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HomeMy WebLinkAbout252 21ST ST - Building Permits , CITY OF COSTA MESA • `ennxi% BUILDING DIVISION ).• ,a,,,,,..L I 77 FAIR DRIVE, COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.costamesaca.gov " FOR INSPECTIONS CALL: (714)754-5626 4 oTMo�. PERMIT NUMBER: M12-00013 • PERMIT TYPE MECH STATUS: ISSUED APN: 42615101 DATE ISSUED: 01/18/2012 ISSUED BY: MDM JOB ADDRESS: 252 21ST ST CM Suite/Unit: Vicinity: SO. FT: 0 SCOPE OF WORK: REPLACE FAU, RELOCATE TO ATTIC, REPLACE DUCTWORK OWNER: WOODRUFF DONNA E Address: Unit: PHONE: City/State/Zip: APPLICANT: RUSS 13USCHMIANN Address: Unit: PHONE: 949-833-1041 City/State/zzip: CONTRACTOR: B AND P SERVICES, INC. License No. 594563 .. l 2-00013 Address: 771 NEWTON WAYUnit: PHONE: 949-833-1041 City/State: COSTA MESA,CA ZipCode: 92627 CELL: ,:4, 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 - �h: 't+ •1 2-O'30•i 3 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related ,Ercgulations. (Ord. No.92-28, § 1, 12-21-92) A4RXPIRATION: 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. .s1 CODEINSPFC110N TYPE gia INTRIALS yODFA INSPECTION TYPE y I/xy�TA 1616 Fixed System Final Fire Prevention 206 Final Mechanical X j--11g7—A7 ",p 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 . . .:.—k, ,1�i .3 S . ` WORKERS'COMPENSATION DECLARATIO•N: Owner ID verified by driver's license. ❑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 vL performance� of the work for which this permit is issued. RsI 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 ❑ I hereby certify that no excavation five(5)or more feet in depth into which a number are:a person is required to descend,will be made in connection with work authorized A 'I by this permit,and that no building structure,scaffolding,falsework,a demolition Carrier: /''l.G.(V��1 .,LS.trance— r or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Gm (Ms seaten need not be completed tThe peen4a valved at one hundred dolars(5100)or fess.) 2 Art 2.Sec.341,Title B,California Administrative Code). Policy Number: MV )ncnn 1-(a‘—,cm ❑ 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,I shall forthwith comply with these provisions. 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 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 :krq�4 � Class# � '�© (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by ,n ---1%---1% /^I S -ypqq, 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). ❑ 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 Lender's Name: hazardous materials)? 0 Yes ❑ 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? 0 Yes 0 No I hereby affirm that under penally 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? 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 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 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 ❑ 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 LLL n purposes. I agree not to occupy or allow occupancy of any building d er it until final inspection. Date Signawre Date /_/P _3057-46(107) And/or Aut Date Sim plMed Prose rip ti VP Cel•LifleiRr of COMR'iall Ce: 20(18 Reside:mie/HI'A C'Alu:ration,r CF-1.1.t-ALT-Id\'A C: Climate.'Lune::I and 3- 7 She Atf ss' 5A- I Gnforcemcu/Agency: ! blue: Permit il: 1n at Conditioned I 'Duct msulatiupi EnuiomenI Type' List Minimum Efficiency' Moor Area I re4 Thennoslit D Packaged lion - jSi . Sved-by system '—(/lamPr' unurav hr e ❑Condensin t Unit D BEI( ' .D Resistance• Inamlterll D Uther L • H.G (CZ 1,?-5) /.Equipment'Type:Choose the equipment beim•,installed; if more than one xystcm, use another CP,I k-ALT-H VAC:for eacttsystem. • G, Minimum Equipment Efficiuucics:.13 SEER,78%AFUE,7.711SPF for typical residential systems. . • • - •Coutrnctor(1)oi:umentatiotf Antilor's/Responsthte•D:signer's'Leciarntion Stats: went) .- _ I certify that this Certificrp of Compliance documentation is accurate and complete.' ' . . . • . . . • I all)eligible under pivisimn)iof the Cnlifornie Business:and Proiesaimn:Code to accept responsibility for the design identifiedPh this • Cenificate of Compliance. - - ... .. • I certify that the energy'tealute::iod performance specifications for the design identified on this Certificate of Compliance conform to-the. - requirements of Title 24,lurid.1 uiid G of the California Code kegulationt. • ' • , . ,. - _ The design features identifiedpn thus Certificate of Compliance are consistent with the information documented on other.applicable: •-_ --=---:. - compliance forms worlsfieit calculation,plans and specitisubmitted o the enfore eat a envy for approval with th 0 perm . ...-. . _. ..._ .. . soul align: .,.. ficaons, panne: ,Sign .. .. . . • .City/StaterLip: C....0. ...\ ---c,." a., -..WIG•SL. . ...- - {,2'.69 t I Phone:eie}.c't- 33 -( O¢ j • . • • • • • • %0O:Residential Compliance.Fornix March 2010 - • I I V.r•t! ..Llwr1'.V W/ Yl UIGY.Kt.;1 .CAN1 CUSTOMIZE id�1T.'1.7LE:T.TTEZWE,W/SLtrIL) 2(1(IR Buil cling Energy Efficiency Stan(larch; residential LTV AC A.l1:era.tinns Climate Zones 7 and 3 through 7 CZ-6 - Lasts) ;-1Cs>?. BUSINESS AND PROFESSIONS CODE, SECTION 7E10 Willful or deliberate disregard and violation of the building laws, including the California Building Code,and local permit requirements constitutes a cause for disciplinary action from the Contractors Stat:License.Bond working in conjunction with the local building department. This action may consist of fines up to 3:5,000 per • violation or suspensionlrevncation Of a contractor's license. WHEN IS A PERMIT REQUIRED? A written consnuction permit shall he obtained from the enforcement agency prim to the erection, construction, reconstruction, installation,relocation, or aiteration of any mechanical system,except as permitted in Appendix Chapter L,Section 112,2 of the 2007 California Mechanical Code. Projects requiring permits include,but alt not limited to: • New HVAC installation • HVAC Changeoul • • Replacement of furnace,coil, PAU, or condenser Relocation of an existing HVAC unit • Adding or replacing more than4011 ductingin unconditioned space. 2008 ntJILDINC;ENERGY EFFICIENCY STANDARDS (7•itle 24, Part 61 REOUIREIVENTS INCLUDE:: .. I. Heating equipment must have a minimum 78%AFUE(Exception: W all'X.floor furnaces;room heaters). 2. Central air.conditioners 8:heat pumps.less than 65,000 Btu/hr must have a minimum l3 SEER. • 3. Newly installed or replaced ducts must have a minimum insulation value of It-4.2. 4. A setback type.thermostat (24 hi'.cloolt with four set points) is required for all alterations. 5. New or replacement ducts must meet the mandatory requirements of Section 150im is All joints and openings in the in the I-NAC system must be sealed. Only UL 181,UL 181A,or UL 1 SIB approved tapes or mastic shall be used to seal duct openings. Connections of metals ducts and the,inner core of flex ducts shall be mechanically fastened. Flex ducts must be connected using a metal sleeve/coupling. • Flex ducts that arc suspended must be supported every 4ft. mm: for horizontal rum: with no more than 2" of sag between supports and 6 ft. max for vertical runs. 6. The CF-6E-MECB-04 must be completed and signed by the installing contractor, The Inspector will collect this form and verify that the model numbers are the same as the installed equipment. • • • i � CITY OF COSTA MESA o S ea BUILDING DIVISION •, ,,' $ DEVELOPMENT SERVICES DEPARTMENT P IT NUMBER IsI ����r,.",.��' I!0 PERMIT I'11 . 606-00178 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.B13}LDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 252 21ST ST Status: ISSUED Suite: Applied: 02/03/2006 Vicinity: BETWEEN 252 AND 258 Issued: 02/03/2006 Primary Occ: Type of Construction: Parcel Number: 42615101 Zoning: Applicant: RICHARD GOODE Address: 1048 IRVINE AVNEUE our) Phone: 714-350-6048 ISSUED BY: NEWPORT BEACH,CA Zip: 92660 Owner: SIMMONS, VIRGINIA W TR Address 144 BROOKLINE LN Phone: COSTA MESA,CA Zip: 92626-6557 Contractor: THE R C GOODE COMPANY Address: 1048 IRVINE AVENUE Phone: 714-350-6048 NEWPORT BEACH,CA Zip: 92660 License: 428825 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT 52 LN.FT.OF 6 FT.HIGH BLOCK WALL ON PROPERTY LINE BETWEEN 252&258 21ST STREET, WITH 6 LN.FT.BLOCK WALL ON EACH PROPERTY FOR ENCLOSURE. TOTAL OF 64 LN.FT.OF BLOCK WALL. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $2,000.00 Permit: $69.25 Claim Valuation: $2,000.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $69.75 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 33-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned fora period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2448-46(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION;, I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars(5100)or less.) ❑ I cerliy that in the performance of the work for which this permit is iss I shall not employ any person in any manner so as to become subject to the workers' ns�tian laws of Calif3m .ne agree that if I sho d become 'act to the workers'compensation provisions of Section 3700 of a Labor e,I shall forthwith comply with these proviSio ppijram'SlAure: ARRAN FAICLURE TO SECURE WORMERS'COMPENSATI• COVERAGE IS UMAWFUL AND SHALL SUBJECT AN EMPLOCIVIL R EMPLOYER-TOCRIMINAL PENALTIES AND NES UP TOONE HUNDRED THOUSAND DOLLARE(5100,000),IN ADDION TO THE •- OF COMPENSATION,DAMAGES AS PROVIDED FOR IN StCTION 3706 OF THE LABOR CODE,INTEREST.AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I ha Dy u_m-Iha4l am licensed r•e'r• 'visions• ha• 9(commencing with Section 7000)of Divisionaeasiness and rofessions Code,and my license is In full loce,and ofl&t LI r i .Affdiaiji Co bactpr's.5lgnstun]: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of DMsion 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500).): IDI,as owner of the properly,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business end Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-properly tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feel in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(38)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title B,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safoty, as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or pres$nt or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes U No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressur_e). ___ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Depanment by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future builtling occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazard0us materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the Califomia Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the tcAir u present or future building occupant other for the work which is the sor of a pliestion aDpI No for such eonstrudion or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? �Yes DI No (Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). __._ _....__ _ _..i_... 7 If a permit from the South Coast res Quality cri ed Management District or other air pollution ooncontrol district3 agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. S c.-tura Cl Le"r'- -ner(s) • /s- _ 1 zn••r Authorized.'..'cant +D) CODE• INSPECTION rift PATE INT?m&l.s CDDE• INSPECTION TYPEDaT� !MaL5 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing Final Re-Roof 211) Final Electrical Si?01 Final Block/Retaining Wall Z L7/J r'ier 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 APPRG :ED CITY OF COSTA MESA - - : Coq- 1-44 F PLANNING DIVISION SUBJECT TO BLDG. DEPT. REG. \'OTE: ADDITIONS, DELETIONS, OR CORRECTIONS SHALL BE APPROVED BY THE PLANNING DIV. + . gD(o -001.1 "'i3 ►X15116 Slfxk LUCIA RY • DATE: 5a I,.N FT of f c.i+ Lull.!kick wc and 1a W f reat mor earl, fien.o_ l �/ &` oto sLuMPsIC[L� Wulf $Icc4.. it€ 6X6-//,i1 . Ce(c*.. lira, *--- � cSl pi?NCF of 1,_-,z' Y. /%1 Rs loNN0. D'►J dRup �c5rpencc �F 952-21 ksr- Evi<19u- CRuzi4-LeRk. _ • c10 /►�e.sct Cck '. F a -2 r ?7cfef) .5'96-3977 tr , Costa M psck Cq st I <947> 33E=767s U Ji ri J UII , , j 1 I ii 4I \• -r , _ix 'I 33 ' FgoNT , RA, yt $ Si b Wail k si Ibecva l k ---->� .. ;I TS , (.c et }tilS.sec CQ SS OF BUILDING: 252 21ST ST. LINTS . CITY OF COSTA MESA — BUILDING PERMIT NAME IF IOlCWN: SIMMONS, VIRGINIA W TR PERM NO: P 077053 ADOREss: 252 E 21ST ST COSTA MESA, CA 92627 PERMIT NO: P 077053 PLAN CHECK NO: N GOVT: N SUPP : N 556-4643 ADPL.MAILING ADDRESS: CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE : OTH ARCHITECT OR ENGINEER: LIC.NO.: JOB DESCRIPTION : GAS VALVE ON OWNERS SIDE OF METER SQ FT: ARCH.OR END'S ADDRESS: UNIT: CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /U-1 coNTRAcroxsNnC: DZ PLUMBING ( 818 ) 331-6700 cONTIIACTORSMMLMO 19755 LORENCITA DR COMMENTS : INSTALLATION OF GAS VALVE FOR EARTHQUAKE SAFETY ADDRESS: COVINA CA uc.No.: 391743 ***************************************** '****'+T' '**+r+E*+E+E+Eit*+E*+E*iEitiF+t***+E+kx- -*+y* -RFiE 91724 LINT: ZONING R EQU IR EMENTS LICENSED CONTRACTORS DECLARATION:I hereby aim under parially of perjury that I em licensed under provisions of Chapter 9 S ETBACKS (commencing with Section 7000)of Division 3 of the Business end Professions Code,and my license is in full force and effect. CITY LIC.No.: 06664 uc.cuss: C 36 sec.NO.: 3917 • EXP: 01 /97 MAIN BUILDING ACCESSORY BUILDING Dale: LI 1'; !+ i FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Contractor LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN OWNER BUILDER DECLARATION:I hereby affirm under paWy of jay t I am.�t)-• the Contractors License Law for the following ason(Section 7WBuenas,sBuenas and Professions Code:AM « ty wt.ill ire•a penny to construct.atter,improve. PARKING REQ: PROV: PARCEL: 42615101 ZNE: REF NO: 'rash,or repair any structure:prior to As issuance,also requires the for such permit to Be a signed statement that he or she licensed pursuant to the prowewd of the Contractors License Law[Chapter 9(commando°with Swum 7000)of Arnim 3 of the PLANNING NOTES> ,� airless end Professions Coder or that he or she is exempt therefrom and the basis for the alleged exemption.Amy violation of Section > 7031.5 by any applicant for a permit subjects the appicantto a civil penally of not more than fire hundred doll=(MSOOD. *jbdE*dEdfdb*jk*jb**BEBEBEjhjEjPdPdEdEdPBE***SE*db*******jb******jh*dE****jF*dE*dE**dE****jg*dEdb****db******jE ❑ Las owner of nea mY employees with wages todTCoand�aoaand�eieedDEVELOPMENT S ER V IC E SteREQUIREMENTS or offered for sob(Section7044.Business and Professions Cehe ComLicense Law does not to an Owner of who bolds or improves thereon.and who does such work tinsel?or hada or through his or her own employees.provided that such imprvvemem are not intended«dfered for sale.If.however.the building«inpov«nem is sold within one years completion,the ZONING APPROVED BY r` DATE: owner-builder will have the burden of proving he or she did not build or improve for the purpose of sale). - ❑ Pia :Code:nthe°«Dehecmt Law does ng not ptoannsed "o°`"ors,ercitprpertyywhobuo construct the m°orimppnr,„ihereonanndwino BUILDING APPROVED BY : /)^ DATE: contracts for such projects with a contrauor(s)licensed pursuant to the Contractors License Law). / — -,, ❑ lamexempt under Section: B.8 PC.,for this reason: APPLICATION ISSUED BY: %77'4 400 jE 1B * E dl B ** E* E k h E E*dE* DATE: E'E;79fFPbEEbEd ** ** Date Owner LEGALIZATION: N F E E SUMMARY STRUCTURAL SEGMENT:N I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sedi«n 25505.25533.end 25534,and that I or any future building occupant will I will not(circle one)need to comply with said stale codes and the requirements for BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING e permit for construction or modification from the AithSIyMananagemenl Didridcoe .Residential nmdion application are exempt from these provisions. PERMIT 7 .00 Dale: Applicant: 25% SMIP/NON—RES PLAN WORKER'S COMPENSATION DECLARATION:I hereby affirm under penny of perjury one d the following declarations: ISSUE FEE 20 , 00 ,43 ❑ Ihave end wilmaintain acertificate oconsent oself-insure for workens'mnpensation.aprovidedforbySwbn370DdtheLabor BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE Code.f«the certdwork TOTALS----> 7 . 00 20 . 00 0 ,00 27.00 27 . 00 00 • 9I have and wit maintain workers'oompensaldn Insurance,as required by Section 3700 of the Labor Code.for the performance of the /� 'X work for which this permit is issued.My workers'compensation insurance canter and policy number are: Caner: GOLDEN EAGLE EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 27. 00 OVER/SHORT: . 00 Poky Number: ATNDF.R 5573 04 /07/96 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK j section need not be completed/the permit is for one hundred dollars MOO)or less.) 27 , 00 --, in I may that i the performance of the work for which this and is issued,I shall not employ any person in any manner so as to - become au ' to he compensation laws d California.eM agree thin B • become subject a the worked' 1E1E1E1E1E1E1E****1E1E1EfE1EiEfElEfklE****iEifiEiElFlFiFiFiFlElEiEiElEiklElliF1l1E1E1Eif1E1E1Eif1E1ElE****iE*1fiE*fEiEiEiEiE1LiE1E1Eif1E**** compenaf 'ice Galion 3700 d the Labor Chea.I hwhh campy Vii;- . y �� IND IV I D U A L•- FEE BREAKDOWN / Date: Applicant: — • A�( II ' Warning:Fear to re wortars'conpatsaron coverage ism nun. and shall .,.. an employer tocr,MmI penalties and TYPE QTY D E S C R I P T I O, N UNIT COST TOTAL COST civil Oo to nes tono hundred thousand dollars(1104000),In add n t the cost o - lion,damages as provided for in section 3706 of the Labor Coda Interest and attorney's baa. PLU 1 GAS SERVICE 7 . 00 7 .00 • CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of perjury that there is a construction lending agency for the END OF FEES performance of the work for which this perms is issued(Sedion 3097,Civ.C). LENDER'S NAME: LENDER'S ADDRESS: I certify that I have read Nis application and stele that the above inf motion is conea l agree to comply with a city and county ordinances p i\ and sista bee relating construction and hereby authorize representatives d ives this city enter eupon the abMed progeny .'1, for inspection purposes. , po .y JONATHAN MOFFATT , yn 6.... 0 nt Name ,) irT',)'// Dale: 15pn Dene Agent/ pplcenUCmtred« (515146.WP) White-Building A Soley;Green-Rle;Canary-Applicant;Pink-Revenue;Goldenrod-Assessor _ 'o 3NSTRUCTION AND PLANNING • POOI 'PA 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 •r ' 6. Electrical UFER Gind. 57. APPROVAL TO COVER-GUNITE '- 7. Footings "i• 58. Electrical ConduiL:Undrgrnd. F I-8. Foundation - 59. Gas Pipe, O Undr§rnd.,Test 9. Water Pipe-Undrgrnd. `. 60. Backwash Lines,P-Trap,0 Undrgrnd. .10. Structural Floor System 61. APPROVAL TO DECK r 11. Property Sewer Line& House:Connection62. Backwash & Receptor-Final 12. Sewer Cap 'e _ 563. Heater & Vent-Final ,�,! ' 13. Roof Drains 64. Plumbing System -Final- 1 14. Rough Plumbing65. Electrical-Final • 15. Rough Electrical-Conduit . 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access.Approval • 17. Rough WiringSign 9 9 68. APPROVED FOR PLASTERING 18. Rough ElectricaLT Bar Ceiling' 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning r Y FIRE DEPT.REQUIREMENT • 20. gough Factory Fireplace _ - ' . APPROVALS,-" Permit#_ • 21. Duan,in Structure . - v ;* 70. 'Underground Hydro i. 22. Ducts, Vehtilating`'' ,T - ` 71. Produett Piping bias 0Oil 23. Gas Pipe-Rough & Test _ - - c r - 72. Underground Flush 24. Roof=Frainin - 9 .t. ` 73. Undergrnd.Storage.Tank t:Gas ❑Oil 25. Roof Sheathing -,. 7 , 1 - 74'1 Overhead Hydro 26. T-Bar Ceiling (Structural) & Monotoat 75; Dry Chemical , 27. Frame and Flashing': a L i 76. Dry Stan6pipe '-`. > - _ . - -r . - 28. Lathing Si-Siding - •- •' 77. FIXED SYSTEM'~1NAL ,_ - 29. Insulation.' i - 78; FIRE?REV. FINAL . ' - 30. Drywall Nailingr ; r- _- _�t{EALTH DEPT. REQUIREMENT 31. Plaster Brown Coact - -_ . _ x , i 79.E FINAL INSPECTION - 32. ElectricalPowar IvlenrFipal 7 "'8 FOOD CERTIFICATE ISSUED_ - 33. Bina{ Elecfric> ,, Notes: q cs �rnp . 34. Final-.Heating;& Air Conditioning- 35. Final Gas.PiprTest •Y .,i_. ' 4 1 36. Hood or Canopy - - _ r -. - n -, 1 _ = 37. Final Factory Fireplace _ - \' - 38. Final-Plumbing - _ �sic L _-7,- - _ c f • 39. Water Service-Final ` 1 • • 40. Gas Service-Final - - t - - - - _ 41. Solar Domestic-Firjal • - _ 42. Backflow Preventer . + - - 43. Backflow Irrigation . ..5„ .ix �. 44. Landscape Irrigation System r _ - - 1 ^' - r. 45. Sound Attenuation t 46. Handicap Regulations - • T 1' 47. FINAL STRUCTURE & BUICDING t 48. FINAL PLANNING 'I6 - Ct. . 49. Electric Release to Edison '' - r ' . w 50. Gas Release to-Southern California Gas Co r - - = • 51. CERTIFICATE OF OCCUPANCY .r . - • No Date O NoR ' � .MOSS, TOM, BUILDER DATE NW 4 D00 JOB ADDRESS 252 E. 21st St. B s` r BUILDING PERMIT NO. 23147.. -• k GENERAL CONTRACTOR Same fr— ti— b—Y VALUE $ 19,212.00 115-153-10 11 LOT TRACT FIRE ZONE 3 DESCRIPTION OF WORK Res. & att. Gal INSPECTIONS Signature DATE GROUP I&J TYPE V ZONE Rl - -C,/-2---7- PERMITS ISSUED Ga_ SUBCONTRACTOR DATE NUMBER K Water i9441S727 -4' \\ Rough Corn. Refrig. :0 Air Cond. 0 • Rough Heating fQ ;/f /1/4-fir ,.yo j /f/�,�(�t- 3/69GZ Rough Plumbing / .(°�,„.L/- Lt" 4.�' if/ .,°/6 f'_a G_Z Z i Miscellaneous Prop. Swr. Line fia'House Con. El St. Swr. 044-AL _ Sprinkling System `:i I' Construction Pole /p trio fr•77,c y P0-1-.1 (('Z 7--LY • lfr Underground 0 Power 0 Rou h Wiring HAI /-5- / ✓, h2J24%9' _2. 3 d''7 Trenches! Forms Steel Rein!. o RdJ'�l - /-7,/ ��f Floor System �� i7 ie/ k,/ y Bond Beam 0 Steel Reinforce 0 Liaoning o,o, .0 0I Sheathing 4' ,, /pv A- y, ,�/sp.. •`.• _ It ii Frame and Flashing .O // /c I /l/ _ p,t, Jl J7V'�rrf,'i�.S Lathing — In del Out FI ?I:- //�`- kuob— m (17, Plaster, brown coat ,rno. �f 29`& r h , Rg,4,i . p Air Con, 0 Final truvitg, Final / , S 5` PithWbing Fixtures, rnal / , 5- Final Gas Test 6 r_ C _ { 1 _ _ Electric Fixtures, Final >? s 23147 FEE RECEIVED COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE £dC14 P.O.BOX 317 COSTA MESA,CALIFORNIA (� 7y nF � D T. For Applicant to Fill In Completely APPLIC1•IIOR FOR"PQRMTISA TYPE OR PRINT BUILDING UIL AFor Office Use Only BUILDING 2�a DDRESS RECEIPT NO. pEgMII fl COSTA MESA, CALIFORNIA 7��J7J U/. . 1 �/• ( * Ern RECEIVeYBY 257 VED_ DATE ISSUE• OWNER y/I (lj C II`f'�C 1- tt�I�.){\Ir1)P�f` /ZI /�J f/y / ADDRESS 1 I .ii' k g41-I ND ✓�,ly/I/`^ BUILDING ADDRESS V•. ') Z- __, Srw (//n/ /�.�. µ1 TEL. r`'^� FIRE ZONE TYPE GROUP'i' CITY Vet/ 1.c_1 1 I NO. 1.141 S- / ARCHITECT /N' /I' TEL APBPROVED ARCHITECT tZATE / ///OR ENGINEE//R((77/ (011e+S it /'r /� �ADDRESS ((&J 2/ - (/�. c . - /HSTF / 7 NO.OPS / USE OP NEW' Ai ,/� /. (' c//�� ]� (R' / PLANS ✓ OUILDINO+y . " CONTRACTORW/.�( ifary J' Xi be I {G U��V pO 1/ (f1�, DescRIPT14N 3a R Lsfi2S v j J 1/µ/j{'I/,fr ADDRESS//7/l/�L��/ �/6llLA/VD l�21 111 -15 � CITY /V/�/ 1 7J1 A.P.NO. 3r/0 4- 1/ NOTE: NO EAVE OVERHANG SHALL BE LESS THAN STATE j TEL. / /-' -14S-7 9O'TO SIDE a REAR P.L. LIC.NO. ZZ2S NO. IP'7(') %"7 l / LEAVES SALES SIZE L I NO.OP BLOBS. ALLOWED (U.B.C.REQUIREMENT) OF LOT NOW ON LOT YARDS APPROVED YARDS APPROVED USE OF MAIN BUILDING - ACCESSORY BUILDING EXISTING BLDG. / / (FROM C/L STREET) SETBACK LINESTREET 57 / FRONT c1- FT. CENTER OF REAR YARD Q /Y� / SIDE YARD LEFT ,J C I RIGHT c< R.SIDE � Fr. F?. DESCRIPTION OF WORK L.SIDE 5 Fr. Fr. NEW k ALTERATION _ ADDITION REAR 71 FT. FT. DISTANCE BET. BET.MAIN B REPAIR MOVING DEMOLISH MAIN BLDGS. I,L. ACCESS.SLOGS. VAR.# "L`� �Yj DATE �/� BUILDING NO.OF /n / �� pp�� SIZE /��(TvJ�T,� ROOMS {�J STORIES C.U.P.# p I APPROVED fit/I 6 EXTERIOR WALL CCa ROOF APPROVED COVERING Co 1 COVERING a A.4/ :Y e!Alr 0 - ) • USE OF BUILDING AND WORK TO BE PERFORMED HOLD FOR SPECIAL REq IREMENT ec'V41/F_%1�/Atfit>I EropC (,C N /Seey/J258 E. 21,s/t St. for requirements I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION J THE AMOUNT SHOWN UNDER VALUATION IS POR THE F AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OP ESTABLISHING A PERMIT PEE ONLY. G PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION 13O SRI�T1n N BUILDI SIGNATURE O OP PERMIT FEE S SIGNAIGNA PERMITTEE J� ! S / aI 42 � 3 /PIAN CHECK $ -574 L/�` AUTHORIZED AGENT TOTAL FEE $ IS-C)20