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HomeMy WebLinkAbout206 22ND ST - Building Permits • 4`slake 9 CITY OF COSTA MESA BUILDING DIVISION Y�� ,, � DEVELOPMENT SERVICES DEPARTMENT PERMIT UMBER F 1 � '4. rib i PERMIT 2-01184 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 206 22ND ST Status: ISSUED Suite: Applied: 07/30/2002 Vicinity: ROOF Issued: 07/30/2002 Parcel Number: 42607126 Zoning: / Applicant: BAIRD, CHRISTOPHER JOHN ISSUED BY: CXR Address: P 0 BOX 10651 " , Phone: 949-650-8823 - COSTA MESA;cA - Zip: 92627 , - , , Owner: BAIRD, CHRISTOPHER JOHN - Address -P 0 BOX 10651 " Phone: - - - COSTA MESA,CA" Zip: 92627 Contractor: OWNER-BUILDER Address: Phone: Zip: License:- 0 • • - ` Arch : - - Eng: Address: - - Address:' - Phone: Phone: Zip: " License: License: SCOPE OF PERMIT / REROOF RESIDENCE ONLY:T/0 EXISTING ROCK ROOF,REPAIR SHTGAS NEEDED,FELT PER MFGR'S SPECS,APPLY COMPOSITION SHINGLES.APPROXIMATELY 900 S.F.REF.:B00-02070 AND B02-00072. . , . FEE SUMMARY Plan Check: $0.00 - - -- - Calc Valuation: - $1,450.00 Permit: $54.00 - - - - Claim Valuation: $1,450.00 SMIP Res: $0.50 SMIP Com: $0.00 • Other: $0.00 Inspection: $0.00 • - . Total: - $54.50 - , , 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: d NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections 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(6/00) - DECLARATIONS I a WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) • (W>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 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 provisi s. Applicant'Sig > ,e ODate:, ������� WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($104000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby 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.It Class II 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 end 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.). p(+ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt erg c. _ / Business and Professions Code for this reason: Sgnature! r �� �� uf' / Exp Verification o1 Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,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 end 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,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 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 aPermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U 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 end Safety Code). 7 II 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 COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-•- cri�.roperty for i pecttii purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. • �o -- -- 730 Signature OLLegal Owner(s)'--- (Date's And/Or Authorized Applicant Date CODE 1 INSPECTION TYPE DATE INTnIALS CODE I INSPECTION TYPE PAM INITIAL$ • 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final i / t5/��1 208 Final Plumbing 200 Final Re-Roof to'21'CZ- 210 Final Electrical 201 Final BIocWRetaining 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 ►r CITY OF COSTA MESA ►�@ BUILDING DIVISION >:f � sI 8. DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F t • . PERMIT JoPoRms,p B02-00072 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 206 22ND ST Status: ISSUED Suite: Applied: 01/16/2002 Vicinity: RESIDENCE ONLY • Issued: 01/16/2002 • Parcel Number 42607126 Zoning: Applicant: BAIRD, CHRISTOPHER JOHN ISSUED BY: Address: P O BOX 10651 Phone: 949-650-8823 COSTA MESA,CA Zip: 92627 Owner: BAIRD, CHRISTOPHER JOHN 04°Address P 0 BOX 10651 Phone: I./^/ COSTA MESA,CA Zip: 92627 gds • Contractor: OWNER-BUILDER . , Address: 0 I Phone: Zip: License: 0 Arch : - Eng: Address: Address: Phone: Phone: Zip: - License: License: SCOPE OF PERMIT REROOF RESIDENCE ONLY:T/O EXISTING ROCK ROOF,REPAIR SHTG AS NEEDED, FELT PER MFGR'S SPECS,APPLY COMP SHINGLES.(RESIDENCE IS APPROX 900 SF). r{c2 3O.>0Z7 t� v FEE SUMMARY Plan Check: $0.00 Calc Valuation: $t,000.00 Permit: $38.75 Claim Valuation: S1,omo.00 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $39.25 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections 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(6/00) v 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 earner 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.) O 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,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE 15100,000),IN ADDITION TO THE TMST 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.4 Class 4 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: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm thal)urider 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 orcounty'whichrequires 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 ProfessionsCode),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 perr+' subjectssu � the applicant to a civil penalty-vet riot inore than five hundred dollars($500).): \LY 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. K...-- 7044,Business and Professions.Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his Or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt r =c. Business and Professions Code for this reason: Signature: p - r' Date: / — /L —0/- Owner ID vedfie by drivers license. 0 Yes 0 No Driver's License No. / Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,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 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? 0 Yes ❑No (Section 25533 of the Califomia 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? ❑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 aEEermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes u No (Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building pemnits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 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 COMPLiANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given Is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-(.tacribe , roppeny,for' sped n purp es.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date OODEri INSPECTION TYPE DATE MALI coot. INSPECTION TYPE pa INImAES 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 Building/Occupancy 4` 9 ` CITY OF COSTA MESA • BUILDING DIVISION > y us ,I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER t R `I'4 PERMIT J. 4419>0ot° B00-02070 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca,usLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 BUIJob Address: 206 22ND ST Status: ISSUED Suite: Applied: 12/29/2000 Vicinity: Issued: 12/29/2000 Parcel Number: 42607126 Zoning: Applicant: BAIRD, CHRISTOPHER JOHN ISSUED BY: Address: P O BOX 10651 Phone: 949-650-8823 COSTA MESA,CA Zip: 92627 Owner: BAIRD, CHRISTOPHER JOHN V 1 Address P O BOX 10651 ^�� / OI Phone: '_,j�'vr COSTA MESA,CA Zip: 92627 • Contractor: 9 Address: Phone: Zip: License: Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF,COVER WITH COMP SHINGLES,RE-SHEATH AS NECESSARY FEE SUMMARY Plan Check: $0.00 Calc Valuation: $900.00 Permit: $35.70 Claim Valuation: $900.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $36.20 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: 67% @10) — E,c 4Q , 6tt-de -9 /0-/e 970 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(6/00) DECLARATIONS 1, WORKERS'COMPENSATION DECLARATION: r ,` I hereby affirm under penalty of perjuiy one Of We following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)Or less.) ' ❑ 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,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby 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.A Class e 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). 1 Lenders Name: Lender's Address: Signature: Date: OWNER-B UILDER'DECLARATIONS: n'I ,, I hereby affirm that.uhder 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 ttiat'he orshe is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Busipess 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 sub' cts the applicant to a civil penalty of not more than five hundred dollars($500).): w. 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.). O I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). 0 jam ex „meitid ac. Business and Professions Code for this reason: • I Signature/ / i roc' — Date: 741019760 ` Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Efpires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,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 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 ❑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 0 N (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 appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution controldistrict or agency? lYes 0 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 Cade). 7 Ifa a permit from the South Coast s Quality Management District or other air pollution control district3 agency is required for the work which Is the subject of this appliwtlon,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Vas 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree t comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the abrpycri props tori pact purpos .I agree not to occupy or allow occupancy of any building authorized by this permi until final i sp n. Signature Of Legal Owner(s) ' D e And/Or Authorized Applicant Date CODE I INSPECTIONTYPE QAC IttTRIALS CDDEI INSPECTION TYPE UTE It11IIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1268 Pool Spa Final 208 /// Final Plumbing 200 Final Re-Roof / ,..2414.1 10 ( Final ElecFire Prey i 'oz _653_72.__ 201 Final Re-Rooetaining Wall (/ 2'1` Final Firetrical do 70 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy _ 02T O / I @6H re ores e N Ak Si © f oofl retnt: r -rota 6 << - - O907O" // ltle /14 J tHa j„ '/r / 45/).7sp r2 . vE AAP G9 k-"/ -ni flu we9 -I G'r -� 44 / p%;t.,,e 774. /ypu CIS,-r 02-Off6-'' a Sf Co S c/ 7 vPJc �2c 27 PROJECT A^7E3S: 206 22ND ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 065J3.. 43WNER'S NAME: BAIRD, CHRISTOPHER JOHN ADDRESS: p 0 BOX 10651 PERMIT NO; B 065382 PLAN CHECK NO: rN GOVT; N SUPP : N COSTA MESA,CA 92627 CONSTRUCTION TYPE: V—N PERMIT TYPE: SIR PURPOSE: OTH 714 ) 650-8823 ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : T/O , RESHEATH & REROOF W/COMP . SHINGLES SQ FT: 1, 100 ADDRESS: UNIT: CLAIM VALUE: 1 , 100 . 00 CALC—VALUE: 1, 100 . 00 GROUP OCC: R-3 / PERMITTEE: CHRISTOPHER JOHN BAIRD ( 714 ) 650-8823 ADDRESS: 206 E. 22ND ST COMMENTS : SMOKE DETECTORS ARE REQUIRED PER 1991 U.B .C . C.M. CA 92627 **************************************yr**yr***aE****x•#aF#tau- *a:#*****r**** ETrn****4l! LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING R EQU I R EMEN TS 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. SETBACK S CITY LIC.: STATE LIC.: CLASS: Dale: Signature: MAIN BUILDING ACCESSORY BUILDING ... - WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure 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.CI. LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN POLICY NO.: EXP.DATE: COMPANY: PARKING REQ: • PROV: PARCEL : 42607126 ZNE: REF NO: 0 Certifiedcopy is hereby furnished. 0 Certified//cop//y�is filedy+ith the city Buildinqg Division. PLANNING NOTES> A - / EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less), D EVEL 0 P MEN T SERVICES REQUIR EMEN TS 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 lonhwnh 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: DATE: , J which this permit is issued(Section 3097,Civ.C). ************************************— * ** * $ ********** z{' '{*. * LENDER: ******************************************************************************* ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT;Y OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from theContractors'Slate 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 27 . 00 . 50 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 SMIP/NON—RES and Professions Code)or that be/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($508). 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 ❑ structure is not intended or offered torsate(Secuion 1044.Business and Professional Code: The Contractors'State License Law TOTALS----> 27 . 50 0 . 00 . 0 . 00 27 . 50 27 . 50' . 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 or REVENUE DIVISION TOTALS--> improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve COLLECTED ; 27. 50 OVER/SHORT: . 00 forme purpose of sale). 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 27 . 00 . 50 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon • and who contracts for such projects with a contractors)license pursuant to the Contractors'State License Law).l am aware ***********************************************************XX******-H.*********a6** that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL ,' FEE BREAKDOWN © I am exempt under Section:807044 "RC. _ tor this reason: OWNER—BUILDER (---?*4C46.01 --4":/ �� / TYPE QTY DESCRIPTIO N UNIT COST TOTAL COS'. / Da /z —/7 -7yOwner:f� SFR 1100 REROOF B VALUE RESIDENTIAL NOZOi . 1 . 00 1 , 100 . 00 Ido hereby cetify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES 25534 and that I or any future building occupant will/will not(circle one)need to comply with said stale codes and the requirements for a r9l p�F-� S permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from S")�OK E DETECTOR 5 ER.E D ' these provisions Date: Applicant: REQUIREDIncotnplote Inspection` - \ I hereby certify that I have read this application and slate that the above information is correct.I agree to compty with all city and county /� ordinances and state laws relating to budding construction and hereby authorR epresentawes of this city to enter upon the above-mentioned Otte ]'"4;- 47e/Siga property Ion inspection purposes. Ar— 01 00132496—P0152497 TOT / q 3 /A ' i DALE: ,.2/i7'93 TII,2c 69+ 1i oat ) / —7 7- / Signature: 1 Driver's License or Social Security a: ' •Aor 1641-46 White—Building;Green—Code Enforcement;Canary—Applicant:Pink—Revenue:Goldenrod—Assessor OCONSTRUCTION AND PLANNING POOL . A APPROVALS Permit r0) APPROVALS Inspector I APPROVALS Permit : Date Inspector 1 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit•Undrgrnd. 55. Electrical Bond-ng 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test -,1/4 6. Electrical UF ER 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, :7 Undrgrni I 10. Structural Floor System 61. APPROVAL TO DECK j 11. Property Sewer Una & House Connection 62. Backwash & Receptcr-Final 12. Sewer Cap 63. Heater & Vent-Final 1 -I 13. Roof Drains . 64. Plumbing System - Final 14. Rough P,umbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-F:n;. -)-- 16. Rough Electric Wiring 67. Fencing& Access Approval T • 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 a* 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping t:Gas L 0l ' 23. Gas Pipe-Rough & Test 72. Underground Flush . . T 24. Roof Framing 73. Underrrnd.Storage Tank Ti Gas -1 Oil : 1 25. Roof Sheathing I 74. Overhead Hydro ...t. I 26. T•Bar Ceiling (Structural) & '�:onocoat 75. Dry Chemical Pitj 27. Frame and Flashing _ 76. Dry Standpipe 2. athing & Siding 77. FIXED SYSTEM FINAL s _ a 29. Insulation 78. FIRE PREY. FINAL i -, 30. Drywall Nailing HEALTH DEPT. REQUIREMENT ' - • 31. Plaster Brown Coat - 79. FINAL INSPECTION I _ 32. Electrical Power Mete;-F•nal 80. FOOD CERTIFICATE ISSUED r . i 33. Final Electric Notes: ' i 34. Final Heating & Air Conditioning /Z�Z O_7 I- ✓act, �� 35. Final Gas Pipe-Test 5 .. _ 444' ' 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing i 39. Water Service-Final • 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer -~ 43. Backflow Irrigation 44. Landscape Irrigation System it 45. Sound Attenuation I .� t 46. Handicap Regulations 1 EXPIRED -__ - 47. FINAL STRUCTURE & BUILDING incomptete Inspections 48. FINAL PLANNING - aYte_SSia 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co I 1 51. CERTIFICATE OF OCCUPANCY No Date 1 -_,‘.‘9-1- NI c.. rousesj A gAsAejazA �«7��_____)0 '` ApPRUVED ..\ . , • 1 '% CITY OF COSTA MESA r L 1"., DEPT. 4LpNNING / I • / SUBJECT TOO BLDG. DEPT. REO. ✓ /IA • ` " X t I K 6' gY DSRECTDR OF PLANNING %fr PAT ID' • .. j n Q / C• QV� ' . NI. i FRO (T o - A— / /• % \f A-Rb r/-v A 7) I I /fl �m 4 i4 eixii 4.1 1 14 r- 04 ini. A__,-. ..l/�77 77 ///%YU//�llTL7/ii2ZIJZ�2 ThZ27%27ll4ITiZ2I.IZ7/Z/Z7/L.//& WEZ'W x / 0o"w0-sti Cori 4I' RueT G ' 4 IGH cLuNtP71ONE Con (;hoc WAt.L 4i•h)(L (> As 9E•;e c. M.Crr`A5`r,B.n n \? p ` 33'O" i 0 SCALE 'I4" = RFc kDskcC c.:7, -E. Mao- MRs, �bp15.- McFAVDCN —COG. E. entii2 c;:r; ) C ostAMPsi'. ) eALtF. • TYPICAL 611 CONCRETE BLOCK FENCE • Cement Coping Optional — .� Channel Block With 13/8 ; GENERAL- NOTES 0 ceszontal Top of all -- ° FFenMORTAR : One Part Plastic Cement, and 'IHIMIIIII Three Parts Sand . 6" Concrete Block Fence GROUT: One Part Cement Three and For Fences 5' or Less - -' I f 11.1. 1't One Half Parts hand Vert. Bars 3/8" 0 at 4'-0"O.C.w °a = - ' ! COPING: One Part Cement, Three LL H �� Parts Sand For Fences Higher Than 5' CONCRETE: Well Mixed I:2-1/2 : 3-1/2 Vert. Bars 3/8" 0 at 32" O.C. _ 11 Max. of 7- I/2 Gallons of Provide Inspection and ' `> Z I Water Per Sack of Cement Cleanout Hole at Location > of Vert. Reinforcement f.� REINFORCING STEEL SHALL CONFORM TO AI I j- SEC. A-I5-39 A.S.T M. Fill Cells Solid With Grout is, o ALL STEEL TO LAP WHERE SPLICED, 2=0' Where Steel Occurs I w , 1111 II MINIMUM. GROUT MAY BE POURED FROM TOP OF allin FENCE IN CELLS WHERE STEEL OCCURS. HOLES SHALL BE CLEAR, CLEAN, AND FREE OF ALL MORTAR, DEBRIS, ETC.,WITH NATURAL GRADE INSPECTION HOLES AT BOTTOM. '•%•C• t ptiQi�D �����Pi�. ' BONDS SHALL BE PROVIDED BY LAYING '4ia hr BLOCKS IN STRETCHER COURSES SO 9 . �/� o,. .e ' - _ ° . a s e ° THAT VERTICAL JOINTS ALTERNATE IN TWO 3/8 0 BARS0 - m. o ° • �.. ° ,• EACH COURSE. .4. CONTINUOUS -s-1I WIDTH TO 16' O.C. MAX. a SEE CHART ,,, STEEL MUST BE TIED IN • i BELOW e DEPTH OF EARTHTOOTH PLACE AT TIME OF TRENCH oI l 1/3 THE HEIGTH OF FENCE INSPECTION. �.L BELOW BOTTOM OF FOOTING. n 4, e i ° 10" w° 2 . — SCALE: 1/2" = I' CHART HEIGHT 6 ' 5' 4' 3' WIDTH 14" 14" 12" 12" THICKNESS 10" 10" 8 " 8 " DEPTH OF EARTHTOOTH . . . 24" 20" . . . . . . 16" 12" SPACING OF EARTHTOOTH. . •12' 14' 16' 16' OWNERS NAME: • City of Costa Mesa, California PERMITDDRESS:NUMBER _ - _ _ _ _ _ Building Department SIGNATURE: • FORM 6U25-2M_0-02 _ —_— _ --- ---- 1333a1S I i, ti I(A H A m 33N3015311m 1 y 33N 30153tl 30N301S3 3�N301S3tl 3014301534 ICP- U ' STRUCTURAL APPROVAL ONLY: _ \\. _ - . Clty��of//�Coda Mesa Building Dept. SEPARATE PERMITS ARE REQUIRED By Ul✓ DATE/14/fLL -I9/, FOR ELECTRICAL, PLUMBING, THESE PLANS MUST BE ON JOB AT ALL TIMES FIEi\I'IIVG, VENTILATING AND MAKE NO CHANGES WITHOUT PRIOR APPROVAL REFRIGERATION WORK OF DEPT. THE ISSUANCE OR GRANTING OF A PERMIT OR APPROVAL '� �d OF PLAYS AND SPECIFICATIONS SHALL NOT BE CONSTRUED Permit #-- r • TO BE A PERMIT FOR, OR AN APPROVAL OF, ANY VIOLATION \_iiIS NUMBER MUST „CCOMPANY OF ANY OF THE PROVISIONS OF THIS CODE. NO PERMIT PRE- ALL INSPECTI©N REQUESTS SUMING TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF THIS CODE SHALL BE VALID, EXCEPT IN SO t FAR AS THE WORK OR USE WHICH IT AUTHORIZES IS UIWFUL � h IFBITUEBtIRLLOtil.iru$ VJtIE'EFEASOR$ARETHE ISSUANCE OF A PERMIT BASED UPON PLANS AND ED, VIEUGGEST THAT THE1 SPECIFICATIONS SHALL NOT PREVENT THE BUILDING OFFICIALC'.!!rEORNIA DIVISION OF,FROM THEREAFTER REQUIRING THE CORRECTION OF ERRORS L SAFETY 6E CONSULTED �,ft f IN SAID PLANS AND SPECIFICATIONS OR FROM PREVENTING ADDITIONAL REQUIREMENi_S. BUILDING OPERATIONS BEING CARRIED ON THEREUNDER WHEN IN VIOLATION QE DA OM QR QE ANY QIHEQ ORDINANCE + ------ QE THE CITU -OWNER PEARCE, CARL, JR. DATE 2-18-59 _ JOB ADDRESS 206 E, 22nd St. BUILDING PERMIT NO. 8677 GENERAL AONTRACTOR Bay Coast Bldrs. - VALUE $ 8,584.00 71i& No gUuh 0.11)0T TRACT FIRE ZONE DESCRIPTION OF WORK Residence c UP I TYPE V ZONE R4 PLAN NO. - 8677 INSPECTIONS DATE SUBCONTRACTOR PERMITS ISSUED DATE NUMBER Trenches Forms Steel g--% a -.0 4• 4-9 Floor System Steel Reinforce Chimney Re-Rod r7 Bond Beam &- , 2 —27 -. 7 .La" Frame and Flashing c61" ,�j ti Lathing, In Out Q. .. i',7Plaster, brown coat ,1J9/s' fi v' Underground soil /1Q.{-5 WIG Pipe TesP11/5 2- c SG Top Out 1-20^51 AA _ Furnace Mis-A-3 SP ir,,J. /� ,-<7—/9-6--9 / Gas Vents _ ' Rough Plumbing /L/O'S 3'9`59 �„ZnrJ.- (o-n -2—/1-S, /7;2 /J,/ o •Cesspool Septic Tank Prop. Swr. Pine Hote_Con. St.444. 7/!rf>1r.4.-Za..-7-6._ 3((j'l-c, ! r 9 `r-c- ..1j _ 19 Final Sprinkling System /yf-/-$'y 7—S`9 1 J lr._ ".Hing Fixtures, Final /Y/-/S's/-7 S9 \f (111 Final Gas Test //,— /t is y-7-S-9 Construction Pole I I Underground Power " I Rough Wiring .,J9 17-- is., -- - araffa 'I Fixtures, Final --.617 _ OCCUPANCY / S Pr!?--s-9 Form 210-5M-1-57 bb77 ,, =. . lS. ! �/ C.N �8677 • V FEB 131958q"A, COSTA MESA BUILDING DEPARTMENT FINANCE DEPT. P.O. BOX 317 COSTA MESA. CALIFORNIA GMTV OF row rp..ES.;\ FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT ADDREISS 206 �` Z2 Sr. BUILDING J/f /COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY OWNER r /� . C Si / -/11 p, RECEIPT NO. ; R/1{$77 ADDRESS 2 2I �/, VOC/ 00 `S 'p', I INKIIMMONEWL!/ CIT O S A /I AGS/J' Np TEL. �0- /9 Y ARCHITECTEnallial LIC. COSTA MESA. CALIFORNIA OR ER 11 T NO. ADOR,..a /T'! 22' ZONE CON1Q7 //��0• �C O 73LDI�ITY NO. 0 3 ( zoNEy� /� �., itE 0 _ADDRESS LU Li LUE:(rM/V( a I 4.00 Si = ' 'L / DATE /ea/ LEGAL LOT =) ' idea P `� ORRECTIONS DESCRIPTION P A.P.NO. i — 7-0— ) / / , SIZE �°/ / 4' NO.O F BLOT / �� OF LOT /‹ n/%S/�/� //�H,�ow ONp /L�o/i' 1 •y r �� EXISTIING BL .O um (/T/l \� ./c./'/\"J E ,� Y na�I SETBACK LINE FROM S\O/ it--�—G�J CI OF !S 'A 1 . SA CENTER OF STREET REAR YARD / 3 E`'„•,. i.. . ),'r .FP /7 • ■ SUBJECT. TO BLDG. DEPT. REG. SIDE YARD RIGHT LEFT DESCRIPTION OF WORK , ' _ NEW ALTERATION , • :Q/ ■ . RE PAI N ■ MOVING MEM. BUILDING , NO.OF (/ / SIZE �� ROOMS ./4 STORIES/✓IE� EXTERIOR ROOF _COVERING WA t/UC/CO COVVERINGe K eat._ f BUILDINGUSE OF EW� /C/ ` e 4/17/ 1 l'{-7CS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT T. , E IS CO' ECT AND AGREE TO COMPLY WITH ALL CITY ORDIN&N ES N. ST YE LA" .TING BUILDING CONSTRUC• TION. At / VALUATION SIGNATOR / PERMIT FEE S c“:• PERMITTEE ' ( �.+'/-,) �- PLAN CHECK S // S / TOTAL FEE S 33 AUTHORIZED AGENT -- Jar? • r 046008 '• 7378 iOYpp/78 145004y ',i COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 1 =' - APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Use Ink Only RECEIVED BY DATE RECEIVED DATE ISSUED BUILDING ADDRESS Z.oG E. ?/�,r(� /D -0,10.C??No 52r- ^� �,f �+ �, t A.P. NO. r -IZZ -.Z. P Ili OWNER M?4-MPS .CD'pte heir bscin Ec/ // •#.// BUILDING J - A/ MAIL , ADDRESS 2v'cf F . Z2 t`4 5 • , ADDRES — CITY C e,,¢T,4ESA- NO MESL S'rp-Lilt TRACT At S LOT�'Q1 BLOCK CONSTRUCTION /� NF,W J ADD ALTER'REPAIR MOVING DFMOI ISH LENDER N( BRANCH OWN QI� e/ LU ADDRESS VALUE ARCHITECT (V f J A C'c IRTEL. i USE • $ / OR ENGINEER { / NO. FIRE ADDRESS ZONE TYPE—GROUP �y,r _ p APPROVED /�. /gD AOs 11 CONTRACTOR O1�(N -era- �J V t l�2� BY L' (/ DATEI t/ /(J ADDRESS ZONE K rt l INO.OF USE OF NEW &&O C(< CITY NOL PLANS BUILDING wA LL p-i STATE CITY YARDS APPROVED YARDS APPROVED gLIC.NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING W SIZE R. OF LOT 1 NO NOW.OFONRLLOTDGS. (FROM CA.STREET) r I FRONT •- / rVei .. I—/"/Y.). - < USE OF rA ��vr't,� - EXISTING BLDG. �� T S y E-{ (frt.._ R. X/ I ala(f�Qytj�� F fY . ✓ O t / E Separate permits are required for Id de electric,plumbing and heating work. a l / I REAR FT. 0 / FT. USE OF BUILDING AND WORK TO BE PERFORMED DISTAN BET. BET.&AIN& �p r MAIN BLDGS. ACCESS. BLDGS. VA Q (Refl./ 772-OCT CA ' l- 16th- Lt)e4f STOFf_ C URP.# APPROVED 7 APPROVED r /0/20/7 p > P—P n C ( H Far)An- '-CA-R� �V tr ,` DATE / W W a.O I hereby acknowledge that I have read this application and state . n pr, that the above Information is correct and agree to comply with m L all laws regulating building construction, and I shall not employ Z any person in violation of the workmen's compensation laws of E 5 the State of California. .: 'I' FT. 3 I hereby certify that I am properly licensed as a contractor under SQ. D the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses are In full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEEnONLY: �' am exempt from the provisions of the State of California Business /Y' 00 a and Professions Code, Division 3,Chapter 9. VALUATION PERMIT FEE $ Y m n 1 /"� ^ PLAN CHECK $ o Signature of /� r'��ir',,t�Cl/\ _ l /,., /�}/�/-/�/7 �_ TAX $ �/ Permittee fJJ�"/�Ji�l - Y 1 --�L}O�`LQQ/ $1 ri ✓ !/ •gra is. • U Authorized Agent TOTAL PAID $ a • D OW•NER McPADDRN EflfTR DATE 10-20-78 1IJOB ADDRESS 20662 nd Street BUILDING PERMIT NO. 46908 GENERAL CON TUCTOR Owner-Builder DESCRIPTION of WORK RIockwa]1 A' '.118-122-21 LOT Por. 293 TRACTNwpt.fits.FIRE ZONE VALUE 1.000.00 L_. ECTIONS Signature Date -TYPE TTT GROUP .T ZONE R-1 DIL PERMITS ISSUED GASSUBCONTRACTOR I Signature WATERDate I Number ROUGH PLUMBING Plumbing PROP. SWR. LINE ❑ HOUSE CON. 0 I y`•SPRINKLING SYSTEM \MISCELLANEOUS ROUGH HEATING AND AIR CONDITIONING - TEMPORARY SERVICE OR POLE UNDERGROUND fl POWER I] ROUGH WIRING Heating and Vent. . TRENCHESFORMS STEEL REINF. U FLOOR SYSTEM CANCELLED BOND BEAM El STEEL REINFORCE ri SHEATHING DATE2-'6. 115 BY FRAME AND FLASHING LATHING - IN 7 OUT n PLASTER. BROWN COAT ST URAL. FINAL Electric HE.. _.G, VENT., REFRIG. AND A.C... FINAL I PLUMBING. FINAL AND GAS TEST 11 I}II ELECTRIC, FINAL BUILDING. FINAL