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Home My WebLink About266 21ST ST - Building Permits 4` F 9 r CITY OF COSTA MESA BUILDING DIVISION I}'�,,,,�' � DEVELOPMENT SERVICES DEPARTMENT PER IT NUMBER �1 �ti ' PERMIT J R"`AI1 .„ggz,fi° B05-00235 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT • Job Address: 266 21ST ST Status: ISSUED Suite: Applied: 02/07/2005 Vicinity: ROOF Issued: 02/07/2005 Parcel Number: 42615104 Zoning: - • Applicant: LEHMAN, JEFF ISSUED BY: p Y A—N Address: 2415 MARGARET DR Phone: (949)646-3571 NEWPORT BEACH,CA Zip: 92663 Owner: CARR, TIM Address 266 21ST ST Phone: COSTA MESA,CA Zip: 92627 Contractor: J S L ROOFING INC Address: 2415 MARGARET DR Phone: (949)646-3571 NEWPORT BEACH,CA Zip: 92663 License: 747706 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF EXISTING ROOF, INSTALL 30#FELT UNDERLAYMENT,&REROOF WITH 30 YR.COMP.(28 SQ.). FEE SUMMARY Plan Check: $0.00 Calc Valuation: $5,200.00 Permit: $125.25 Claim Valuation: $5,200.00 SMIP Res: $0.52 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $125.77 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or If work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections end 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(WOO) r. 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. ray, 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'co pen--tion Insuranc: -:rrier agtl'policy number are: _ -Canf¢rr t' ' ✓K Pollcy.:Number:" thissection need not be completed if the permit is value. -("no hundred dollars($100)or less.) -"(T ^ r ❑ I certify that in the performance of 'e work for w • this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Calif•.G a /'nd agree th. I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisi• . / vAppliciiri4Slgneture: i i / rDe16:_ Z D -WARNING:FAILURE TO SECU- .`tlj : / ;u •MP -AT ON COVERAGE IS UNLAWFUL AND SHALL SUBJECT Ni EMPCOYERTO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARE 15100,..' N'..ITP% TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed undary&o 'si. s pf Chapter 9 mmencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full ut force and effect. 4 ' Class#J C 3 ConuaclofS-Signamre,c7 v.. / M arc-, 7'-') — s a CONSTRUCTION LENDING An'NCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. _ Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes ❑No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Gm 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). .....e South Coast Air Quality Districte.t. r other airpollution llutio.. onto.district 7 application,If a permit haveathe South res ced Management Heor and Sr air goltionclon 4l 3i 3 been agency is required for the work which is the subject of this all of the disclosures prescribed by California Health Safety Code Section 42303 made? 0 Yes ❑No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and c' dinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the os': above-described property for inspection purp .gree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Stay .gal Owner(s) Date .A • .nzetl,Applicant-_ rDate rer— CODEC if ■' DAL IMI11AL5 COOED INSPECTION TYPE BdIE IaRTIAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 2 Ser-Or 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 Property Profile • Page 1 of 2 DataQuickt* lard and property data you can build or Property Profile Primary Owner: STELLE,GEORGE TR Secondary Owner: Mail Address: 463 BROADWAY COSTA MESA, CA 92627 Site Address: 266 E 21ST ST COSTA MESA, CA 92627 A Telephone Number: mo ��` ANN: 4264 51-04 'Cat `I Reference APN: , _ $/ • ' Census Tract: 632.014 �CAuFQR�h4pAy' +" Housing Tract Number: 516 Geo Levet:0 Lot Number: 254 Page Grid Old: 31-E2 Page Grid New: 889-B3 Legal Description: NEWPORT HEIGHTS LOT 254 N WLY 60.5 FT SELY 403.5 FT SWLY 275.3 FT - EX NELY 1 25 FT- Subdivision: Property Characteristics Bedrooms: 2 Year Built: 1956 Square Feet: 848 Bathrooms: 1.0 Garage: Lot Size: Total Rooms: 5 Fireplace: Number ofUnits: I Zoning: Pool/View: Use Code: Single Family Residence Heating/Cooling: Sale & Loan Information Transfer Date: 11-20-1979 Seller: Document: 0134030056 Transfer Value: $169,000 Cost/Sq Feet: $199.29 Title Co.: First Loan Amt: (..ender: I..ast Trans W/O$: 06-05-2000 Loan Type: Interest Rate Type: Last"Trans W/OS Doe: 0000294240 Assessed& Tax Information Assessed Value: $130,312 Percent Improvement: 38.56 Homeowner Exemption: Land Value: $80,064 Tax Amount: $1,953 Tax Rate Area: 15044 Improvement Value:$50,248 Tax Status: current C 2004 DataQuick Information Systems.This information is compiled from public records and is not guaranteed. OWNER GRANT, FRED R.. / DATE 3-21-56 , JOB ADDRESS 266 - 68 E 21st St. BUILDING PERMIT NO. 2518 GENERAL CONTRACTOR Hanson , Siguard VALUE $ 14,640.00 I AP 118-150-3 BLOCK TRACT Rental Prnpartg (Dnp1 Ay) GROUP I & J TYPE V ZONE R4 FIRE DISTRICT 2537 PERMITS ISSUED INSPECTIONS DATE SUBCONTRACTOR ��u"�K ",P DATE NUMBER Footing Trench r! (:, I-,Z.-igp�� Foundation Forms and Grade to Garage ,p.a.c,-.2-<.ey & t'a, 4—) • - Rough Framing ./ i 1'1'5 -17'7a— -7., �•„3�'-/ Plumbing, Rough rSia" yyZZ 1 �/a— Plumbing, Rough Complete)LU 6-- / (79cSt /)7 n,;. , i/i/ 4-?..i . i ,,. ?-023-SIA [/cf„I 5 - Temporary Pole _ / Wiring, Rough di/f,ss 17/946 A eaJX tc-jJoA ) el--s-- t 2. /7 e r.A ,- 7 Heating,Rough _ r� 4Heating, Final Y,/ ,,tcrJ,/,6,A-G. s/9.56 44.1".2, 8 /sewer, House /Sewer,St. /A 04A,F.e, , o' ,,)--ii-3-6. 1/3 /6 Septic Tank or Cesspool L” 'ng, In 4.P, Outx 6.-4%. C P. rring _ ,f% 4. U. t, _ . Plumbing,Final,Fixtures Complete !jF it. i 'o Plumbing,Final Gas Test/ ' /, , ffir -Y 7A, &/' ,—.a '7. ,-{$/ )114-1 Wiring,Final . . ( dez- 'Qlili- , ?✓ of--/ C., fz—/ Occupancy r 4 7—6----4 FORM 210 3M 10.05 2518 UWNtK rLILI NULT , xicnara UAIt J-JLflhI JOB ADDRESS 266 E. 21st Street BUILDING PERMIT NO. 43743 GENERAL CONTRACTOR Owner—Builder DESCRIPTION of WORK Blockwall AP No. 118-153-08 LOT TRACT FIRE ZONE VALUE $ 100.00 I' ECTIONS Signature Date TYPE GROUP ZONE s PESMITS ISSUED A GS SUBCONTRACTOR Date l Number I Signature WATER Plumbing ROUGH PLUMBING PROP. SWR. LINE I. HOUSE CON. 0 RINKLING SYSTEM Yui SCELLANEOUS I \ ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE ‘i UNDERGROUND 0 POWER 5 ROUGH WIRING Heatin• and Vent. • TRENCHES • FORMS • STEEL REINF. 7 '�- _ I' FLOOR SYSTEM BOND BEAM r] STEEL REINFORCE Sid f % 4.4a1 SHEATHING FRAME AND FLASHING LATHING - IN 5 OUT 5 PLASTER. BROWN COAT STRUCTURAL, FINAL Electric y„ G• VENT.. REFRIG. AND A.C., FINAL 147:*NG. FINAL AND GAS TEST 5 ELECTRIC, FINAL BUILDING. FINAL 047,1 -I04c • J 43743 . "R 3. 7 if:7;;00173O1 -:•,', .:-...s.:5,5( COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 A:'L AT ON FOR STRUCTURAL PERMIT For Applicant to Fill in Comple • —Use Ink Only RE, r ED :V D•TE :ECEIVE• D TE ISSUED BUILDING wr. \ ; • o., 5tv., ADDRESS i�Gnr��/1 �///��-A-- r • P l II ...lX- c X fA ��"��,� J A.P. NO.I /5-5-10(OWNER MAIL t •�7 yr BUILDING r 21 S ADDRESS ; 2 i c ADDREAka1S o� i f- TEL. TRACT . LOT 57 /BLOCK CITY6s rnp—r� NO..00._2,411 � J�„ CONSTRUCTION NEW ADD ALTER REPAIR MOVING DEMOLISH LENDER BRANCH ----` �� OWNER ADDRESS (/ VALUE ARCHITECT TEL. USE "'r'�`''� $ / OR ENGINEER NO. FIRE \ ADDRESS /-/q_/ ZONE Wi(fY PE GRO/U�P `J.T XONTRACTOC7 /r„^^."-/�t�/ BvPROVED DATE ✓` ✓G'/ ADDRESS ZOINO.OF USE OF fyyjM`� /J TEL. PLANS BUILDING - •/ �,t( i.CITY NO. / Jr 4%.. / - STATE CITY YARDS APPROVED YARDS APPR/•� ED f; 49 LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY B ILDING W SIZE NO.OF BLDGS. (FROM C/L STREET) Ci.. OF LOT I NOW ON LOT FRONT FT. I r 1 (Q • ( / y USE OF �D5 1 / /i r I' ftd EXISTING BLDG. R.SIL1fr FT. / , ..V] I E Separate permits are required for tl y F P P h L.SID , /��. ,t y� electric,plumbing and heating work. 1. 9 W REAR Fl�t'i .,. MAIN FT. [.., USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. M & 0 SS MAIN SLOGS. ACCE . BLOCS. .a )i ` {� i D VAR.# DATE /\ G ��VV�� j(� C.U.P.# APPROVED / �y r APPROZ6,- '1� / � DATE ?`, 19_7,7 cd w c. O I hereby acknowledge that I have read this application and state n ad that the above information is correct and agree to comply with m la+ all laws regulating building construction, and I shall not employ Z any person in violation of the workman's compensation laws of v 1.17 the State of California. /a LFT. cco 3 I hereby certify that I em properly licensed as a contractor under the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the provisions of the State of California Business VALUATION PERMIT FEE $ — v and Professions Co Division 3,Ch ter 9. n dG PLAN CHECK $ ^� Signatur f d ---ma,/,-,c //,/////� :_.-.----- $ / m n Permittee $ ( _ TAX $ LIC.' ou.2 U Authorized Agent TOTAL PAID $ s' 521