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Home My WebLink About163 22ND ST - Building Permits Ir CITY OF COSTA MESA. • ape BUILDING DIVISION 04401*. x._1111,9_11.71•1 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER v.4 PERMIT B07-00302 mri (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesaB3114DING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 163 22ND ST Status: ISSUED Suite: Applied: 03/14/2007 Vicinity: FIRST AND SECOND FLOOR Issued: 05/31/2007 Primary Occ: R3 Type of Construction: V-N Parcel Number: 42613306 Zoning: Applicant: COUTE, JOHN J Address: 163 E 22ND ST Phone: 714-402-3829 ISSUED BY: COSTA MESA,CA Zip: 92627-1737 Owner: COUTE, JOHN J Address 163 E 22ND ST Phone: 714-402-3829 COSTA MESA,CA Zip: 92627-1737 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 000000 Arch : Eng: JOSE VENTOCILLA PE Address: Address: 24636 CRESTA CT Phone: Phone: 949-910-0942 LAGUNA HILLS,CA Zip: License: • • 92653 License: 47942 i • SCOPE OF PERMIT ADD 1,142 SF TO S.F.D.NEW 2ND STORY(466 SF FIRST FLOOR AND 675 SF SECOND FLOOR)TO AN EXISTING SINGLE STORY SFD,NEW 52 SF DECK AND A MINOR INTERIOR REMODEL. FIRST FLOOR WORK TO INCLUDE THE CONVERSION OF AN(E)BEDROOM INTO A DRESSING ROOM,ADD A NEW BEDROOM,EXTEND THE(E)BATHROOM, REMOVE(E)NON-LOAD BEARING WALL IN KITCHEN AND EXTEND THE KITCHEN.SECOND FLOOR WORK TO INCLUDE THE ADDITION OF A MASTER SUITEWITH A SLEEPING AREA, 2 WALK IN CLOSETS,2 DRESSING AREAS,A MASTER BATHROOM AND DECK AREA. CONVERT 2 BEDROOM, 1 BATH TO A 2 BEDROOM,3 BATH S.F.D. • REF:DR-06-23 • • FEE SUMMARY Plan Check: $1,737.94 Calc Valuation: $400,000.00 Permit: $2,673.75 Claim Valuation: $400,000.00 SMIP Res: $40.00 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $4,451.69 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right ' .0-0 PARKING Existing: 0 Required: 0 Proposed: 0 • • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all- required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.' ` FOR INSPECTIONS CALL: (714)754-5626 2446.46(600) 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: (Thi action need not be completed if he permit is valued at one hundred dollars($100)or less.) _.(.certify that in the parlor•= • the work for which this permit is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws : 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 p �i plicantSIgnature: ��ar rDate:�-MO JI /`^' ! --.--- .LwARMNG:FAILURE TO CURE W+ PENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE TIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS(.100,000L IN `�1714' •THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLA- • •N: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect.Llc.# Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: 9 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 Imself 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.). ' 9- ' I,.ee owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions 7 Code:The contr��yyyors (cense 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 pursue . hr' ontractors License Laws.). ❑ I am exe - n•• s.. Business and Professions Code for this reason: Stgnatbre: .A...�� _ • -.;.Date:_ .1'7 ' /,2-t0J7 ..;.c.. ..-----Ownerifted b dd1rilC-T se. •I' ❑No er's License No.; / E><plres:_�nj—C7 ps Verification of 0 nershi• e• documen,'.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: 9 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-ore than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,ora volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater then 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? 9 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 ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? JI Yes 1 No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLI •C •i D 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 t. •mply Pith : state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described P.1:1:14,I. uryoses.I agree not to occupy or allow occupancy of any building authorized by this per it unci final inspection. ifirre 'nature• 'egel'Owner(s) � - ..•• zed Applicant ` Date CODE t INSPECTION Mk RALE INTRIALS WOE INSPECTION TYPE PL_E ItERSIA I 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing _ 200 Final Re-Roof 210 Final Electrical ' r i 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/Q, 3 .oR' QE/ _t,,s- • .•."' �y_ 05-31-2_'071:do At _ 001-00173 l NEWPORT-MESA UNIFIED SCHOOL DISTRICT N° 6625 CERTIFICATE OF COMPLIANCE OF DEVELOPMENT FEES PURSUANT TO AB 1800 AND AB 181 To: (✓) City of Costa Mesa District Receipt No. ( ) City of Newport Beach ( ) County of Orange Plan Check No.:WI- l wZ Applicant: _ Jol,bn Jose?n C'ou l e Address: lb3 &, V2 ST: ce817A. Sa c-a "2--Co Y7 61 Telephone Number: f�l-'fa'Z�S K2 Tract/Parcel and Lot Number(s): Crag -. a - 1 5-3—De Location of Project: )Wn 6 _ 2/i1ei\p Number of Square Feet of: f py�� C� C� Residential Space t l2 0..x $1.84 Total ' ` '^) 0'r2 C./ Commercial and Industrial Space x $.30 Total Commercial/Industrial Project is: (Check One) Warehouse _ Motel _ Preschool R 8 D _ Bank _ Auto Repair Movie Theater _ Neighborhood Shops _ Hospital Mini-storage RacquetHeafih _ Large Office Heavy Industrial _ Hotel _ Office Bldg. Regional Shops _ Medical Office _ Restaurant Light Industrial _ Office Park _ Fast Food This project is exempt because This certifies that the above-named Developer/Applicant has paid school facility fees in compliance with Government Code sections 53080 and 65995. The Building Pemits for this square footage in this proposed development may now be issued by your jurisdiction. Checks are to be made payable to Newport-Mesa Unified School District. of - By: Authorized Reprnentativ The above represen E tion square footage is true. Applicant agr: : -t If it is : :etermined that such representations are not true,then this certifi by:to II automatically terminate and th: . ounty shall be notified. Date: /%.aI 3/01 •! o I , 44a„oaf% CITY OF COSTA MESA 0. s P.O.BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628-1200 Cfiir- 'y ., J, DEVELOPMENT SERVICES DEPARTMENT • February 14, 2007 John Coute 163 22nd Street Costa Mesa, CA 92627 RE: DEVELOMENT REVIEW DR- 06-23 770 SQ. FT. SECOND-STORY ADDITION MINOR MODIFICATION FOR REDUCED LEFT SIDE SETBACK 163 22ND STREET, COSTA MESA Dear Mr. Coute: Review of the Development Review for the above-referenced project has been completed. The application, as described in the attached project description, has been approved, based on findings and subject to the conditions of approval (attached). The decision will become final at 5 p.m. on February 21, 2007, unless appealed by an affected party (including filing of the necessary application and payment of the appropriate fee) or is called up for review by a member of the Planning Commission or City Council. If you have any questions regarding this letter or the project, please feel free to contact me at 754-5640. Sincerely, HANH NGUYEN Assistant Planner • Attachments: Project description Findings Conditions of Approval Code and Special District requirements Approved conceptual plans cc: Gary Wong, Engineering Division Starnes Family Trust \ Fire Protection Analyst 4980 Barranca Pkwy#200 V Building Division . Irvine, CA 92604 • • Gregory Smith Dorothy Quiroz 157 22nd Street 401 Irvine Avenue Costa Mesa, CA 92627 Newport Beach, CA 92663 Building Division(714)754.5273 • Code Enforcement(714)754-5623 • Planning Division(714)754-5245 FAX(714)754-4856 • TDD(714)754-5244 • www,ci.costa-mesa.ca.us February 14, 2007 ' DR-06-23 Page 2 John Coute 178 22nd Street #B Costa Mesa, CA 92627 February 14, 2007 17R-06-23 Page 3 PROJECT DESCRIPTION • The applicant proposes to construct a 770 square-foot, second-story addition in conjunction with a 470 square-foot, first-floor addition to an existing, one-story, single-family residence. • 'A minor modification is also requested for the east (left) side of the first-floor addition to extend the nonconforming east side setback of 4 feet, 5 inches (5 feet required). Staff supports the encroachment because the encroachment will not be greater than what exists and it is only for 20 additional feet on the first floor; the addition will also maintain the same 8-foot plate height as the existing residence. Furthermore, the addition will be located adjacent to the east neighbor's driveway and garage, minimizing privacy and visual impacts on that neighbor. • The proposed second story satisfies the intent of the Residential Design Guidelines. The second floor is set back at least 7 feet and 12 feet from the east and west (side) property lines, respectively. Various building planes and roof forms are incorporated into the design, providing visual interest and minimizing building mass. The rear setback is proposed at 47 feet, exceeding Code requirement of 20 feet. • Except for one window on the east side of the residence, all other second-story windows will be at least 12 feet from the side property lines. A condition has been included requiring the second-story window that is seven feet from the east property line be non-openable obscure glass or clerestory to minimize privacy impacts to the east neighbor. Therefore, privacy of the adjoining neighbors would not be negatively impacted because of the proposed second-story window locations, setbacks, and design. • Since access to the proposed second floor is not integrated with the main living area, a condition has been included requiring a land use restriction to inform future property owners that the property can only contain one dwelling unit, unless all applicable requirements for a second dwelling unit can be met. • The General Plan designation for the property is Medium Density Residential, which allows a maximum density of one dwelling unit per 3,630 square-foot of lot area. The site contains one dwelling unit on a 6,750 square-foot lot, consistent with both the lot's General Plan and Zoning designations. FINDINGS A. 'The proposed project complies with Costa Mesa Municipal Code Section 13-29 (e) because: 1. The proposed development and use is compatible and harmonious with uses both on-site as well as those on surrounding properties. 2. Safety and compatibility of the design of the buildings, parking areas; landscaping, luminaries, and other site features including functional aspects of the site development such as automobile and pedestrian circulation have been considered. 3. The project is consistent with the General Plan and Zoning designations because the number of dwelling units on the property does not increase. February 14, 2007 OR-06-23 Page 4 4. The planning application is for a project-specific case and does not establish a precedent for future development. B. The information presented complies with Costa Mesa Municipal Code Section 13-29(g)(6) in that the minor modification for a 4-foot, 5-inch east (left) side setback is compatible with the anticipated development in the general vicinity. Granting the minor modification will not be detrimental to the health, safety, and general welfare of the public or other properties or improvements within the immediate vicinity. Specifically, the encroachment will not be greater than what exists and it is only for 20 additional feet on the first floor; the addition will also maintain the same 8-foot plate height as the existing residence. Furthermore, the addition will be located adjacent to the east neighbor's driveway and garage, minimizing privacy and visual impacts on that neighbor. C. The project has been reviewed for compliance with the California Environmental Quality Act (CEQA), the CEQA Guidelines, and the City environmental procedures, and has been found to be.exempt from CEQA under Section 15301 for Existing Facilities. D. The project is exempt from Chapter XII, Article 3, Transportation System Management, of Title 13 of the Costa Mesa Municipal Code. CONDITIONS OF APPROVAL Ping. 1. A land use restriction executed by and between the property owner and the City of Costa Mesa shall be recorded prior to the issuance of building permits. This land use restriction shall inform future property owners that the subject property can only contain one dwelling unit with one kitchen, unless all applicable development standards for a second dwelling unit can be met. The applicant shall submit to the Planning Division a copy of the legal description for the property, and either a lot book report or current title report identifying the current legal property owner so that the document may be prepared. 2. The second-story window that is seven feet from the east property line shall be non-openable obscure glass or clerestory to minimize privacy impacts to the east neighbor. An alternative type of window that minimizes privacy impacts to the east neighbor may be permitted under the direction of Planning Staff. 3. All new and existing construction shall be architecturally compatible with regard to building material, style, colors, etc. with the existing residence and detached garage. Plans submitted for plan check shall reflect all above-mentioned revisions and indicate how architectural compatibility will be accomplished. 4. No modification(s) of the approved building elevations including, but not limited to, changes that increase the building height, removal of building • articulation, or a change of the finish material(s), shall be made during February 14, 2007 l) ' DR-06-23 Page 5 construction without prior Planning Division written approval. Failure to obtain prior Planning Division approval of the modification could result in the requirement of the applicant to (re)process the modification through a discretionary review process such as a minor design review or a • variance, or in the requirement to modify the construction to reflect the approved-plans. 5. All construction-related activity shall be limited to between the hours of 7 a.m. and 8 p.m., Monday through Friday, and 8 a.m. to 6 p.m. Saturday. Construction is prohibited on Sundays and federal holidays. Exceptions may be made for activities that will not generate noise audible from off- site, such as painting and other quiet interior work. 6. The conditions of approval, Code requirements, and special district requirements for Development Review DR-06-23 shall be blueprinted on the face of the site plan. 7. The applicant shall contact the Planning Division to arrange for a Planning inspection of the site prior to obtaining a final inspection from Building Safety. This inspection is to confirm that the conditions of approval and code requirements have been satisfied. Eng. 8. Maintain the public right-of-way in a "wet-down" condition to prevent excessive dust and promptly remove any spillage from the public right-of- way by sweeping or sprinkling. CODE REQUIREMENTS The following list of Federal, State, and local laws applicable to the project has been compiled by Staff for the applicant's reference. Any reference to "City" pertains to the City of Costa Mesa. Ping. 1. Approval of the development review is valid for one (1) year and will expire at the end of that period (February 15, 2008) unless building permits are obtained and construction commences, or the applicant applies for and is granted an extension of time. 2. All required setbacks abutting a public right-of-way shall be landscaped, except for walkways and driveways which provide access from the street. The property owner shall be responsible for the maintenance of the landscaping on the property. 3. Existing mature trees shall be retained wherever possible. Should it be necessary to remove existing trees, the applicant shall submit a written request and justification to the Planning Division. A report from a Califomia licensed arborist may be required as part of the justification. Replacement trees shall be of a size consistent with trees to be removed and may be required on a 1:1 basis. This requirement shall be completed under the direction of the Planning Division. 4. Street address shall be displayed on the fascia adjacent to the .main entrance or front door in a manner visible from the public street. Numerals shall be a minimum 6" in height with not less than '/2" stroke and shall February 14, 2007 DR-06-23 Page 6 contrast sharply with the background. 5. Any mechanical equipment such as air-conditioning equipment and ductwork shall be screened from view in a manner approved by the Planning Division. Roof mounted equipment is prohibited. 6. Installation of all utility meters shall be performed in a manner so as to obscure the installation from view from any place on or off the property. The installation shall be in a manner acceptable to the public utility and shall be in the form of a vault, wall cabinet, or wall box under the direction of the Planning Division. Bus. 7. All contractors and subcontractors must have valid business licenses to do I Lic. business in the City of Costa Mesa. Final inspections, final occupancy, and utility releases will not be granted until all such licenses have been obtained. Bldg 8. Comply with the requirements of the California Code of Regulations, Title 24, also known as the California Building Standards Code, as amended by the City of Costa Mesa. 9. Submit a drainage plan as part of the plan check submittal package. 10. Submit an erosion control plan as part of the plan check submittal package. Eng. 11. A construction access permit and deposit will be required by City of Costa Mesa Engineering Division prior to start of any on or off-site work necessary during construction for street sweeping. Fire 12. Provide an approved smoke detector to be installed in accordance with the 2001 Edition of the California Fire Code. SPECIAL DISTRICT REQUIREMENTS The requirements of the following special districts are hereby forwarded to the applicant: Sani. 1. It is recommended that the developer contact the Costa Mesa Sanitary District at 949.645.8400 for current district requirements. AQMD 2. Applicant shall contact the Air Quality Management District (AQMD) at (800) 288-7664 for potential additional conditions of development or for additional permits required by AQMD. CDFA 3. Comply with the requirements of the California Department of Food and • Agriculture (CDFA) to determine if red imported fire ants (RIFA) exist on the property prior to any soil movement or excavation. Call CDFA at (714) 708-1910 for information. • PLANNING APPLICATION SUMMARY Location: 163 22nd Street Application: DR-06-23 Request: • Development Review for a 770 sq. ft. second-floor addition in conjunction with a 470 so. ft. first- floor addition SUBJECT PROPERTY: SURROUNDING PROPERTY: Zone: R2-MD North: R2-MD Single-family residence General Plan: Medium Density Residential South: R2-MD Multi-family residences Lot Dimensions: 50 ft. by 135 ft. East: R2-MD Single-family residence Lot Area: 6,750 sq. ft. West: R2-MD Multi-family residences Existing Development: A 900 sq. ft., one-story. single-family residence with a 310 sq. ft., detached one-car garage. DEVELOPMENT STANDARD COMPARISON Development Standard Code Requirement Proposed/Provided Density: Zone/General Plan 1 du/3,630 sq. ft. 1 du/6,750 sq._ft. Lot Size: 12,000 sq. ft. 6,750 sq ft. Lot Width: 100 ft. 50 ft. Building Coverage: Building—residence NA 13% (900 sq. ft.) Building—residence addition 7% (470 sq.ft.) Building—detached garage 5% (310 sq.ft.) _ Driveway NA 8% (530 sq.ft.) Total Lot Coverage 33% (2,210 sq.ft.) Open Space 40% (2,700 sq.ft.) 67% (4,540 sq.ft.) Building Height: 2 stories/27 ft. 2 stories/26 ft. 2nd to 151 Floor Ratio`: 80% x 1,370 sq. ft. = 1,096 sq. ft. 56% (770 sq. ft.)' Setbacks—main structure: Front 20 ft. 20 ft. Side (left/right)— 181 story 5 ft./5 ft. 4.5 ft.'/12 ft. Side (left/right)—29d story' 5 ft./10 ft. average 7 ft./12 ft. Rear 20 ft. 47 ft. Building Separation 6 ft. 6 ft. Parking: Garage 2 2 Open ' 2 2 TOTAL 4 4 Existing nonconforming 2Residential Design Guidelines 3Includes 52 sq. ft. deck • CEQA Status Exempt-Class 1 • Final Action Planning Staff • NOTICE OF EXEMPTION To: ❑ Office of Planning and Research From: City of Costa Mesa 1400 Tenth Street, Room 121 Development Services Dept. Sacramento, CA 95814 77 Fair Drive, P.O. Box 1200 Costa Mesa, CA 92628 0 County Clerk-Recorder County of Orange 0 $43 Filing Fee Attached P.O. Box 238, Santa Ma, CA 92702-0238 0 No Fee—City projects exempt from filing fee • Project Title: Development Review DR-06-23 Project Location: 163 22ntl Street Project Location—City: Costa Mesa Project Location—County: Orange County Description of Nature, Purpose, and Beneficiaries of Project: Construction of a 770 sq.ft. second story in conjunction with a 470 sq. ft. first floor addition to an existing residence. Name of Public Agency Approving Project: City of Costa Mesa Name of Person or Agency Carrying Out Project: Hanh Nguyen,Assistant Planner Exempt Status: (Check One) ❑ Ministerial (Sec. 21080(b)(1); 15268); ❑ Declared Emergency(Sec. 21080(b)(3); 15269(a)); ❑ Emergency Project(Sec. 21080(b)(4); 15269(b)(c)); ❑ Categorical Exemption. State type and section number: _ Class 1, Existing Facilities ❑ Statutory Exemptions. State code number: Reasons why project is exempt: Project involves additions to single-family residence, not located in an environmentally sensitive area. Lead Agency Contact Person: Hanh Nguyen Phone: (714)754-5640 If filed by applicant: 1. Attach certified document of exemption finding. 2. Has a Notice of Exemption Yes ❑ No ❑ been filed by the public agency approving the project? Signature: Date: Title: Assistant Planner FISH & GAME FEES: Pursuant to Section 711.4(c)(2)(A) of the California Fish and Game Code, the project is exempt from fees since it is exempt from CEQA. • Signed by Lead Agency Date received for filing at OPR: ❑ Signed by Applicant Filed with the County Clerk: ❑Yes 0 No Date Filed: • Form Updated November 2001 • • /9'1CITY OF COSTA MESA , ‘Z` BUILDING DIVISION F „ lI DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT J4y,� VE07-00474 ammo (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa€LfTRICAL PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 163 22ND ST Status: ISSUED Suite No Applied: 05/11/2007 Vicinity: Issued: 05/31/2007 Parcel Nunmber: 42613306 Applicant: COUTE, JOHN J ' • Address: 178 E 22ND ST#B At Phone: 714-402-3829 ISSUED BY: i- • COSTA MESA,CA Zip 92627-1737 Owner: COUTE, JOHN J Address 178 E 22ND ST#B Phone: 714-402-3829 COSTA MESA,CAZip: 92627-1737 Contractor: OWNER-BUILDER Address: Phone: • Zip: License:000000 SCOPE OF PERMIT ELECTRICAL PERMIT FOR A 1,142 SF ADDITION TO ADD A 2ND STORY(466 SF FIRST FLOOR AND ' 675 SF SECOND FLOOR)TO AN EXISTING SINGLE STORY SFD,A NEW 52 SF DECK AND A MINOR INTERIOR REMODEL.REF#:B07-00302 WORK TO INCLUDE:29 LIGHT FIXTURES,40 OUTLETS, 19 SWITCHES, 1 SERVICE TO 200 AMPS AND 1 SUB PANEL TO 200 AMPS. - • • FEE SUMMARY • Quantity Quantity ISSUE FEE $23.50Temp Dist System/Lighting 50.00 0 Temp service test $0.00 - Busway/100 ft $0.00 0 Res. a/c package $0.00 - Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0 Lighting Fixts $28.57 29 up to 50 kva/kw $0.00 0 Recept Outlets $36.60 40 up to 100 kva/kw $0.00 0 Switches $1.10 1 - over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 • Service to 200a $30.50 1 -. 1 Misc.Conduit . - ,. $0.00 0 Service to 1000a $0.00 -0 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1hp $0.00 :0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 . 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 .0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $30.50 .1 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 :0 Temp Pwr Pole 50.00 0 TOTAL CALCULATED FEES $150.77 Interned Pole $0.00 0 COMMENTS/ SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work Is suspended or abandoned for a period of 180 days. • ......- INSPECTIONS: INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes,.an required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of thislerinit. FOR INSPECTIONS CALL: (714)754-5626 - 2446-46(6/00) • DECLARATIONS WORKERS'COMPENSATION DECLARATION: . 1 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. O 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($100)or less.) • [VI certify that in the performan•.AI. -work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of =lifo d 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 provi 41 / 2/ Applicant Signature: 1a y/Date: /,y /;)-(10-2 WARNING:FAILURE TO SE RE WO4}j 'ENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINALP ALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS(5100,•:.,IN A.., y COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class# " Contractor's Signature: _ Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the 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 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.). • pi I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The cont,,,��..4.,,pppors 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 p u. .t:1 Contractors License Laws.). ❑ I am exe iL.,,- Business and Professions Code for this reason: Signature: -aw Date: Q 24'J-3. -, , Owner ID verif:• by• er -�p=nse. :1 Ya 0 No Driver's License No. , Expires: z . Verification •4 Owner1r b 4:-of docume 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'rare than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 6,California Administrative Code). O 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,ora volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health end 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 e application ap,rmit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes IU P No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (if"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? D 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 COMPLIAN - AND •UTHORIZATION 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 w all s�: laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described prope•; insp' ;• es.I agree not to occupy or allow occupancy of any building authorized until final inspection. elir Sigf} • .al Owner(s) DatA : I \ . A.,i-• •. orize.,Applicant Date CODE 6 INSPECTION TYPE QAAI INTITIALS CODE It INSPECTION TYPE GALE INTRIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 7-ZO-a8 ' 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval _ 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy- I P , e 1 I -r III • CITY OF COSTA MESA - 4 ) BUILDING DIVISION Ff „, �• • DEVELOPMENT SERVICES DEPARTMENT P MIT NUMBER PERMIT B07-00317 *tt '"*'aertm`l (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.c S_DING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 163 22ND'ST ' • Status: ISSUED Suite: Applied: 03/16/2007 Vicinity: SHED AT REAR SFD • Issued: 03/16/2007 Primary Occ: U-1 Private Gar/Carport/Shed Type of Construction: V-N Parcel Number: 42613306 Zoning: Applicant: COUTE, JOHN J Address: 178E 22ND ST#B S Phone: 714-402-3829 COSTA MESA,CA ., Zip: 92627-1737 ISSUED BY: .-,_ Owner: COUTE, JOHN J Address 178E 22ND ST#B ' Phone: , COSTA MESA,CA - Zip: 92627-1737 Contractor: OWNER-BUILDER . Address:. = , Phone: Zip: License: 000000 , Arch : Eng: Address: Address: • , , ( Phone: . Phone: • " Zip: License: License: SCOPE OF PERMIT CONSTRUCT 240SF DETACHED STORAGE SHED ATTHE REAR OF AN EXISTING SFD. , FEE SUMMARY__ Plan Check: $54.11 • . Calc Valuation: $3,000.00 Permit $83.25 - . -- ' • Claim Valuation: $3,000.00 SMIP Res: $0.50 SMIP Corn: $0.00 ' Other $0.00 Inspection: $0.00 , Total: $137.86 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 ' e • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result In the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 244646(6/00) 1 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 sec' need not be completed If the permit is valued at one hundred dollars($700)or less.) I certify that in the performan •of t :work for which this permit is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Califo Ia,a A agree that if I should become subject to the workers'compensation provisions ofSectign 3700 of the Labor Code,I shall forthwith '•T�. comply with these proviscm... h I Applicant Signature: �A4Date: 3 t6 117 WARNING:FAILURE TO SEC RE WORKE-. CO PE, •TION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100••. c pis-• •.T OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3708 OFTHE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,end my license Is in full force and effect.Lic.# Class# Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: t 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 subjests 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•. a •rs 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 pu suanti the Contractors License Laws.). ❑ I em 0 t u.. Business and Professions Code for this reason: Signature: I.! • Date: "II tip Owner ID - ed'g icense. 0 Yes 0 No Driver's License No. $ Expires: (B+7L f eq Verificat.n of Ow YYYVVV ,,, (t 4.e of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has e 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 9 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,ore volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature end 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 II 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 as plication apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LI Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 yes 0 No 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 COM `l�IAND E 'ORIZATION 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 compst: : s and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property fo . rp•-:s.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. �' � 31«10-3 •tr0 owner(s) Date 0' •. .nze. .pplicant Date CODE L INSPECTION TYPE ME INTRIAL$ CODE( INSPECTION TYPE ail =SL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Bullding/Occupency 3.Z.O-92 )e..... CITY OF COSTA MESA 4 44S BUILDING DIVISION F '„ ) DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER t PERMIT ►/IVI07-00290 66151) I PO (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 163 22ND ST Status: ISSUED Suite No Applied: 05/11/2007 • Issued: 15/3 00 Vicinity: / Parcel Number: 42613306 ISSUED BY: t ' Applicant: COUTE, JOHN J Address: 178E 22ND ST#B Phone: 714-402-3829 COSTA MESA,CA Zip: 92627-1737 Owner: COUTE, JOHN J Address: 178 E 22ND ST#B • Phone: 714-402-3829 COSTA MESA,CA Zip: 92627-1737 Contractor: OWNER-BUILDER Address: Phone: Zip: • License:000000 SCOPE OF PERMIT - MECHANICAL PERMIT FOR A 1,142 SF ADDITION TO ADD A 2ND STORY(466 SF FIRST FLOOR AND 675 SF SECOND FLOOR)TO AN EXISTING SINGLE STORY SFD,A NEW 52 SF DECK AND A MINOR INTERIOR REMODEL. REF#: B07-00302 • MECHANICAL INCLUDES: 1 FAU< 100K BTU, 1 REPAIR/ALT COOLING/HEAT, 1 HOOD W/MECH EXHAUST,AND 4 VENT FANS. FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $14.80 1 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $13.70 "1 Evaporative Cooler $0.00 0 Inst/Rep.Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Ref rig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 Combressors/Absorption Systems Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $0.00 0 - 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $10.65 1 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct $29.00 4 Over 50 hp[Over 1,750 BTU $0.00 0 Appliance $0.00- Olr Boilers Fire Dampers $0.00 0. Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp "$0.00 0 Inst or Relocate Appl Vent $0.00. 0i 15 to 30 hp $0.00 0 Air Handlers< 10000cfm • $0.00 0` ' 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0, Other Mechanical Fee Floor or Suspend Heater $0.00 0. Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $91.65 COMMENTS/ SPECIAL CONDITIONS • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§1, 12-21-92) - EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days,or it work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. :- FOR INSPECTIONS CALL: (714)754-5626 ✓ 2448+16(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 end 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 completedl' the permit Is valued at one hundred dollars($100)or less.) VIQ I certify that in the performan ]of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of alit•r -nd 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 ovist AS Applicant Signature: 0_ Date: r i t ,3i// 0,-Orr-5 WARNING:FAILURE TO 5- URE W..4 ER MPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PIES AT1D CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100:.•),IN 1:•ITION '•THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lie.# Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). . Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such Improvements are not Intended or offered for sale.If,however,the building or Improvement is VOld 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.). • 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 e 1tractors License Laws.). El am exempt s: ./ Business and Professions Code for this reason: Signature: 1.�'.. • `., _ Date: 2,4u44 3� 2-C Owner ID verifies .y driver'p' ; 'I Yes ❑No Driver's License No. - Q Expires: 10%/0 Verification of 0 ershi. •..91117,0 •ocu . t,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^ore than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 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 Califomia 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 end Safety Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aPermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No ....attach certificate oc...compliance the appropriate air r.pollution control ..tr.l officer).8 (If yes", certificate of compliance from appropriate acofficer). • 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 COM' AN w AND AUTHORIZATION OF ENTRY:1 certify under penalty of perjury that I have read this application and state that the information given is correct. I egrets.... co •I it' :II state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described.40 .f sp=c ion purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. S. \ J 11a ?T ?a'? ei : ature Of Legal Owner(s) . / Date • l �Ia, r •uthorized Applicant Date CODE I INSPECTION TYPE RAM ILITITIALS CODE I INSPECTION TYPE PEE © ,I 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1'"^o-m O FL: 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site . 204 Final Demolition - 250 Final Building/Occupancy • - ! i CITY OF COSTA MESA 11 rias BUILDING DIVISION F i �_ , DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4 + PERMIT • -atPoi.acn d`' /407-00349 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 163 22ND ST Status: ISSUED Suite No Applied: 05/11/2007 Issued: 05/31/2007 Vicinity: I Parcel Nunmber: 42613306 / / �/ Applicant: COUTE, JOHN J ISSUED BY: ,� r • Address: 178 E 22ND ST#B • • Phone: 714-402-3829 COSTA MESA,CA Zip: 92627-1737 Owner: COUTE, JOHN J Address 178 E 22ND ST#B Phone: 714-402-3829 COSTA MESA,CA Zip: 92627-1737 Contractor: OWNER-BUILDER • ' Address: Phone: Zip: License: 000000 SCOPE OF PERMIT PLUMBING PERMIT FOR A 1,142 SF ADDITION TO ADD A 2ND STORY(466 SF FIRST FLOOR AND 675 SF SECOND FLOOR)TO AN EXISTING SINGLE STORY SFD,A NEW 52 SF DECK AND A MINOR INTERIOR REMODEL.REF#:1307-00302 PLUMBING INCLUDES: 1 BATHTUB, 1 DISHWASHER,RELOCATE GAS SERVICE, EXTEND GAS LINE,2 SHOWERS, 1 KITCHEN SINK,4 WASH BASINS,2 WATER CLOSETS, 1 WATER HEATER AND 1 WATER PIPING. FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $9.80 1 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) 50.00 0 Receptors • . $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units 50.00 0 Septic Tank $0.00 0 Wash Basin $39.20 4 Dishwasher 59.80 1 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor $0.00 0, . - Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 • Sewer Private Line $0.00 0 Water Closet(Toilet) $19.60 2 Drain, Roof $0.00 0 Shower $19.60 2 Water Heater/vent $12.30 1 Drinking Fountain $0.00 0 c Sink,bar $0.00 0 Water Piping(Inst or Rep.) $9.80 1 Expansion Tank $0.00 •, 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 • Sink,Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $0.00 0 • Sink,kitchen $9.80 1 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 I Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $9.80 1 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $9.80 1 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 • ' • TOTAL CALCULATED FEES: $173.00 COMMENTS /SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit'shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all- requiredInspectionsInspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of thispie it< FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 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: ((rrhiis,6action need not be completed if the permit is valued at one hundred dollars($100)or less.) [3 I certify that in the perfor ;e•fihe work or which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Cal nl:I:nd at that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these p., ' i. ? r^� Applicant Signature: `�4 Date: �&��- 3�, J.� WARN NG:FAILURE TO ON GE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL E HuNGRED TTHOUSAND DDOLLARE(500, ' E5. T OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS AND CIVIL FINES UP TO 'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.M Class If Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: . I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to Its Issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property, m EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Th Code:The contractors Lic nse r 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 I. e C ntra �n ' . e Laws.). Ly/ I am exempt under s: . _di \ Business and Professions Code for this reason: Signature: •v '' ‘ _ Date:Date: 3 Owner ID verified by div: s licen a :+e! 0 No Driver's License No. Ex res: /QS Verification of Ownershi•by(type•4` 1ocu t• .-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal 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 L i No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (ii'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: t Date: CERTIFICATE OF COMP ANCE i D AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agre: to comply wi 1state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described • ..:4zty • in lection•. •oses.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. � E. :Of eget Owner(s) /nat. 3/ ��.7 Date A�• ••hod d Applicant Date CODE 0 INSPECTION TYPE IMIE 1NTITIALS CODE 0 INSPECTION TYPE PATE INfITULS 1616 Fixed System Final Fire Prevention 206 Final Mechanical q IY 1266 Pool Spa Final 208 Final Plumbing Wo-o13 @3,, 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 I Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. tel 0396 7/30/86. 8.00 TL. Ch Y OF COSTA MES CONSTRUCT ON PERMIT - PERMIT NO. TRACT NO. LOT NO. UNIT NO. _ _ ' ��3 flN i.14177/ , AppProlicantsct Mailingai P �7' TYPE OF CONSTRUCTION -Li NEW G ADD ,ALTERATION LI REPAIR wne 's Na Address ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# Zone ' Owner's Name COl� Phone DESCRIPTION OF WORK/USE OF BLDG. Address S Main Building: Accessory Building: Arch/Eng. License No. TYPE OF PERMIT El GRADING LI FOUNDATION LI STRUCTURAL E Front 4- p Address CI❑ TENANT ELECTRICAL CI PLUMBING El MECHANICAL OTHER B Rear , • N Contractor's Name 43'K�IS/cog' �' Ct/le/C- Phone -1/9-9-78 - 'T6'S f4f1 V/Eu/ S/}vnt-A1i1 ' PROJECT DESCRIPTION SQ. FT. • OCCUPANCY C Right N Address(mailing) ��/�rJ( CON ST RUCTION TYPE VALUATION$ _ CityLicense No. Gfj/� g Left R ZONE GRADING CU.YDS. ACRESR LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided E I hereby affirm that I am licensed under provisions of Charter 9(commencing Remarks: Planning Notes: Q with section 7000) of Division 3 of the Business and Professions Code, and M my license is in full force and effect- T • License Cla s C.-10 License No. 3r3?AS - - S, Date 130.&, Signature PLUMBING - ' FEES WpRKERS'COMPENSATION DEC (RATION Bar Sink Showers ereby affirm that I have a certificate of consent to self-Insure or a certificate ELECTRICAL FEES Workers' Compensation Insurance, or a certified copy thereof (Section • Backflow'Preventef Service Sink .,800, Lab. C.) Automatic Washer ' Transformer 0 15-50 KW I'.�s ,f Policy No. C1'04/1'ol&4d Company girt Backflow lrrigasair Sewer Cap0 50+KW - Construction Pole Sub. 1 Certified copy is hereby furnished. Certified copy is filed with the city B Division` Bathtubs Sewer Connection Cooking Unit / Meter 'up to 100 amps �1 ate AOROo Applicant ! EXEMPTION FROM WORKERS'COMPEN ATION 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 ❑Electric Sub Panel I certify that in the performance of the work for which this permit is issued, I ‘S..„,..‘ shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank .— Fan _ Motors 00.1 HP ❑i'h:8 - Workers' Compensation Laws of California- Date Signature Floor Drains Swimming Pool w/Spa F.A.U. .\ NOTICE: If,after making this declaration,you Should become subject to the Ine.Solar 09-15 HP 016-15+ . Workers' Compensation provisionsofthe Labor Code, you must forthwith Floor Sinks Urinal Fixtures comply with such provisions or this permit shall be deemed revoked. Microwave CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes \ I hereby affirm that there is a construction lending agency for the performance - Pole Light of the work for which this permit Is issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets Lender's Name Range • • Lender's Address Kitchen Sink Water Service SwitchesSign ' OWNER BUILDER DECLARATION • I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal ' following reason (Section 7031.5 Business and Professional Code: Any city or 9 P Standing Sections county which requires a permit to construct,alter,improve,demolish or r¢ air P-Trap any structure, prior to Its issuance, also requires the applicant for such permit Laundry Trays 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 Drains the Contractor's License Law(Chapter 9(commencing with Section 7000)of i , • vision 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 - • . ,31.5 by any applicant for a permit subjects the applicant to a civil - enalty'of not more than five hundred dollars($500). U 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 Hood or Type I 0 DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such Improvements are not Intended or offered for Boiler sale, If, however, the building or improvement is sold within ono year of com- Canopy Type II 0 Zoning Approved By • Date pletion,the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By Date U I,rove for the r of the property,f oe). e-�`�'�- t rs owner of thet rojectam exclusively contracting with licensedioncon- Duct-Structural Refrigeration System Application Issued By _ Dat hetors the project (Section 7044, tBusiness and of property Code: _ The Contractor'smproLicense Law does notoraapply to an owner je is thla who Duct-Ventilating 00-100,000 BTU ❑100,000 BTU; SUMMARY OF FEES builds or Improves thereon,and who contracts for such projects with aeon- • tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMIP ' $ proof of their Worker's Compensation insurance should be provided to me. _ PLAN CHECK $ PERMIT ❑ I am exempt under Section ' B.& P.C.for this reason Firepl/Fact.BIt. ICBG# Fire Dampers PLUMBING $ ISSUANCE $ • Date Owner HeatingSystem&Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $ I hereby certify that 1 have read this application and state that the above 00-100,000 BTU 0100,000 BT ELECTRICAL �• 17 GRADING $ • information is correct. I agree to comply with all city and county ordinances - $ and state laws relating to building construction,and hereby authorize repro- PLAN CHECK 50% $ MICROFILM $ sentatives of this city to enter upon the above-mentioned property for inspection purp9 e J • � MECHANICAL $ TOTAL FEE $ S7)- p'oD Signature ' Date 7�Ob Reinspection Fee $15 1 Issue Fee $ 3 PLAN CHECK 25% $ • Drivers' License or SS# CMF 0865-46,rev.10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor • .y 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 s 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding C 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test i 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, D Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. 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 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20, Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping D Gas 0 Oil • 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical • 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL IN$�PECTION • . 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED A 33. Final Electric ry ?-6k. Notes: No yr ( - 64 cCc'4i JG �'L f7 N/f O 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test Cal a J,L y�yt, 36. Hood or Canopy vV• 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. Date VSJJECT ADDRESS: UNIT: ''lgN'R'S NAME: 163 22ND ST CITY OF COSTA MESA - BUILDING PERMIT PERM NO: 3 053464 - �!DDRESS: COiiTE@ JOHN J 163 E 22ND ST PERMIT NO: 3 053464 PLAN CHECK NO: 03143-91 S GOVT: N SUPP: N � '3 COSTA MESA,CA 92627 CONSTRUCTION :'YPE: PERMIT TYPE: STR PURPOSE: 0 H ARCH/ENGINEER: 645-3165 REG.NO.: , ADDRESS: UNIT: JOB DESCRIPTION , 20LF-2 . 3FT, 260LF-6F7 HIGH BLOCK WALL SQ FT; 280 PERMITTEE: CLAIM VALUE: 5, 600 . 00 CALC-VALUE: 5, 600 , 00 GROUP OCC: R-3 / ADDRESS: JOHN COUTE ( 714 ) 645-3165 163 E 22ND ST COMMENTS: CITY STANDARD BLOCK WALL C.M. CA 92626 ********4x-nc.* xx ***xx*x**** s*Tx*a6x x *-§(**xx. +*r*****}; t;(* (VI OtETC97 O RLICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTj 7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACKS CITY LIC.: STATE LID.: CLASS: REQUIRED Date: Signature: MAIN BUILDING --- -- ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate 01 consent to sell-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FENT: FT — IN REAR: FT IN Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: CI' N POLICY NO.: EXP.DATE: COMPANY: PARKING REM: PROV: PARCEL: 426/ 3306 ZNE: R2 : REF NO: 1 Certified copy is hereby lumished. 0 Codified copy is filed with the city Building Division. PLANNING NO'i ES> TWO 2 1 /2 FT. HIGH WALLS, 10E7. LONG, 10E7. FROM P IL • TWO > 6FT, HIGH WALLS 115 FT. LONG• ONE 30FT, LONG 6FT, WAIL; Elate: Applicant: *********:•Fif*xx***If**IE*******if#********ler***x4**********************�*` •ti:x******* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permits for one hundred(MOO)or less). DEVELOPMENT SERVICES R E Q U I R E M E N,. .. S I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become //�� sublecl to the Workers'Compensation Laws of Cabtornia. ZONING APPROVED BY LP c r‘ DATE: - 8 t 1 (q, _ Date: Signature: •- NOTICE:If,ager making this declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE: 7N I Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. r .. •. CONSTRUCTION LENDING AGENCY: hereby affirm that there is a construction rending agency for the performance of the work for APPLICATION ISSUED BY: DA 1 t.:..whichthispermitisissued(Section3097.Gv.C). ************ ************i�**x *** F***t*****7• *-11:x. , �Y LENDER: *****************************************If*****!F****IE*x****.x********;04********** ADDRESS:-. LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter.improve,demolish,or PERMIT 81 . 00 , 56 repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SM.I P/NON—RES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN 52 . 65 any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars(S500). ISSUE FEE I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV--> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE `X structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTAL S----> 81 . 56 0 . 00 52 , 65 134 . 21 134 . 21 . 00 • � does not apply to an owner of a property who builds or improves thereon.and who does such work himself/herself or through iihis or her own employees,provided that such improvements are not intended or offered for sale.If.however the building or AO improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED: 134 . 21 OVER/SHORT: . 00 mrmepurpose olsale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SHIP/70T GRADING PLAN—CHECK I,as owner of the properly,am exclusively contracting with licensed contractors to ••struct the project(Section 7044,Business 81 . 00 . . . 56 52 . 65 ❑ and Professions Code: The Contractors'State License Law does not apply to an r' A property who builds or improves thereon . anti who contracts for such with acortractor(s)license pursuant to ' rectors*state License Low), am aware ' *********Li**#:*If*****************It************'n**.*y,***IX**********************.*x.* That proof of their Worker's Compensation insurance should b 'provided to / INDIVIDUAL F E E BREAKDOWN O I am exempt under Section: B. &P.C for this �` ' I _ell& TYPE QTY DESCRIPTION UNIT COST TOTAL COST Date: g 4 owner: !/�.. , 00 I do hereby certify that I am aware of and understand the requirements of Calif• earth nd•. Code Sections 25505.25533,and SFR 280 RLS CONCRETE BLOCK ' WALL / FT', 20 5, 600 . 00 25534 and that I or any future building occupant will/will not(circle one)need t i ly w sari •codes and the requirements for a END OF FEES permit for construction or modification from the Air Duality Management Distr s• Code applications are exempt from these provisions. • Date: Ap want: 7 I hereby certify that I have read this applicalio and slate that the abr motion is correct.I agree to comply with all city and county ordinances and state laws relating to building c struction and •reby)?l•• re i latives of this city to enter upon the above.mentione777ddd property for ins Iediaf purploses. •, ' • • Driver's License or SocialYYYSecurity 5: - '+` ^n(^r Sij �l",'Ur4r, " Cl- 1641-46 White-Bwld'mg',Green-Code Enforcement:&is ••i ant:Pink-Revenue:Goldenrod-Assessor t tl4TF: 0L-0.1°) r Lift' 1+l 17 CONSTRUCTION AND PLANNING POISPA APFbDVALS Permit # Date Inspector APPROVALS Permit # Date Inspector 1. Tem$orary Electrical Service or Pole 52. Pool & Equipment Location F 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, O Undrgrnd. ' �Yh t • 10. Structural Floor System - 61. APPROVAL TO DECK - i' 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final - '3. '-- /-pet,'' • 12. Sewer Cap . '} 63. Heater & Vent-Final • �-" -' 13. Roof Drains 64. Plumbing System • Final /� • 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas O Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro • 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT c 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Noit,� k 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 '0, 47. FINAL STRUCTURE BUILDING Ii / /l 48. FINAL PLANNING 49. Electric Release to Edison . 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date J PARTY WALL AGREEMENT jl NOT ILTInt •F. , l`U r 'l' r ram AGREErmr, uade and entered into this day of \ y� 114/4 ; by and between N'd Ma r3 heti( hereinafter referred to as 'LAND admit", and Lk CooM. hereinafter referred to as 'ADJACENT PROPERTY OWER". It is hereby agreed that a party wall will be constructed on the property line between 16 3 ZZ b — 51 (Adiress of Adjoining Properties) in the City of Costa Mesa, County of Orange, State of California, as per map recorded in Book , Page of Miscellaneous Maps, in the office of- t e County Recorder of said County. The party wail shall be permitted to encroach IN WITNESS VEERED'', the parties have entered into this Agreement the day and year first above written. LAND ChNER$ ADJACENT =v. .d OFEa32 L, Signat ' e Siirany - 1411.1 MArAa • Nam (Typed or Printed) Name (Typed or Printed) /`02 SF S,X', //WC 4 IL. t CO 3 6, 2?tJ'() 5 r ass (Address)(Address) G iy) M •. PARTY WALL AGREEMENT NOT P RI r�TION 1�v �1 REQUIRED j• T_13 AC�/�tEEPENT, made and entered into this 1 day of Q,� .{�)l} ( I i q ( , by and between 4 hereinafter referred to as 'LAND CANER'. and £L.5( e WCop hereinafter referred to as 'ADJACENT PROPERTY OWER'. It is hereby agreed that a party wall will be constructed on the property line between lb, 4 lc 7 C, ZZ ND sr 6%14 k1e54 - (Address of Adjoining Properties) in the City of Costa Mesa, County of Orange, State of California, as per nap recorded in Book , Page of Miscellaneous Maps, in the office of the County Recorder of said County. The party wall shall be permitted to encroach NJ-Wolin arAinmUctitrpfruthi@ 10) 1, 167 l= 22 ncl St Got Q00W IN WITNESS WHER Ce, the parties have entered into this Agreement the day and year first above written. • LAND • 11109 109 ADJACENT PROPERTY ate Si•` AipW Signature; e •r re 4S .Si'E )4/44Q /POc • Name •-• or Printed Name (Typed or Printed) 163 C, fl sl / �, as deg± oJ C.1, (Ar�ress) ly� YY),AtG�s'�. ass-) 9�oA7 974 7 a h • '• PRI CTAODRESS: 163 22ND ST • UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 053778 O..ER'S NAME: COUTE@t JOHN J • ADDRESS: 163 E 22ND ST PERMIT NO: E 053778 PLAN CHECK NO: N GOVT: N SUPP: N COSTA MESA,CA 92627 CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE: OTH 645-3165 ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : CONTROLS FOR GATE /INTERCOM — ETC. SQFT: ADDRESS: UNIT: CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 / PERMITTEE: JOHN COUTE ( 714 ) 645-3165 ADDRESS: 163 E 22ND ST COMMENTS: REF B53464 C.M. CA 92626 *************SE**************+E**************REst******+t******************x******** LICENSED CONTRACTOR DECLARATION: I hereby atlirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code.and my license is in lull force and effect. S E T B A C K S CITY LIC.: STATE LIC.: CLASS: Date: Signature: MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to selhinsure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Compensation Insurance.or a certified copy thereof(Section 3800,Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN POLICY NO.: EXP.DATE: �COMPAY: g PARKING REQ: PRO/: PARCEL: 42613306 ZNE: REF NO: ❑ Certified copy is hereby famished. El Certified copy is tiled with the citycityBuilding Division. PLANNING NOTES> > ate: Applicant- ******************************************************************************* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred(5100)or less). DEVELOPMENT S E•R V I C E S REQUIREMENTS I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California. ZONING APPROVED BY . • DATE: Date: Signature: NOTICE:II.after making this declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE: Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. �� CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y: — /J /(,�] which this permit is issued(Section 3097,Civ,C). ********************** ia.s.s. + -— a DHAF iTI'REF IF* ** iF*iFk �iEl! LENDER: ****************************************** *********************************** ADDRESS: LEGALIZATION:N F E E S U ' MARY STRUCTURAL SEGMENT:N OWNER BUILDER DECLARATION: I hereby affirm that lam exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECT• C MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct.alter,improve,demolish,or PERMIT 1 00 repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 0 g SMIP/NON—RES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 1500 . rq I. as owner of the property or my em oyees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUr PLAN—CHECK TOTAL PAID DUE 1..0 structure is not intended or offeredfor sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS---- > 11 . 00 15. PO 0.00 26. 00 26 . 00 . 00 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 employees,provided that such improvements are not intended or offered for sale.If,however the building orimREVENUE DIVISION TOTALS--> COLLECTED: 2 6. 00 OVER/SHORT: 00 forptneeperpose oilsae)mn one year of completion,the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044.Business 26. 00 ❑ and Professions Cade: The Contractors'Slate License Law noes not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s)license pursue 0t 'Contractors'State License Law).l am aware ******************************************************************************* that proof of their Worker's Compensation insurance should be pr. INDIVIDUAL F E E BREAKDOWN ❑ I am exempt under Section: B.S P.C. for this reason' "k► / TYPE QTY DESCRIPTION UNIT COST TOTAL COST --'Dale: gllolR( Owner:_ ELE 1 MISC APPARATUS NOT LISTED REQ PERMIT 11 . 00 11 . 00 I do hereby certify that I am aware of and understand the requirements o He. s and Safe. Code Sections 25505,25533,and END OF FEES 25534 and that I or any future building occupant will/will not(circle one) ompl wit aid s de codes and the requirements for a permit for construction or modification from the Air Duality Managemen r ident al.. ruction applications are exempt from these provisions. Ihirr Date: Applicant: I hereby certify that I have read this application and state that the abs•e nl/Gr/tion is correct.I agree to comply with all city and county ordinances and state laws relating to building construction and hereby ulho present.' of this city to enter upon the above.mentioned property for ipeel n purposes. `— Date: q�IA °11 Signature: ,lam _ :_! ..... _ _ Driver's License or Social Security e: � ,:::*,E: - ` 1' 1641.46 White—Building:Green—Code Enforcement: -"eYlt r✓• nue:Goldenrod—Assessor . IleCONSTRUCTION AND PLANNING POIIIIIA 44 APPROVALS Permit# Date Inspector APPROVALS` Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location0- 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement =_ -- ,3?fi`Eqct rical Conduit Utility-Undrgrnd. 54. Forms 4;tElectrical CondultrUndrgrnd. 55. Electrical Bonding L15ti {eel� Reinforcerncnt 56. Rough Plumbing & Pressure Test i 449;iE}ectrical UFEF3,Grnd. 57. APPROVAL TO COVER-GUNITE -- - 73CF6otings a - 58. Electrical Conduit-Undrgrnd. s 8: Foundation " 59. Gas Pipe, 0 Undrgrnd., Test Ai i . 9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK - J. ------ . - '' 11. Property Sewer Line.8* House Connection 62. Backwash & Receptor-Final - 12. Sewer Cap 63. Heater & Vent-Final ,' r 13. Roof Drains L ~ 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT ,J. c„• n - J' "IV.• i' - '>, 20•+Rough Factory Fieplace •C S -4 ' r, r :APPROVALSp Permit# • _+ 21'Ducts,in_Str Ucture _ yi , t. X70. t7hder'grpuM HAIro .; ' 22.'Ducts, Ventilating.; - + _ v; 'L' * .71. ProductrPPping C3 Gas O'Oil 23. -Gas-'Pipe7Rough &'Wiest ?: - r T •s _ " x X72. Undergrodnd Flash a !n a.! :- r J. J \1 .. y 24. ,Rolf Framing - ••', 'R ^ C - - 5.73aUndergrnd:Storage•Tank f Gases 0 Oil S 25. Roof Sheathing j.. 7. ;-,' , ; • pia ,F ''74�-.Overhead Hydro:- ' x 26.`T-Ba1 Ceiling (Structural) &;Monocoat s s; C' tn' 75KDry Chemical * • o: 27.7-Frame and Flashing - ` ' t, " ' 76. Dry Stan ijpe - l ` -" • .28.Lathing. Siding }- %� r & +- •• N` ; 77,x FIXED SVS_TE iE1NALI S -29. Insulatidn I I �(_ 78 FIRE PREY. FINAL u; 41,;-30. Drywall,Nailing , S :1 I I ! o u. NEALt' D H, EPT' R.EQUIREMJIENT I I S ..! Cr" . - C31. Plaster Blown Coat' _ t„ - I ., v r,79nFINAL IIVS,PECTIr, i - It v !.32. -Electrica`'Power Meter-Final -7. M I r. -80(rfDOD CERTIFIEA? IS6bkDr S �33.;-Final Eleetriy' .c n T �� c1 ' I t ,fix 'N �. s_ _ -4 al * . C to rr j 1 ,r ' ,r7. ' . :;34.,-Fin2i Heating$ Airrd7enditiomg_ 1- It r .- y.� ;.!y r_ S ._p t; - 3 _ w -._ .1 35.'Final Gas'Pipe-Test` •r - I - p HO., o: r'> n r C 0 . •7 rt y * 1 36.rHood or, Cano T _ - * ,14 • ..0 `37• .cFinal Factory Fireplace, T .L 'r.. I I• . -. i^ 38. Final Plumbing - it . •. .. r._: s IV I It :> c! :7 j . :139. Water Service-Final.: i rc + i 7 C' , :,it • IX: ir: 40. Gas Service-Final x ., - x `' ` { . ."4 C i 1. Solar Domestic-Final - •• ' 0 , ^ 0- ' ' * n , I. .. . -42.�Backflow Preventers * - I 14 43. Backflow Irrig - ' ation- .4S r '+ '- J. * • he i 4 - . Landscape Ircgatiop System- gib' * ` ' -' 44 <45'rSound Attenuation• -'7°- a S tt-- - '" . v4' * . ^ 1 I.I ...461.Handicap Regulations " t * b �� •., v 47._FINAL STRUCTURE & BUILDING ' . N n - T 'Y 48.:FIN-AL PLANNING ; r y' • ° • fu •r'Its - r49.-Electric Release to Edison I t I I * r = ..c i r• ; r50.,Gas.Release to Southern California Gas Co 2 I ; .. '' o O n J • olr -.51. CERTIFICATE OF:OCCUPANCY' * ;. .S i-' kl:_ 'x __ No Date PROJECT ADDRESS: 163 22ND ST UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO; B 053821 OWNER'S NAME: COUTEQ JOHN J ADDRESS: 163 E 22ND ST . PERMIT NO; B 053821 PLAN CHECK NO: 03498-91 L GOVT; N SUPP; N COSTA MESA, CA 92627 CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE; ALT ' ARCH/ENGINEER: 645-3165 REG.NO.: ADDRESS: UNIT: JOB DESCRIPTION : REMODEL ENTRY OF EXISTING SFD SQ FT: 42 PERMITTEE: CLAIM VALUE: CALC-VALUE; 579 . 60 GROUP OCC: R-3 / ADDRESS: JOHN COUTE ( 714 )645-3165 163 E 22ND ST COMMENTS' NO PLANN APP 'L RE r D PER JKB 09-11-91 , `LE_F- j S3464- C.M. 7 CA 92626 Sr*;F*�r�E�E*4*******�E*�F;r***� *** �F;r;r�E*�E;E*Sr;e�rr�E******4**F �E *** *F *•�r*�F*�e�r�r�E�r�E�r�r�F*** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS 70001 of Division 3 of the Business and Professions Code.and my license is in lull force and effect. SETBACKS CITY LIC.: STATE LIC.: CLASS: • Date: Signature: MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a ceniflcate of consent to self-insure or a certificate of Workers' FRNT; FT IN REAR: FT IN FRNT: 32 FT IN REAR: 107 FT IN Compensation Insurance.or a certified copy thereof(Section 3800.Lab.CI, LEFT: FT IN RGHT: FT IN LEFT: 34 FT IN RGHT: 12 FT IN POLICY NO.: EXP.DATE: COMPANY: PARKING RE • PROV: PARCEL : 42613306 ZNE: R2 REF NO: N " Ceniged copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. PLANNING N TES> PROPOSED 42 SQ FT. FREESTANDING COVER ALONG THE FRONT HALF > OF THE PROPERTY, • Date: Applicant: ******************************* *********************************************** EXEMPTION FROM WORKERS'COMPENSARON DECLARATION: (This section need not be mmpleted if the permit is for one hundred($100)or less). D E V E L O P M E N T SERVICES REQUIR EH E N'.7 S I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become ,� —� subject to the Worsens Compensation Laws of California. ZONING APPROVED BY ( " '— �.' DATE: -. Date: Signature: NOTICE:If.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE: Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. __ CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: �_ �_ = DATE. O f2 I'"3 which this permit is issued(Section 3097,Civ.C). ********************. .4 �.•s•s-� — . .— . . . . . . . . . . . . . **********, * * * **** LENDER: ******************** ********** ************************'Jf*l********** ADDRESS: LEGALIZATION:N F E E S U MARY STRUCTURAL' SEGMENT:Y OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTR ' MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve.demolish,or PERMIT 1 7.0 0 50't teoair any structure,prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed SMIP/NON-RES - pursuant to the provisions of the Contractors State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN 11 . 05 any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE s 4,1 I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID 4. DUE ($ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 17. 50 0 . 0 % 11 . 05 28 . 55 28 . 55 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through - his ro herm owntischprovided that pimprovements me are not intended or offered pfor sale. ainothowever build building or REVENUE DIVISION TOTALS--> COLLECTED: 2 8. 55 OVER/SHORT• 00 1 improvement or hof sold withineone year of completion,suhlmp ove entsr will have the burden of provingd forhe/she did not r the or improve ( �— tor the purpose ofsale). BLDG PMT PLUMBING ELEC ' IC MECHANIC FIRE SMIP/TOT GRADING 'PLAN-CHECK ` 17.00 , 50 11 .05 I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business j� ❑ and Profess'. s Co e: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who mract for such projectswith acontractor(s)license pursuant to the Contractors'State License Law).l am aware *****************************************.)(.*******.**-*-***.*.**.****************f***** that pro o'm• Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN ❑ I am ex:y,t u :er Section: B.&P.C. i . 0f'Yy et TYPE QTY DESCRIPTIO N UNIT COST //TOTAL COST I• l Dale: nfyI Am tsof SFR 42 RES-PATIO COVER-POST & TRELLIS 13 . 80 ' 579 . 60 I do hereby•emfy l r m e , of and understand the requirements of California Health and Satety Code Sections 25505,25533,and END OF FEES 25534 and at I or T77 j��fll tore b y ding occupant wiUwill not(circle one)need to comply with said state codes and the requirements for a permit for ionstruc S, r mo!• ation from the Air Duality Management District.Residential construction applications are exempt Horn mese prowl •: ---- Date. A. Applicant: I hereby cert{,{ ave read this appbcation and state treat the above information is correct.I agree to comply with all oily and county ordl 11y4$y . a relating to bullrtg construction and hereby authorize represent al Nes of this city to enter upon the above.menlioned proper9� on :oncoses. � �,1 � .— Date l a re: ' Odvr 's IL se onecunl =`Ili (- " 'r ..• . 9F:itY - '- ' 1641.46 • • , :udding:Green—Code Enforcement Canary—Applicant:Pink—Revenue:Goldenrod—Assessor PO0t IA CONSTRUCTION AND PLANNING _ APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location ‘i 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3..'EiFctrical Conduit-ljiility-Undrgrnd. 54. Forms • ,':'431Electrical Condu t�Undrgrnd. 55. Electrical Bonding ' ' 5. Steel Ffeinforcement 56. Rough-Plumbing & Pressure Test - 6i-%jectrical UFER..Grnd. 57. APPROVAL TO COVER-GUNITE cc ".7: Footings k b-'ctt,L- c‘\0-(SE,.p 1 58. Electrical Conduit-Undrgrnd. '-- 8. Foundation 1 59. Gas Pipe, 0 Undrgrnd.,Test �. 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line,& House Connection 62. Backwash & Receptor-Final ,r .r 12. SeVver Cap ,z 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing "' 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final ,t 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough ElectricNt-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT ' 20..rRough Factory Fjreplace . 'zrti % - ; - k , ,APPROVALS rC-Permit # -t _ 21.?Ducit, in_Str btu e.~ ' x * '- _ :'x ' 'y e: y, t. x ,70. hJndegYputnd Hydro 22. Ducts, Ventilating a: I C S r ,S •t•* n in. Productrp ng OlO s O10il .r T. * -' C- ^ r r 23.',Gas-PipeT4oudh &Test I 'gr [ = I-'^ , '72, Under ' ' S K ^ if '1 C - 9'r'ound Fluslx _ 24.tRoo't Fra'rning+ OR . "--4-. • ; _-, C .- * $ S73�JUndergrnth Storage:Tank 0 Gas ❑Oil 25. Roof $hg'athing •�r '$- r. . ' . F s74iOyerhead'Hydro-.r c ok e 4. ' 26,E --Bar Ceiling (Strycturall & fylonocoat _ . 4 ' v 4 ; • 'R 75_'Dry Chemical . - u; 27.LFramea1d Flashii ^a _ �" .._� x 76f Dry Standpipe C?; " ,-• 28. Lathing`;& Siding]' - ::-.1." -r..rr 7' : rT ' ? • _ _ _ J,-i= ;: .. .r 77s FIXEDSYSTEn..,'? - 29. Insulatio + - •- •"' 1"•.11 '1 I •'f r ._ •�.' " . j t, 78.,:FIRE PREY. FlgJAL -r D J: u..- t 0 -2.c`.m e i 1 r x to 1730. Drywall Nailing ,7; ;�;�- HEALlH,DEPT1 REQUIREMENT 31. Plaster Blown Ode _ "J!: I F S. 79OFINAL INSPECTIkN 4' C T 32.•-Electrica6Power MewjFinal: it' .. :,J :p ,;80:,-F00D CERTIFICATE ISSUED- ' Y 33.4FinaF Elt tri �'" r .J -" I ° ' '1Notes: c -;3_ -: ` S C- f34.,Final Heatingf& P:i;Conditioning j" .' 1 - y (i. `Y Y 35. Final Gas:Pip-e-Test * •; • . - 'I; "Hood or CanoPY:t _ t• ' }'S .1r' ig 36. 1 % . r ., . I , I� f. 7. 7. "c t ;,ttl. -37.-Fina(Fabtory Fireplace I Str r_`. 'r: .1' 1 ! it -,. S r-li,. 38._FinalPlumbing .- , :t _-,) I I la -r 1 '39.-Water Service-Final• ' ! - I 'r a. _Ini + r L40. 'Gas Service-Fninal • .n1t t1. ,(r In ` -- *41. Solar Domestic-Final. w C I i` r q }' ' 42. Backflow Preventer'. • 01 `t. y - ' Er t- 0-- •2 v _itic, . (r .. a'. >_. • , Irl r, 43. Backflow Irrigation tr rr.s „ 1 `p t C 44. Landsca a Irtigatid5 System '� '• ' - '` '' ^• t'J '- :S J =' ,Q, p Jl n:a ..:L. . to .. . .• 1: OJ ?, C:'J 1 ?J 0 .-. .0 45._Sound ,'4 -.atiorr •PJYE- to• 't ; `r is 'I la NI ::z t.a . .. r •r f. v x • P . •_46. Handicap Regulations `� •%X 1 .� 3 47._FINAL STRUCTURE & BU1WG ;.:J,-..;:t., /� " li�kP`- sQl`" 48. 'FINAL PLANNING i irtoM TN i.� _ b -.49.-Ele• ctric Release to Edison i _ '" ' o . y 1. u .. v 50. Gas Release to Southern California Gas Co -r z--� 1 a < o.c.- . 1: a 1 .51. CERTIFICATE OF:OCCUPANCY ' ' �. - : -r..No. Date I. STATE OF CALIFORNIA },ss. COUNTY OF OADIAT �/�7"/�,-,,,, �1 O On this 9 day of �f/4YW` (� , In the year 19 9i, befoLeme, the undersigned, a Notary blit in and for said State, personally appeared ..........„.„-..........--,-....,,a-, - i a. OFFICIAL SEAL ROSA A.CE SIMONE , Koury Public California (or proved to me on the basis of satisfactory evidence)to be the person-whose name_ ORANGE COUNTY subscribed to the within instrument,and acknowledged to me that—he= N. � By Carom.EA.Apr.TY.1887 /5 ' . executed it. WITNESS my hand and official seal. A // �(:k4ei tpi1! Yl �. ckbQg �I4ii ' Notar Pus lc in and for said State. ACKNOWLEDGMENT—general—WM Form 233CA—eev. 02 ®1902 WOLCOTTS.INC. (pore class 0.21 (Individual) STATE OF CALIFORNIA SS. COUNTY OF OTdnge On August 15, 1991 ,before me.the undersigned,a Notary Public in and for said State.personally appeared *** Elsie Rood Cronic *** (or proved to me on the basis of satisfactory evidence), to be the person whose name is subscribed • OFFICIAL$ EAL to the within instrument and acknowledged that She KYLE S.H.WHITEHEAD °. executed the same. ��n NOTARY PUBLIC•CALIFORNIA PRINCIPAL OFFICE IN ORANGE COUNTY WITNESS my hand and official Sfeal1�i�I p ,�o /1� My Conint sial Exp.Mat 31,1995 SignatureLiSIVOlk •\�/VlM/,l/'sllA/l/" • LE-7617/132) (This arra for official nolarial wn STATE OF CALIFORNIA alai" ss. COUNTY OF ,T On this q day of figM , in the year 19 q , bej tme, th�undder�ned, a Notary PSlic in and for said State, personally appeared C. N s^,"".'!•"� OFFICIAL SEAL — / % R08A A.OE BIMONE , �e relc, 'p, ! Notary Public California ar roved to me on the basis of satisfactory evidence) to be the person-whose name__ aL*.�Y ORANGE COUNTY /S' subscribeiWthe within instrument,and acknowledged to me that—he r f ,;Y'`,,, AryComa Exp.Apr.2t.INS executed it. WITNESS my hand and official seal. / • ` 44aehakTo atA '"` 0 m/At eland 7 jableis ofitt i2 AO ',ublic in and for said State. ACKNOWLEDGMENT—General—WdUns Form 233CA—Rev.5-82 ©1982 WOLCOTTS.INC. Ipnce clan 8-21 ) STATE OF CALIFORNIAOran e ) ss. COUNTY OF 9 ) On July 24 1991 , before me, the undersigned, a Notary Public in and for said State, personally appeared Daniel_Marshall*** • ( Personally known to me (or proved to me on the basis of C,fl�fl�l�ll�y✓✓!f!✓✓lrrrrlltr satisfactory evidence) to be the person(s) whose name(s) OFFICIAL SEAL is/ale subscribed to the within instrument and acknowledged y e . KLONG 0 '�'•:•-y NOTARYY PUBUGCALIPoRNIA SW447/1'•% :a PRINCIPAL OFFICE IN to me that he/s1O4 y executed the same. 1 ORANGE COUNTY WITNESS my hand and official seal. o.-• My Commission Expires Sept 4.1994 Signature (This area for official notarial seal) SF.423.4 (REV A•7182) (CA) (INDIVIDUAL)