 Final Site 204 Final Demolition � 250 Final Building/Occupancy WORKERS'COMPENSATION DECLARATION: Owner ID verified by driver's licen, J Yes ❑ No I hereby affirm under penalty of perjury one of the following declarations: Drives Liclfine No. Expires: ❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed): 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a number are: person is required to descend,will be made in connection with work authorized ,by this permit,and that no building structure,scaffdding,falsework,a demolition Carrier WCp`rGrJ O -� or dismantlingthereof,will be more than thirty-six (This section need not be completedtl a pend is valued at one hundred dollars($100)or less.) (36)feet high.(Chap.3.2,Grp /17 '?�� 7-/7 2,Art 2,Sec.341,Title 8,California Administrative Code). Policy Number J / ! "f ,/ ❑ As owner-builder, I will not employ anyone to do work which would ❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issued,I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of Califomia, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Cod hall forthwith comply with these provisions. Applicant's Signature Date / Division of Industrial Safety Permit Number: Applicant's Signature Date HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes ❑ No ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST,AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. 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 LICENSED CONTRACTORS DECLARATION: 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license is in full force and effect. /A� /a,registration form for acutely hazardous materials? ❑Yes ❑ No �Lic.# `7 7/7/�I ass# J / (Section 25533 of the California Health and Safety Code, with some Z,�� exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely Contractors Signature Date r 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 CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? ❑Yes 0 No (Section 25534 of the California Health and Safety Code provides that the Lender's Address: 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. Signature Date 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes ❑No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? ❑Yes ❑No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Government Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits). 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 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes ❑No applicant for a permit subjects the applicant to a civil penalty of not more than (If yes",the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). ❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec.7044, Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes ❑No thereon,and who does such work himself or herself or through his or her own 8. (If"yes", attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and 1:1I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. LICENSED CONTRACTORS to construct the project(Sec.7044, Business and Professions Code: The contractors License Law does not apply to an owner of Signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that ❑ I am exempt under sec. • the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of Business and Professions Code for this reason: 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. a(ppq,,oTnature of Legal Owner(s) Date Signature Date 309-46(3/0]) /\ And/or Authorized Applicant Date CITY OF COSTA MESA BUILDING DIVISION '�• ,.! 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)7544856 • www.ci.costa-mesa.ca.us , . T_ �. f FOR INSPECTIONS CALL: (714)754-5626 Sorvomvp PERMIT NUMBER: M08-00074 PERMIT TYPE MECH STATUS: ISSUED APN: 42627312 DATE ISSUED: 05/23/2008 ISSUED BY: JOB ADDRESS: 227 E 20TH ST CM Suite/Unit: Vicinity: LIVING ROOM SQ. FT: 0 SCOPE OF WORK: REPLACE EXISTING WALL FURNACE WITH NEW WALL FURNACE @ LIVING ROOM. REF: BX08-00084 FIRE DAMAGE REPAIR TO ROOF STRUCTURE AND LEGALIZE A 216 SF LIVING ROOM ADDITION OWNER: BIES,JAMES L TR - Address: 2310 WESTMINSTER AVE Unit: PHONE: City/State/Zip: COSTA MESA,CA • . ";74 APPLICANT: FLORES,BENJAMIN Address: Unit: • ' ` PHONE: 714 651.8172 City/Slate/zZip: CONTRACTOR: KEVIN BARRY AND ASSOCIATES INC License No. 779374 Address: 1636 E EDINGER AVUnit: SUITE B PHONE: 949-496-2421 City/State: SANTA ANA,CA ZipCode: 92705 CELL: MECHANICAL PERMIT FEE SUMMARY MECH ITEM FEE: $38.30 PLAN CHECK FEE: $0.00 INVESTIGATION FEE: $0.00 REINSPECTION FEE: $0.00 TOTAL FEES: $38.30 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No,92-28.§ 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. CODE/ INSPECTION TYPE pAa INITIAL$ CODER INSPECTION TYPE np1TF 1616 Fixed System Final Fire Prevention 206 Final Mechanical G 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 • WORKERS'COMPENSATION DECLARATION: Owner ID verified by driver's tics D Yes 0 No I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires: ❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed): compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. CD-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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: . permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a member are: person is required to descend,will be made in connection with work authorized Stn T-2 Co rnee/1S,t4$)ON y f 4t9�RM/triO/vi' by this permit,and that no building structure,scaffolding,falsework,or demolition Carrier: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2.Grp (Tlut seaun need not be cwnpetedtthecpern*isrefiredet one hundred ddars( coir)wless.) 2,Art 2,Sec.341,Title 8,California Administrative Code). cPollcy Number /C997 ( - 2G0� ❑ As owner-builder, I will not employ anyone to do work which would ❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issued,I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California, and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant's Signature nate " S, -2 3 re, c„-- Division of Industrial Safety Permit Number: Apprpnt's&gravure HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. 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 LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license is infullforce and effect. a registration form for acutely hazardous materials? 0 Yes 0 No 'Lc#) '7 ! 37v Claa#- f ' J (Section 25533 of the California Health and Safety Code, with some "La 23 -pc- exceptions, requires registration with the Costa Mesa Fire Department by r� each business which at any one time has on hand a quantity of acutely cmuadors Signature Date 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 CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? 0 Yes 0 No (Section 25534 of the Califomia Health and Safety Code provides that the Lender's Address: 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. Signature Date 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5. the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Govemment Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be fumished on applications for non-residential building permits). 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 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes 0 No applicant for a permit subjects the applicant to a civil penally of not more than (If'yes",the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). ❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec. 7044,Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 No 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 8. (If"yes",attach certificate of compliance from the appropriate air pollution sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and ❑ I. as owner of the properly, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. LICENSED CONTRACTORS to construct the project(Sec.7044, Business and Professions Code:The contractors License Law does not apply to an owner of Signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors Ucense Laws.). certify under penalty of perjury that I have read this application and state that ❑ I am exempt under sec. • the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: 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 authoriz by this per it until final inspection. Signature of.Legal Owner(s) L_Date Signature Dale 3057-46(3/07) And/or Authorized Applicant Dale CITY OF COSTA MESA BUILDING DIVISION FT�:AI� 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us k fl . FOR INSPECTIONS CALL:(714)754-5626 PERMIT NUMBER: P08-00117 PERMIT TYPE PLUM STATUS: ISSUED APN: 42627312 DATE ISSUED: 05102/2008 ISSUED BY: JOB ADDRESS: 227 E 20TH ST CM Suite/Unit: Vicinity: SCOPE OF WORK: REPLACE 1 BATH TUB,2PTRAPS AND 1 KITCHEN SINK FOR FIRE DAMAGE REPAIR, RE:BX08-00084 .5/23/08- PERMIT SUPPLEMENT TO INCLUDE (1) BATHROOM SINK, (1)TOILET, (1)DISHWASHER 8 (1)WATER HEATER LOCATED AT SHED STRUCT @ REAR OF PRO. OWNER: BIES,JAMES LTR Address: 2310 WESTMINSTER AVE PHONE: City/State/Zip: COSTA MESA.CA - 7 APPLICANT: TONY MARTINEZ Address: PHONE: 714-6844111 City/State/zZip: CONTRACTOR: KEVIN BARRY AND ASSOCIATES INC License No. 779374 Address: 1636 E EDINGER AV SUITE B PHONE: 949-496-2421 City/State: SANTA ANA,CA ZipCode: 92705 CELL: ARCHITECT: License No. PHONE: ENGINEER: License No. PHONE: PLUMBING PERMIT FEE SUMMARY PLAN CHECK FEE: $0.00 PERMIT FEE: $94.60 TOTAL FEES: $102.10 • 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: 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 final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. CODE INSPEC11ON TYPE IN1TAL6 CODE I INSPECTON TWE a6Th 114111161.6 1616 Fixed System Final Fire Prevention 206 Final Mechanical 0� 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 WORKERS'COMPENSATION DECLARATION: Owner ID verified by driver's Iia ❑Yes ❑No I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires: ❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document.i.e.-property tax bill or deed): 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: 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 0 I hereby certify that no excavation five(5)or more feet in depth into which a number are: person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffdding,falsework,or demolition Carrier: STA trc. Cornpen 4131-1 eco )p--754/G,a7061e t tl/Un or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp (This sedan need not be com�p/^etedacnepenniu valued at one hundred collars(S100)or less.) 2,Art 2,Sec.341,Title 8,California Administrative Code). Policy Number: /C9 I`/ 7 srJ — 7 ❑ As owner-builder, I will not employ anyone to do work which would ❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California, and agree that if I should become subject to the workers'compensation provisions of Section 3700 of Applicant's Signature Date the Labor Code,I shall forthwith comply with these provisions. , Z 3 rec-- Division of Industrial Safety Permit Number: liwnfs Signature Dale HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE. INTEREST.AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. 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 LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license is in full force and effect. a registration form for acutely hazardous materials? 0 Yes ❑No Lic.# 7 7937 c/ Class# 8 (Section 25533 of the Califomia Health and Safety Code, with some r_ Q_of exceptions, requires registration with the Costa Mesa Fire Department by J g each business which at any one time has on hand a quantity of acutely tractor's Signature Date 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 CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? ❑Yes ❑ No (Section 25534 of the Califomia Health and Safety Code provides that the Lender's Address: 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. Signature Dale 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes ❑No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Government Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits). 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 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes 0 No applicant for a permit subjects the applicant to a civil penalty of not more than (If yes", the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the Califomia Health and Safety Code). ❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Ouality Management District or other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec.7044,Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes ❑No thereon,and who does such work himself or herself or through his or her own 8. (If yes",attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for sale. If. however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of Signature Date , property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractors)license pursuant to the Contractors License Laws.). . certify under penalty of perjury that I have read this application and state that 0 I am exempt under sec. • the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: 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 authorzetlby this final inspection. 5c_ Si attire of Legal Ownerdsd D/ 'O �' Signature Date 30946 pm]I And/or Authorized Applicant Date • CITY OF COSTA MESA BUILDING DIVISION 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us f 1 �T,+�ti � �. FOR INSPECTIONS CALL:(714)754-5626 %%a'°ts� PERMIT NUMBER: P08-00117 PERMIT TYPE PLUM STATUS: ISSUED APN: 42627312 DATE ISSUED: 05/02/2008 ISSUED BY: JOB ADDRESS: 227 E 20TH ST CM Suite/Unit: Vicinity: SCOPE OF WORK: REPLACE 1 BATH TUB, 2PTRAPS AND 1KITCHEN SINK FOR FIRE DAMAGE REPAIR, RE:BX08-00084 OWNER: BIES,JAMES L TR Address: 2310 WESTMINSTER AVE PHONE: City/State/Zip: COSTA MESA,CA APPLICANT: TONY MARTINEZ Address: PHONE: 714-684-4111 City/State/zZip: CONTRACTOR: KEVIN BARRY AND ASSOCIATES INC License No. 779374 Address: 1636 E EDINGER AV SUITE B PHONE: 949-496-2421 City/State: SANTA ANA,CA ZipCode: 92705 CELL: ARCHITECT: License No.. PHONE: ENGINEER: License No. PHONE: PLUMBING PERMIT FEE SUMMARY PLAN CHECK FEE: $0.00 PERMIT FEE: $62.70 • • TOTAL FEES: $62.70 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. CODE E INSPECTION TYPE DRT IN7111AL5 cQDga INSPECTION TYPE Qttg INTIMAL$ 1616 Fixed System Final Fire Prevention 208 Final Mechanical //� 1288 Pool Spa Final 208 Final Plumbing /t// . - +�I 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 • WORKERS'COMPENSATION DECLARATION: Owner ID verified by driver's licen, J Yes 0 No I hereby affirm under penalty of perjury one of the following declarations: Drivers License No. Expires: ❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed): 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: 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 0 I hereby certify that no excavation five(5)or more feet in depth into which a number are:(� � person is required to descend,will be made in connection with work authorized W K0 f ` '" �1 by this permit,and that no building structure,scaffolding,falsework,or demolition Carrier: Or t7..y/ or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp (Pt snna/ / `I completed t7f1( valued al one hundred dollars($100)o-less) 2.Art 2.Sec.341,Title 8,Califomia Administrative Code). Policy Number: N 0 As owner-builder, I will not employ anyone to do work which would ❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issued,I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of Califomia, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of Applicant's Signature Date the Labor Code,I sh}III forthwith comply with these prov icons. z,Or Division of Industrial Safety Permit Number: Applicant's Signature / Data HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes 0 No ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the Califomia Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEYS FEES. 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 LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons.or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000) of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my licens�ey'/�iy/,fu gem(aand effect. registration form for acutely hazardous materials? ❑Yes 0 No Lic.tt ! ! 4J ` — Class tt Section 25533 of the California Health and Safety Code, with some �_- exceptions, requires registration with the Costa Mesa Fire Department by each siness which at any one time has on hand a quantity of acutely Contractors Signature Dale ha dous 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 CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ 1 hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lenders Name: hazardous materials)? 0 Yes 0 No (Section 25534 of the California Health and Safety Code provides that the Lender's Address: 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. Signature Dale 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Government Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits). 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 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes 0 No applicant for a permit subjects the applicant to a civil penalty of not more than (If yes",the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). ❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec.7044,Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 No thereon,and who does such work himself or herself or through his or her own 8. (If yes",attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for sale. If. however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. ❑ I, as owner of the UCENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code: The contractors License Law does not apply to an owner of Signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractals)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that ❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: 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 or Legal Owner(s) Date Signature Date 3067-46(OA)) ! v And/or Authorized Applicant Date - CITY OF COSTA MESA -� ` BUILDING DIVISION Fa �'AI J � 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.0 FOR INSPECTIONS CALL: (714)754.5626 ' PERMIT NUMBER: E08-00053 PERMIT TYPE ELEC STATUS: ISSUED APN: 42627312 DATE ISSUED: 02/13/2008 ISSUED BY: RMD JOB ADDRESS: 227 E 20TH ST CM Suite/Unit: Vicinity: 227 1/2 SCOPE OF WORK: RELOCATE AND UPGRADE SERVICE PANEL TO 100A FOR UNIT 227 1/2. OWNER: BIES,JAMES L TR Address: 2310 WESTMINSTER AVE Unit: PHONE: 949-631-2195 City/State/Zip: COSTA MESA,CA APPLICANT: MARTINEZ,TONY Address: 1636 E EDINGER AV Unit:SUITE B PHONE: 949-496.2421 City/State/zZip: SANTA ANA,CA CONTRACTOR: KEVIN BARRY AND ASSOCIATES INC License No. 779374 Address: 1636 E EDINGER AVUnit: SUITE B PHONE: 949-496-2421 City/State: SANTA ANA,CA ZipCode: 92705 CELL: ELECTRICAL PERMIT FEES Electrical Plan Check Fee: $0.00 Electrical Permit Fee: $54.00 Reinspection Fee $0.00 TOTAL FEES $54.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28, § 1, 12-21-92) EXPIRATION: 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 final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. CODE S. INSPECTION TYPE pAft INTRIALS CODES INSPECnON TYPE psg INTnIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing �/ 200 Final Re-Roof _ 210 Final Eledrical�Q.GWGRpf 7::$17—Fir 1 ��� �'"/`rnY(///'12W� 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 ^' '1 WORKERS'COMPENSATION DECLARATION. Owner ID verified by div,,. .,lict . ❑Yes 0 No I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires: 0 I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed): compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. O I have and will maintain workers'compensation insurance,as required by DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: 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 0 I hereby certify that no excavation five(5)or more feet in depth into which a number are: person is required to descend,will be made in connection with work authorized /'/ /.G (b 1��7 by this permit,and that no building structure,scaffolding,falsework,or demolition Carrier d$1T hl or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp (This retied, m!nenot be camper if The aemtnu valued al one hundred dollars(sfoo)a less.) 2,Art 2,Sec.341,Tiller),California Administrative Code). Policy Number: it / Lf I —le° 0 As owner-builder, I will not employ anyone to do work which would 0 I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issued,I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. 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 CoCe/I shall forthwith comply with these provisions. Applicant's Signature Date 07�t z-/Vor Division of Industrial Safety Permit Number: Applicant's Signature 0a1e HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST. AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. 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 LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license is in full force and effect. a registration form for acutely hazardous materials? 0 Yes 0 No Lic.# 77/17( Class# I (Section 25533 of the California Health and Safety Code, with some Z 4j'tkr exceptions. requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely comraaor's ----es Date 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 CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? 0 Yes 0 No (Section 25534 of the California Health and Safety Code provides that the Lenders Address: 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. Signature Date 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5. the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Government Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits). 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 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes 0 No applicant for a permit subjects the applicant to a civil penalty of not more than (If yes", the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). ❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec. 7044,Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 No thereon,and who does such work himself or herself or through his or her own 8 (If yes",attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for controle ",a sale. If, however, the building or improvement is sold within one year of officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and O I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. LICENSED CONTRACTORS to construct the project(Sec.7044.Business and Professions Code: The contractors License Law does not apply to an owner of Signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that 0 I am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of Business and Professions Code for this reason: 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) Date Signature Date '��� 2-/7^QCK 3057-06(3/07) And/or Authorized Applicant Date a Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. COSTAM�ESA GCONSTRUCC3TIION PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO. 'Or t'Address , E•�� -c CM `l�b1V E 2 0.74- r I ' , Ap`p1fcant ding QF- s. • a ILf_. el. TYPE OF CONSTRUCTION Li NEW LI ADD yfmLTERATION ID REPAIR f FF9F A/fA/H7 R,nf IL n L qM J • ��' - c01-61-)12 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER • ` A.P.# I Zone Ow17e��i�lame((��r • •rr e.. Om DESCRIPTION OF WORK/USE OF BLDG. (ZPS\Q•&t^E"� Address Ef 1pf-� s u� ht` PL v , 9)k) O S Main Building: Accessory Building: Arch/Eng. _��� en - No. TYPE OF PERMIT GRADING ❑ FOUNDATIONE Z �I}'f. ElSTRUCTURAL Front • o Address ❑ TENANT LS ' LECTRICAL ❑ PLUMBING ❑ MECHANICALN 8 Rear Contractor's Name&'e k4-"-Q- Phone 9-i_Ca/le 13I OTHER C Right N Address(mailing))Liar. OP*A-v\LLE PL PROJECT DESCRIPTION SQ. FT. OCCUPANCY K G CONSTRUCTION TYPE VALUATION$ S Left City License No. �(/' I 'Z ZONE GRADING CU.YDS. ACRES R LICENSED CONTRACTOR DECLARATION 1 Ping. Ref.# Parking Req./Provided E I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: \w��/- � SQ�"� 1 /• �� Planning Notes: M 0 with section 7000) of Division 3 of the Business and Professions Code,and ` c my license is ln}1111 fgr�and effect. •129 too A, _ ^5 $ T License Cla,�S5sj,, (� l ,- License_ s, • a�I �-�l/ Wim.({`/ Date tee' • Signature _� xfa. l.✓ PLUMBING FEES WORKERS'COMPENSATION DECLARA.\ON Bar Sink Showers - / ' hereby affirm that I have a certificate of consent to self-Insure or a certificate 1 ELECTRICAL FEES Workers' Compensation Insurance, or a certified copy thereof (Section •. kflow Preventer Service Sink /♦ ,00, Lab. C.) Automatic Washer Transformer 0 15-50 KW Policy No. Company Backfl. • Irrigation Sewer Cap Construction Pole Sub. 0 50+KW 8 Certified copy is hereby furnished. Certified copy Is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit . t Meter Our)to 100 amps S DQ Date Applicant EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps (This section need not be completed if the permit Is for one hundred ($100)or less). Dishwasher Solar Piping-'- Dryers ❑Gas DElectric Sub Panel I certify that in the performance of the work for which this permit is Issued, I shall not Comnpemployo any person in any an neral so as to become sub'e t to t o the Drinking Fountains Solar Tank Fan • Walker C p ton Laws ofin anyfo ia. "'S as to -e t t the Motors❑O-1 HP 011/2-8 Date signature L.J Floor Drains Swimming ••.1 w/Spa• F.A.U. I NOTICE:If,after making this declaration,You s uld come subject to the Ina Solar ❑8-15 HP 016-154- Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Ur • comely with such provisions or this permit shall be deemed revoked. Fixtur¢s Microwave CONSTRUCTION LENDING AGENCY Gas Service Outlets '•ater set . Boxes Pole Li ht I hereby affirm that there is a construction lending agency for the performance g of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Heater Lender's Name p / Water Outlets Range Lender's Address Kitchen Sink Water Service Switches Sign OWNER BUILDER DECLARATION - 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 Garbage Disposal Standing Sections 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 Y Y Generator ❑0-5 KW❑5-15 KW Trash Compactor to file a signed statement that he/she is licensed pursuant to the provisions Of ROOF Drai 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 'refrom and the basis for the alleged exemption. Any violation of Section 4.5 by any applicant for a permit subjects the applicant to a civil - ,ally of not more than five hundred dollars($500). \ Li I. as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 compensation, will do the work,and the structure is not Intended or offered . - - Reinspection Fee I $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES - 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 •EVELOPMENT SERVICES REQUIREMENTS: employees, Provided that such improvements are not intended or offered for • er Hood or Type I D sale. If, however, the building or improvement is sold within one year of com- Canopy Type II ❑ Zoning Approved By Date pietism,the owner will have the burden of proving he/she did not build or int- Duct-Un. ound Building Approved By /�j•{ J4 Date A/Q J H"7 Prove for the purpose the f oe). �� orb o` 0 / ❑ I, as owner of the property, Se exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Date_ tractors t0 construct the project (Section 7044,Business and Professions code: The Contractor's License Law does not apply to an owner property who Duct-Ventilating ❑0-100,000 BTU CI 95,100 BTU SUMMARY OF FEES builds or improves thereon, and who contracts for such projects with a con- _ tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System D Multiple D .•• Rep.. •Iteration BUILDING PERMIT $ SMIP $ proof proof of their Worker's Compensation insurance should be provided to me. - PLAN CHECK $ PERMIT 0 I am exempt under Section B.& P.C.for this reason Firepl/Fact.Bit. ICBG# Fir- mper ISSUANCE$ $ Date owner Heating System& Ducting Registers •PLAN CHECK 25% $ ENERGY P.C. $ I hereby certify that I have read this application and state that the above 00-100,000 BTU ❑100,010 : L--" ELECTRICAL $ 8 -�� GRADING $ information Is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of his city to enter u•o the abve-mentioned property for Inspection p •oses. �' 4\s- 7 �a Signature .t.• _ `l Date MECHANICAL $ TOTAL FEE $ ' Drivers' License or # t R-' pection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ - CMF 0865-46,rev.10/B4 White - Building: Canary -Applicant; Pink -Accounting;Goldenrod - Assessor ,-------- CONSTRUCTION AND PLANNING POOL &SPA 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 UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd, 70. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final i 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 i 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 PREY. FINAL ' 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 1547 etriz 80. FOOD CERTIFICATE ISSUED 33. Final Electric 91107 Ma> 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 ' 48. Special Requirements Completed 49.-Electric Release to Edison •^ 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Datekik_ r ' OWNER JOHNSON, FRANK DATE 10-111-55 JOB ADDRESS 2271 E. 20th St. BUILDING PERMIT NO. 1975 GENERAL CONTRACTOR Owner-hail ricer VALUE $ 180.00 BLOCK TRACT Restucco garage GROUP J TYPE V ZONE RL FIRE DISTRICT 1991k PERMITS ISSUED INSPECTIONS DATE SUBCONTRACTOR DATE NUMBER Footing Trench Foundation Forms and Grade to Garage Rough Framing Plumbing,Rough to Slab Plumbing, Rough Complete Temporary Pole �. Wiring, Rough Heating,Rough Heating, Final Sewer, House Sewer,St. Septic Tank or Cesspool Lan-Ing, In Out F :ring / Plumbing,Final,Fixtures Complete Plumbing, Final Gas Test /a .L_ Wiring,Final ,! C! Lar✓tnce C S Lc.. Occupancy 1- //7 Se Costa Mesa Building Department 4 ne(APPLICATION FOR PERMIT • 111 EAST 20th STREET BUILDING 1 / COSTA MESA, CALIFORNIA 7 . FOR OFFICE USE ONLY FOR APPLI9ANT TO FILL IN Receipt No. Permit No AAddress YYj p %. �,O I I /I / J Costa Mesa, California Rec ed by I !D R.ec d. I ,Date Issued / .. �- � Nearest $T' A,(- 4[ / ',7[-i S / /`�f/ cross SL '✓�f/ 'A..,y/','x"..:20!%$• Building / /tt k dy Address Owner dY1 Mall Costa Mesa, California Address 9 g- 7' 2 "• d Nearest n Tel. Cross St.t. CitY1 c-3 to 2140.5 et No. Zone gq I PlansNo.of I TYp Group Architect or Lic. Engineer No. Approved`L9 , / & y v 1 ^G� Date .Idress CORRECTIONS / No.y tic.Contractor� 0"/.� Wall% Address'• Legal I1LotII Description No. Block i Tract (Attach Metes and Bounds) / uL t --1 • � Now on Lot L , SUse of at ize of Lot No.of cal n COSTA Existing Bldg. ?,'1 Families( I Rooms ��4e V� V�v'� MESA x Setback.Line from u - Rear Yard '! V Center of Street 7- Side Yard 7- p DESCRIPTION OF WORK " re Azi New I .�{I Alteration I✓I Addition I ,//�/�, 3. �.S1 S. /, /,3 Repair I ' I Moving I I Demolish 1 J)f / J G /// 'Iding , r No.of �J'c-�`� '1-0 3 ? y�f"� >"e X.34 Rooms / Stories C/ - 'CriWall I Roof — Covering Covering Use of New G, Buildingye) APPROVALS d Foundation Location Inspector Date ,,J Forms,Materials, L! C Cl t7 (! e t j-,5 1 ¢ -e-- Under-Pinning Frame: Fire Stops, Bracing,Bolts I hereby acknowledge that I have read this Application Iand state that the above is correct and agree to comply Lath.Int. with all City Ordinances and State Laws regulating building constructio Lath.Ext. Signature of Permittee '. tai ' r. 1 2 <�1-. Plaster, Int. R'� �' ni.t!y Authorized Agt. Plaster,Ext /J Valuation O Permit Fee $ , O G Masonry Reinforced $ Itp Plan Check$ _ t/ Total Bond Beam Fee $ r?, G O`er_c......-._. — • t o o d COSTA ¢ OCT 14-55PnbEsa 5017 '':::uc:z.no a. • i - Street . • PLOT PLAN - Show location and distances from property line and between buildings. . • • 1 OWNER JOHNSON; FRANK J. DATE 4-11-6o JOB ADDRESS 2272 - 20th•Street BUILDING PERMIT NO. 11768 GENERAL CONTRACTOR @ir7i@i'/build@ ' VALUE $ 51.0.00 AP. No.118-093-22 LOT R203 TRACT Npt Jite FIRE ZONE , DESCRIPTION OF WORK patio cover INSPECTIONS DATE I GROUP 7�,t TYPE V ZONE R14. Underground Soil U.G. Water PERMITS ISSUED I -ground Gas --- SUBCONTRACTOR DATE NUMBER G dead Water and Gas Rough Heating Rough Plumbing Miscellaneous Prop. Swr. Line House Con. St. Swr. Sprinkling System Heating, Final Plumbing Fixtures Final Gas Test Construction Pole Underground Power Rough Wiring Trenches `—Forms Steel jl / 3 -6 0 Floor System Steel Reinforce Chimney Re-Rod Bond Beam Sheathing Frame and Flashing L%thing, In Out �Fi,x�''s, '•r, brown coat Pining Fixtures, Final - I Electric Fixtures Final -..&W -,`/-4/111100S7 — v Building, Final OCCUPANCY Form 210-5M-11-59 5-B P 1-1-76B N. 1176 �� RECEIVED /COSTA MESA BUILDING-SAFETY DEPARTMENT JJ 1/111-!aa ' P.0. SOX 817 COSTA MESA. CALIFORNIA ������FyIINppA��NC�EEp�D�EPT. For Applicant to Fill In Completely APPLICATIFNV'FOR PCRMITMEA8A TYPE OR P INT BUILDING BUILDING ..‘ ADDRESS 7.-2 / J /T e n-2, )yJl , COSTA MESA. C• LIFORNIA For Office Use Only L / } / y�� RECEIPT NO. PERMIT-NOJ. OWNER i -/ 1 1 .4 u/.../- u1e/1 I I .h � Q MAIL RECEIV BY O T fl HIVED O TE I IJEQ ADDRE2.-2-74 r i {{ j'Q I I, G D I ' ((//1 CITY NO.j/j.Q tTaDDRESP '/ IJ��- AFtgw,TENEE Ho. COSTA MESA. CALIFORNIA 4 �/ ADDRESS ZONE/�P��y�/ �1 //J/� UP GGG,.//� FIRE • '�/l- I' !/ / 11- f .4,4 (1 L„�/ APPROVED TYPE A EGR�I�� (/ CONTRACTOR 7 V ADDRESS - D-/ - #2.--‘, ZONING J�/ )72-4--3 n///�/ , ZONE ',II,NO.OF �J USE OF NEW I� CITY C Z�✓ L // yn` a R 71 PLANS r BUILDING p`Rr/ U STATE TEL. LEGAL .;._,.—�I LIC.NO. NO. /�DESCRIPTION / O R° O7-a03 AT .1 812E f 3 /o 115 .0/1 NO. OF BLDOS. / qJ N 7-J' OF LOT ��. c. /I Now ON LOT A.P.NO. / O-' 8�-3—y>"--- / USE OF EXISTING BLDG, -A-1--0 . YARDSEVES APPROVED ALLOWED SETBACK UNE FROM (CENTER LINE ST.) // CENTER OF STREET REAR YARD FRONT -,G. --O, 14-07.,..."---1 FT. .f IN. SIDE YARD I LEFT I RIGHT _ R.SIDE �i(i(/ 1 ( �_j nFT. IN. DESCRIPTION OF WORK L.SIDE �� •c YT. IN. NEI' I II ALTERATION I ADDITION ( REAR pL�/�FT. / 0,1-6�/ 'IN. REPAIR I II MOVING I II DEMOLISH I APPROVED Chi _ / ( / DATE 4-/1-t, O BUILDING // �i NO. OF f� IY a AM SIZE / /6 ROOMS STORIES W" / EXTERIOR WALL I ROOF „,,,,,yyy... COVERING COVERING C ✓7/ ��USE OF BUILDING AND WORK TO BE PERFORMED / if a�.l'4 1 .+7,L-fn <4!1, • y I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE OS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSEE O OSHOWN P ESTABLISHING A PERMIT IS FOR THE UNDER PEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION. VAL. TION d f SIGNATURE OF _ _ J/ PERMIT FEE S PERMITTEE /� /2 melte- ?—� r,I / a ////((////// S J [ \PLAN CHECK S r 41' AUTHORIZED AGENT / A 0 TOTAL FEE S / b. i OWNER FRANK J, JOHNSON - • DATE 4-13.-6o JOB ADDRESS • ' 224 - 20th Street BUILDING PERMIT NO. 11767 GENERAL CONTRACTOR owner/builder • VALUE $ 336.00 AP.No. 118-091-22 LOT203 TItACTMpt.fits. FIRE ZONE. DESCRIPTION OF WORK deep freeze rpgm INSPECTIONS DATE I GROUP I&J TYPE V ZONE RI} Underground Soil U.G. Water PERMITS ISSUED 1' rground Gas SUBCONTRACTOR DATE NUMBER (. .lead Water and Gas Rough Heating Rough Plumbing Miscellaneous Prop. Swr. Line House Con. St. Swr. Sprinkling System Heating, Final Plumbing Fixtures Final Gas Test Construction Pole Underground Power Rough Wiring Trenches Forms Steel 4.1, YID c- a - /3 — O Floor System Steel Reinforce Chimney Re-Rod Bond Beam Sheathing /9. j77 0— `i�' — .7' 7-6 ° Frame and Flashing ,f3, I- - — .27 —60 Lathing, In Out I telly, brown coat l a bing Fixtures, Final Electric Fixtures Final Building, Final1I51'(•-6 n S OCCUPANCY N,1,1 .S'i .An Form 410-5M-11.59 S-B P n767 L1176? FEE RECEivE� ,' /34 LI-II-&O COSTA MESA BUILDING-SAFETY DEPARTMENT (� • P. O. BOX 317 COSTA MESA. CALIFORNIA (;FINANCE DEPT . •For Applicant to Fill In Completely APPLICATION FOR COSTA TYPE T BUILDING BUILDING .Ii tD C OefJyJ'��, ADDRESS 4. COSTA MESA. CALIFORNIA I For Office Use Only /� I 1 ; /-y�Hgiik 1 RECEIPT/N{O. 1 V 1±111TTNS1 MMAIL ES�// GL27</(/1/ !�\ �' RECHV� o>• 7liv8 II Agi/LL IBlV1Eop S (//'{ TEL. N FI ^ /7 I7/ -r 'I/' _ CITY NO. ADDRESS -at f- / ��/ ARr••'TECT TEL. OSTA MESA. CALIFORNIA OF .(NEER NO. `Rp`' ADDRESS FIRE Y �/ ,/[I 0 ZONE RSV TYPET GROUP VVV APP E CONTRACTOR ern_e/1 A7-( /l BY w tw ? �) / DATE��//� ADDRESS 9s 7 7 7./ - l (\_�ll{I `+` \l�. NING �y /J p2,_...06.„. /(I/^�"�/I ZONE NO.OF USE OF NEW QW�L•t/ CITY / 1 .../a. 1 ' 6 AA l/L PLANS y BUILDING ,,(� .. m..�rl , STATE TEL. , R l ''T''� /-, ��F/I/_�'��L/ T LIC.NO. NO. DESCRIPTIONLESCL PS I Lo / . 2 OS /S. • SIZE � / �'J ^.0 cJ )C/0)14, OF LOT 4.3_2uCX a,6/ v I NOWONLOTS (} USE OF YARDS EVES EXISTING BLDG 2 L/I , _ _ APPROVED JyA.LLOWED SETBACK LINE FROM (CENTER LINE 13T.1 it-C-00 i ( L ce-�l-. 1 S CENTER OF rneet REAR YARD FRONT �J g-a/ IN. SIDE YARD I LEFTI �, flIGHT R.SIDE �['S • FT. -IN. DESCRIPTION OF/WORK L/FT. / IN. N L.SIDE NE I II�IIIII ALTERATION I I?II ADDITION I REAR ````/��q�0 FT. 1. E l IN. `-- REPAIR I • xMOVING I II DEMOLISH I BPFROVED/� �I / /I DATE /71---7/-6 6 • BUILDING --// // NO. OF 6/(1/57/ SIZE �I{ ,- ROOMS STORIES EXTERIOR WALL ROOF COVERING COVERING Ci // USE OF BUJ •IFIG AND WORK TO BE PERFORME /' • s _ — — - IF / C6 fl/ o r /l 0-f7-7•-n I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IB FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONBTRU VALUATION �` SIGNATURE OFy/,// PERMIT FEE S 2• PERMITTEE Qfrinel-Ano Si:t G B PLAN CHECK S �T AUTHORIZED AGENT i Tx E TOTAL FEE d 10294 . IrCOSTA MESA BUILDING-SAFETY DEPARTMENT [tel• ?((/j y ]7 P.O.BOX 317 COSTA MESA. CALIFORNIA rllld.l_I ;I- DEPT FOR APPLICANT TO FILL IN COMPLETELY APPLICATION FOR PERMIT ',EC 7.. At—, OR PRINT C.,[/ BUILDING BU ILDING��/ 2� /A +J I ker✓ 7 a� ADDRESS r V COSTA MESA, CALIFORNIALI ` ) ` ' FOR OFFICE USE.ONLY OWNER n,f//' - /ON,vso/�( I RECEIPT NO. PERMIT qO. MAIL ///" , .r� ������ RECEIVED BY DATE RECEIVED` DATE ISS ED7 ADDRESS ,'.0 AN(j��-e 9- / V� r c7 EL. BUILDING CITY o cr/9 Al/r/ESA NO. ADDRESS ARCP'TECT -- LIC. .- COSTA MESA. CALIFORNIA OR .NEER NO. ADDRESS .--' FIRE �� /- ZONE TYPED 41 -.. GROUP � STATE APPROVED / t // CONTRACTOR Sr/Ff LIC.NO.. BY /� DATE (�S� ' ADDRESS 227- ` 2oM S/Mel ZONING LEGAL LOT /� 2 ZONE NO.OF USE OF NEW DESCRIPTION /yN�O. el J (BLO �C K J (TRACT Airy (P�Lp�A�NNSSSJ.JK ,/ I BUILDING pW L/, A.P.NO. //l/ �O Y 3 e9 / _ APPROVED `' \ / / / A { I/� BYYARDS EVES L DATE OF LOT ��A/�/� ItJ �� I NOW ON LOTS /' . REQUIRED ALLOWED USE OF / l (CENTER LINE ST.) EXISTING BLDG. P,,/s WF /C /-"1�Y' FRONTAdde Gy IN SETBACK LINE FROM CENTER OF STREET REAR YARD R.SIDE ; //ry///////J////// SIDE YARD LEFT I RIGHT L.SIDE �%,�"/ IN. DESCRIPTION OF WORK REAR IN. NES I I ALTERATION Ai I ADDITION I 1 REPAIR 1 II MOVING II DEMOLISH BUIS ZE DING A/C' yS r /iiIVO.OF ROOMS ^/T� STORIES / M rI.Y �,� 1. i EXTERIOR COVERING/WALLSiareb COVVERING/l OM/rOL ' USE OF BUILDING AND WORK TO BE PERFORMED �r / - 5 /49 21u/ASO/A/6 ro SE USFo 4S" -------, paik-AL/y 6.. /,eS/,D E Di kiPF. /6-4-. /t i,,' f` 4. t/,4//SHt,/J sTe'tovm-y • v t o�� I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PLY WITH ALL CITY ORDINANCES AND TATE LAWS REGULATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. BUILDING CONSTRUCT VALUATION /'� SIGNATURE OF PERMIT FEE $ /0 ` �i PERMITTEE / 11n •'l�`1A Grf J_. ///j ='f YA/ PLAN CHECK $ ALLTHO-.� D .ii�,l �/ 7 TOTAL FEE $ i s