HomeMy WebLinkAbout216 22ND ST - Building Permits .. 1
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CITY OF COSTA MESA -
BUILDING DIVISION
> ,r DEVELOPMENT SERVICES DEPARTMENT PERMIT NU ER
I. �1 PERMIT 0 511
-off
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa. �LDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 216 22ND ST Status: ISSUED
Suite: Applied: 09/26/2000
Vicinity: FRONT PORTION OF HOUSE Issued: 09/26/2000
Parcel Number: 42607124 Zoning:
Applicant: ALLEN, MIKE ISSUED BY:
Address: 537 NEWPORT CENTER DR
Phone: (949)673-9222
NEWPORT BEACH,CA Zip: 92660
Owner: TAGLIAFERRI, JERALD W
Address 216 E 22ND ST
Phone:
COSTA MESA,CA Zip: 92627
Contractor: ABOVE IT ALL ROOFING
Address: 537 NEWPORT CENTER DR
Phone: (949)673-9222
NEWPORT BEACH,CA
Zip: 92660 License: 765842
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
REROOF FRONT PORTION OF EXISTING SINGLE FAMILY RESIDENCE WITH ATTACHED GARAGE(14 SQ).TEAR OFF
EXISTING WOOD SHAKES,RESHEATH WITH OSB, INSTALL 30#ASTM FELT UNDERLAYMENT,&REROOF WITH 25 YEAR
COMPOSITION SHINGLES.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $2,200.00
Permit: $83.25 Claim Valuation: $2,200.00
SMIP Res: $0.50
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $83.75
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 isnot 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
2448.46(8/00) '
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.
Sr 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'ggiapensa on Insurance carrier and policy number are:
Carrier: S ( Y' )(17 Policy Number: 229.-00.-00
(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 Califomi ,and ee that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these pC7/2 /00�� /
Applicant Signature: � Date: 7 ((`��VC)
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($106,0D0),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under.rovi ions of Chapter 9(commencing with Section 7000)of Division 3 of the Busi s arlq Pplessions Code,and my license Is in full
force and effect.Uc.# 74" t Class ii f'yJ
� ^
Contractor's Signature: n v � Date: �fff� 0
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,atter,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 en 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 em exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑Yes ❑No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-properly 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,Ttle 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 ❑No
(Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Masa 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? U Yes IJ No
(Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No
(It'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(Duality 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 ❑No
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
`gnat Of Legal Owner(s) r'-1 /rte „00Date
And/Or Authorized Applicant Date
CODE# gISPEgfQtLTYPF Pall INTMAL$ CODE( INSPECTION TYPE gsg 1NTIDEL6
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final z /`gQ- ✓ 208 Final Plumbing
3
200 Final Re-Roof /9 —00 " h 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
�/
APPlica nt LO(ill in all space;except those within heavy border lines and sign all appropriate declarations.
nz.
clrY OF COSTA MESA CONSTR UCTION PERMIT t PERT NO. TRACT NO. LOT NO. UNIT NO. 1570 12/15/87 90Q0 TL
i. Project Address. £/4 f ,2a7: 3�s8�o '
S'py,r TYPE OF CONSTRUCTION ❑ NEW U ADD LSALT ERATION U REPAIR
Applicant's Mailing Address /���Z�, ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A,P,# Zone
Owner's Name rJ1/ 7. ��Ff3-/1 i4��SPhone DESCRIPTION OF WORK/USE OF BLDG.
Address S/7,22a S Main Building: • Accessory Building:
Arch/Eng. — License No. ,_.--
TYPE OF PERMIT ❑ GRADING 10 FOUNDATION ❑ STRUCTURAL E Front ZZ
Address - •
lE❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL /� Z BB Rear 1 N
OTHER
Contractor's � . Phone PROJECT DESCRIPTION SQ. FT. OCCUPANCY I —.3 C Right - N
Address(ma r •
CON ST RUCTION TYPE VA/ VALUATION S Left G
City LiR
cense 'o. ZONE GING CU.YDS. ACRES Ping. Ref.# Parking Req./Provided E
• LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: QM
with section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force and effect. T
License Class License No. S
Date Signature PLUMBING FEES
WORKERS'COMPENSATION DECLARATION Bar Sink Showers
I hereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL - FEES
f Workers' Compensation Insurance, or a certified copy thereof (Section
:00, Lab. C.) Backflow Preventer Service Sink Automatic Washer Transformer 0 15-50 KW '
olicy No. _- Company Backflow Irrigation Sewer Cap0 50+ KW
' copy is hereby furnished.
Certified Construction Pole Sub.
Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit Meter pup to 100 amps t
Date Applicant -
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps
(This section need not be completed if the permit is for one hundred ($100) or
less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel
•
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. Drinking Fountains Solar Tank Fan Motors❑0.1 HP ❑1%-8
Workers' Comp
aws of California. //� __
Date 77 Fc C'3 Signature �ou Ir'—r—af� Floor Drains Swimming Pool w/Spa F.A.U.
-NOTICE: If,afte making this declaration,you Uld become subject to the Inc.Solar 09.15 HP 016-15+
Workers' Compensation provisions of the La r Code, you must forthwith Floor Sinks - Urinal
comply with such provisions or this permit shall be deemed revoked. Fixtures Microwave
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet �'1
I hereby affirm that there is a construction lending agency for the performance I C.Ays,��ry Elf) O( Device Boxes Pole Light
of the work .for which)this_permit is issued (Section 3097 ',ply. C.) Interceptors Water Heater 0 Outlets •
Lender's Name �1iA�� _ Range
Lender's Address 5- Kitchen Sink ' Water Service Switches - Sign `
OWNER BUILDER DECLARATION —.----�_
I hereby affirm that I am exempt from the Contractor's License Law for the 1 Lavatories Auto-Wash '1
following reason (Section 7031.5 Business and Professional Code: Any city or rte\ 7 Garbage Disposal Standing Sections
county which requires a permit to construct,alter,Improve,demolish or repair P—Trap Laundry Trays Generator ❑0-5 KW ❑5-15 KW
any structure, prior to its issuance, also requires the applicant for Such permit 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 ,
Division 3 of the Business and Professions Code) or that he/sheis exempt - -
'herefrom and the basis for the alleged exemption. Any violation of Section - ,
131.5 by any applicant for a permit subjects the applicant to a civil I _
_natty of not more than five hundred dollars($500). •
-
��+-as owner of the property o yl t '"` 'a'• Reinspection Fee $15 -Issue Fee $ 3
•
. fpwill do the work,and the structure is not Intended or offered I Reinspection Fee I $15 - Issue Fee - $ 3
f ecfion 704x, 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 DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not Intended or offered for Boiler Hood or Type I 0 tonin Approved
, sale. If, however,the building or improvement is sold within one year of com- • Canopy Type II 0 9 pP By Data � -
prprove the owner of have the burden of proving he/she did not build or im- Duct- Under,Gfound Building Approved By Datee_�
D t, for the rpurposeoftoe). -
❑ I, as owner of the property, Se exclusively contracting with licensed Con- Duct-Structural Refrigeration System Application Issued By Dat
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑0-100,000 BTU ❑100,000 BTU - -
builds or improves thereon,and who contracts.for such projects with a con- SUMMARY OF FEES
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple ❑ System Repair/Alteration BUILDING PERMIT $ SMIP $ '
proof of their Worker's Compensation insura ce should be provide. to PLAN CHECK $ ,.yr� PERMIT
❑ I am exempt under Sectionct • ' B.&&fir.C. re.t. Firepl/Fact.Blt. ICBG# Fire Dampers PLUMBING $ (,� ISSUANCE $
Date 2-4 /owner .A / ��• �� Heating System& Ducting Registers ENERGY:P.C. $
PLAN CHECK 25% $
I hereby certify that I have read t s .pplicatio- • d state that the above ❑0.100,000 BTU 0100,000 BT - ELECTRICAL GRADING - $
information is correct. I agree to comply with a city and county ordinances $
and state laws relating to building construction, and hereby authorize uprepre-
sentatives of this-city to enter on t e' above-mentioned property for . PLAN CHECK 50% $
inspection purposes,. Date 42' 2 p.
Signature .!y MECHANICAL $ TOTAL FEE $ /e�
Drivers' License or S Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
CMF 0865-46,rev.10/84 white - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor
<41
CONSTRUCTION AND PLANNING POOL &SPA
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
t
1. Temporary Electrica4Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
B. Foundation 59. Gas Pipe, 0 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 0 Gas ❑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 INSPECTION
•
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED -
33. Final Electric Notes:
• 34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test ,-�-• -
36. Hood or Canopy
37. Final Factory Fireplace •
' 38. Final Plumbing /2i
_ 4_Y7, Lap
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
y_
No. Date
- I
• •se to fill in all spaces except those within heavy border lines and sign all appropriate declarations. _
1TY Of COSTA MESA CONSTRUCTION PERMIT _- PER T N / TRACT NO. LOT NO. UNIT NO. _ t --
Project Address '// ,C �2 " e,j �(0�3 I B9a I2/2'-/B7 , 15050 'it
Applicant's Mailing Address � .•••9),5TYPE OF CONSTRUCTION LI NEW LI ADD ALTERATION U REPAIR )
Owner's Name bee (/C!'(//Aot'S ❑ CONVERSION LI DEMOLISH El OTHER A p # I Zone
/
Phone DESCRIPTION OF WORK/USE OF BLDG.
Address —.�'s" • S Main Building: Accessory Building:
Z
Arch/Eng. ��.o'To License No. TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION El STRUCTURAL E Front • 0
❑ TENANT 111 ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B N
Address A Rear 1
Contractor's Name Phone ❑ OTHER C Right N
Address(mailing) •/i� p' PROJECT DESCRIPTION SQ. FT. OCCUPANCY K G
•L✓ CON STRUCTIO/YPE _ VALUATION$ -CO° S Left R
City License No. ZONE GRADrNG CU.YOS. A RES�• Ping. Ref.# Parking Req./Provided E
LICENSED irm that
I am R DECLARATION
unprovisions
�• { O E
I hereby affirm that I am licensed under provof Charter 9 (commencing Remarks: ' // / q //1tv� d1 Planning Notes: M
with section 7000) of Division 3 of the Business and Professions Code, and f iL/ /�, {/r.t,l7 s� T
my license is In full force and effect. , '
S
License Class ' License No.
Date Signature PLUMBING FEES a - i `
WORKERS'COMPENSATION DECLARATION Bar Sink Showers •
ELECTRICAL FEES
:,yr,,reby affirm that I have a certificate of consent to self-insure or a certificate ''
MOrker5' Compensation Insurance, or a certified copy thereof (Section
.:'U'N0, Lab. C.) Backflow Preventer Service Sink - Automatic Washer' Transformer 0 15-50 KW
Policy No. Company Backflow Irrigation Sewer Cap Construction Pole Sub. 0,50+KW
1 9 Certified copy is hereby furnished.
Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit Meter Due to 100 amps
Date AppliCant -
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Clover 100 amps
(This Section need not be completed if the permit is for one hundred ($100)or
less). Dishwasher Solar Piping Dryers ❑Gas DElectric Sub Panel
I certify that in,the performance of the work for which this permit is Issued I - Motors❑0-1 HP ❑1'h-B
shall not employ any person in any manner -o as to become bj- t• he DrinkingFountains
Workers' m at' ws of / Solar Tank Fan
/Gn�PCrIF wit/ CalifornL !
Date G U�6 / Signature saga/ L Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar 09-15 HP❑16-15+
NOTICE: If,after making this declaration, you s •uld become subject to the •- -
' Workers' Compensation provisions of the Labo Code, you must forthwith Floor Sinks Urinal Fixtures Microwave
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes Pole Light
I hereby affirm that there is a construction lending agency for the performance
of the work for •which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets Range
Lender's Name -'
-
Lender's Address Kitchen Sink Water Service Switches Sign
OWNER BUILDER DECLARATION
I hereby affirm that I am-exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal Standing Sections
following reason (Section 7031.5 Business and Professional Code: Any city or
' county which requires a permit to construct,alter,improve,demolish or repair P—Trap Laundry Trays Generator ❑0-5 KW 05-15 KW Trash Compactor
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 Roof Drains
the Contractor's License Law(Chapter 9 (commencing with Section 7000) of _
'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
e alty of not more than five hundred dollars ($500).
'/ as owner of the property o ^ e-"�•� - Kee d or Reinspection Fee $15 Issue.Fee $ 3
•
i11 !9 ,,,- e+*.-o 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 - DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0 Zoning Approved By • Date
sale. If, however, the building or improvement Is sold within one year of corn- Canopy Type II ❑
pletlon, the owner will have the burden of proving he/she did not build Or Im- Duct- Under Ground Building Approved By Date
prove for the purpose of sale). C1C7�7�Ji/
❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Dat: L�G ��
tractors to construct the project `Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU SUMM/ r OF .EES
builds or improves thereon,and who contracts for such projects with a con-
tractor(s) /
5 /�U L�®
tracto
s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ f I SMTP $
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.Blt. ICBG# Fire Dampers PLUMBING $ ISSUANCE $
Date Owner Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $
I hereby certify that I have read this application and state that the above 00-100,000 BTU 0100,000 BT ELECTRICAL $ GRADING $
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction,and hereby authorize repre- PLANCHECK 50% $ MICROFILM $
sentatives of this cit to enter upon he ab• —mentioned property for e e
inspection purpos• �- p MECHANICAL $ TOTAL FEE $ /v 'S
Signature 'L.- _ Date �� O%�
Drivers' Lice e or SS -- _ Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK '25% $
-
CMF 0865-46, rev. 10/84 White - Building; Canary -Applicant: Pink -Accounting; Goldenrod - Assessor
CONSTRUCTION AND:PLANNING POOL&SPA
`moi" Date Inspector Date Inspector
APPROVALS (Permit# APPROVALS Permit#
1:
temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings .. 1 58. Electrical Conduit-Undrgrnd.
8. Foundation ;•.; 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
_ 10. Structural Floor Sys(em) 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 0 Gas 0 Oil;
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical (],4 k
r
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREY. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION •
Y.!
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED';
33. Final Electric Notes: (V!
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 r
ziastost
•
44. Landscape Irrigation System 4 1\--;- /
45. Sound Attenuation -
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING 7Z-/2147 �iI/�Ly, -
48. Special Requirements Completed r u'�``��''�r
49. Electric Release to Edison
50. Gas Release to Southern California Gas 05 r
51. CERTIFICATE OF OCCUPANCY
-
No. Date ' J'.
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OWNER VAN DE WALKER LYLE E. TE 9-1�-5� .
JOB ADDRESS 216-22nd St. BUILDING PERMIT NO. #3711
GENERAL CONTRACTOR Owner Bldr. VALUE $ 11,736.00
AP118-120-2
L 293 BLOCK 1 TRACT Npt, Hgta. Res. w/at.t._ g r.
GROUP ; 1 & J TYPE V ZONE Rl} FIRE DISTRICT 373L
PERMITS ISSUED
INSPECTIONS DATE SUBCONTRACTOR
� DATE NUMBER
Footing Trench ,e�/1':� 'd,•65;7t;-L.`•65;7t;-L.` _ ....P.-Iran-et-1,a- e-6( /sr ✓5-e-oe
Foundation Forms and Grade to Garage .#: /o-/p--.E . to a f✓ :e c1,-„, if - - ' 's
Rough Framing l Y /// J''7 `+ _ /
Plumbing, Rough to Slab "e 5 /.® -
FYTemPlumbing,Rough Complete ?nee 5 n J>.o/3., Gtir-S..(zvy/ 40/-T 6 c l A-Y- 7/-FY--
Temporary
porary Pole
Wiring, Rough 1T "...Per(rr ,�l'�.e_tr.-fl[ -' , 0-..26-("� 'cl —
Heating,Rough C�511/A lfh,Lt/.;'J C) L - 1 ' ) -P - 7a 9.Y---
Heating,
l t_
Heating, Final V f- .1' /C4 rc,, - . -ni 4-) _ /_ r!, A'/:,- - -
ewer uwise Sewer,St."�,� 17 J .5-a C 57 S a 9 a --
"Septic Tank o Cesspoo=:l7- 3-_ - _ ,-., 5---:5- f, 9 .)---
L_- "ng In Its . i Out 0/ 7 f
L :ring IL V/rA / i,
Plumbing,Final,Fixtures Co :late, ,'i , • 1
Plumbing,Final Gas Test .�/ l A a l'/ /t. . .i A t' -.
-
�')6 C fi''.4 —
\
Occupancy Ai ,I 3'
Wiring,Final .� ( di (�2%-eI
FORM 210 3M 10-S5 .3714
Costa Mesa Building Department APPLICATION FOR PERMIT —
P. O. Box 317 x`�`�'•�4 BUILDING
COSTA MESA, CALIFORNIA
FOR OFFICE USE ONLY
FOR APPLICANT TO FILL IN Receipt No. Permit/ No.
AddressBuiln /E0 -• ,7
. n{ 'S m . I �//
Costa Mesa, California Received by Date''R//ec'd. ate Issued ,r
Nearest 4 9—i T s /,! l.-
Cross St.mA ,,,,, ^` 0AA—L.., Building
Address
Owner ce kP 1)4....- A#"lfl/ / .b� Costa Mesa, California
Mall
Address - or S Nearest
_ Tel. Cross St.
CITY eA.otitl c.,3'it a-. No.., Ar-A)4O/ Zone I Plans
Engineer
I 13ee 1 / Group-.
Architect or No. d,(�� 1J �/
Engineer No. Apby r ve" Date " V.
Address CQR EC ONS
City Lic. may , n
Contractor et-,NNo
) No. �- / t,(t/� /
Address
1
Legal ILot � I I
Description No., 93 Block I Tract Nr , IAPPloVLD
CITY O� rOSTA MESA
(Attach Metes and Bounds) "OR -ISI 0 -' 2-- PUG DEPT.
Size of Lot /�.yd9�/ I Now o L tNo.of � Y SUBJECT •LUG. UtF I. rc G. (/
lyse of I No.of ' I No.of ` iii— S
Existing Bldg. Families Room 9 Y 0
...
Setback Line from i Rear Yard • /. / _L DAT , - —
Center of Street SG Side Yard Y s/(, •N TE _ /
DESCRIPTION OF WORK
New I ✓I Alteration I I Addition I
ca
Repair I Moving I I Demolish I 7
�*-
Building t't r No.of ,oSize yy x 7 y Rooms 10 Stories i
Exterior Wall Wood oof S t'Fr/WC 5 APPROVALS �t
Covering p/. 1 r I R
Acne. Covering iC
Use of New n J
Building 1� 'S, a f u-tF i ("ft-- Foundation Location Inspector Date
Forms,Materials,
Under-Pinning a
Frame: Fire Stops, K.Bracing,Bolts t=
I hereby acknowledge that I have read this Application p
and state that the above is correct and agree to comply Lath.Int.
with all City Ordinances and State Laws regulating a 1
building construction. Lath. Ext
Pee of .g /� ( Plaster, Int
Signal Permittee A.n , l �l•,•.nQL. �r4IR[.t.
Authorized Agt Plaster, Ext co
- I IN
Valuation // Permit Fee $ ,2, Masonry Reinforced 0
4, -7 3 FJ -- lan Check $ / Bond Beam
� Total e�
TJT4� � Fee $ - FINAL i a.-
F
FORM 3ffl 10.33 O. P S S. Canal.
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•
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•
•
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Street •
PLOT PLAN
Show location and distances from
.
• property line and between buildings.
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OWNER L. E. Van De Walker DATE 10-6-58 _
JOB ADDRESS 216 22nd Street BUILDING PERMIT NO. 7711 j
lG NERAL CONTRACTOR Self VALUE $ 1011.00
P. o. LOT TRACT FIRE ZONE DESCRIPTION OF WORK Wood Fence
Cnr1UP TYPE ZONE PLAN NO.
11...PECTIONS DATE SUBCONTRACTOR PERMITS ISSUED
DATE NUMBER
Trenches Forms Steel
Floor System
Steel Reinforce Chimney Re-Rod Slfffa
Bond Beam 41111111
Frame and Flashing / I
Lathing, In Out IMMORMIIII
Plaster, brown coat r / ' 'e f
I.ndcrground soil W/G Pipe Test I I .I "
Top Out
Furnace rali
Gas Vents t t 00" ✓
Rough Plumbing Millentranarellaill
Cesspool Septic Tank I /1' HI I v Vall
Prop. Swr. Line House Con. St. Swr. MILMIlardrini
Sprinkling System nallinillni
Heating Final MNIffnaMIN=NEI
P' "in. Fixtures, Final iiMnIS
l Gas Test I it " I L'"
Construction 'ole
Underground Power
Rough Wiring
Fixtures, Final -
'OCCUPANCY
Form 210-5M-1-57 77113
COSTA MESA BUILDING DEPARTMENT
P. O. BOX 317 . CE r® I 7743
COSTA MESA CALIFORNIA FEE 1''Y
FOR APPLIC A NT TO
C•L. OF STREET------ (0 -n:s' - -J1
Fl�� CE Y` t• I BUILDI r. e "1
_�iPROP. LINE A MIN Owne n /,�� rift"'
rr- -- -- — �I2 FT. 6IN-FOR \C'� ° r �
' 10 FT. FOR 60 'FT. STREET—rr50 FT. STREET � Mail Address,�'-,�� k —2.-a c. - �� „ale•
City /4 i
49 "An Ph. Nope �)
Contractor --Pe/f Ph. No. t
Address /
.50 H IOFliP City Lic. No. State Lic. No.
SO FT, A W Size of Lot /0 k 7S AP No.,�� K— ii-b �)�_
W
IT
I- W + F- Setbacks: C/L Street Salt-
- Rear/6
W Z m N �tj� '•
¢ J W Side Yard - Right / /�/ LLeft 7 �j ,/
Typeco
egi
of Fence
a NALLEY QR PROP, LINE I a 0i
C
J m _ < cc
—, I hereby acknowledge that I have read this application and state
ti it . u �; Q that the above is correct and agree to comply with all City Ord-
52 e.I a a 2 w inances and State ws n uilding constructi.
di O Z -I O SSignature
10 I of Permitt o i �,
u L mo FT Agent
' _ 0 ~ U •
37 6 IN. Fa eh), '- I FOR OFFICE USE ONLY
'-FT. W m ' _
Z V Cl) a FT 1IPermit No.
r
a ( co I s '7743
0 L. 60 FT ST. _1 Received by r Date Received Date Issued
? -- :— / /D- 6 -s e /D- 6 -s
I
F._ FT. ST. H f H t
_—0C_ .—LINE t' t. — _ — — — — I ' VALUATION 9 6-49
\� -- -- — — // Permit Fee $ oC
0 _
in
A
I I $ 7/652 JG- Plan Check $
C.L. OF STREETS I t-r7
TOTAL FEE $
U,SE REVERSE SIDE FOR D
1\ •
MAXIMUM 4 FT. FENCE MAY BE PLACED ON DOTTED LINES -- - ---
MAXIMUM 6 FtFENCE MAY BE PLACED ON SOLID LINES ETAILS
.OWNER VAN DE WALKER, L. DATE 10-10-55 ,_
JOB ADDRESS 216 E. 22nd Street BUILDING PERMIT NO. 7792
GENERAL CONTRACTOR Anthony Bros. VALUE $ 2,500.00
11 -tL0-02
P. No. LOT TRACT FIRE ZONE DESCRIPTION OF WORK Swim Pool
(:--NIPTYPE ZONE R-4 PLAN NO.
II`oPECTION8
!/'re q/qTE SUBCONTRACTOR PERMITS ISSUED
/ /. / /� DATE NUMBER
Trenches Forms!/ Steel j� ,
Floor System
Steel Reinforce Chimney Re-Rod
Bond Beam
Frame and Flashing
Lathing, In Out
Plaster, brown coat
Underground sash W/G Pipe Test ! JJ
Top Out en° Ci mP-c_n .At' TJX/ , _. 7
Furnace • I
Gas Vents / `�,c G fji2/ ten/ /G -..2 7-58 /dr.-3r/1--Rough Plumbing a.2- e3 -Vents / n/rNn V 4/7A70 s•/O-/O SB &O/s-s A
Cesspool Septic Tank \,
Pp 9-t%Wi LiseG ellit eir5wr. /1-1--c$ _
Sprinkling System
Heating Final t
P' '•ing Fixtures, Final
E. Gas Test /5— /4'f£t%'2-St.
onstrC ole •
Underground Power
Rough Wiring 1-1 f1414,e,/Y/A- nt /O-2S S8' 7.2 S-7 1---- kik
Fixtures, Final i.././r la - .3 S-1' 1
�OCCLIPANCY
'Form 210-5M-1-57 7792
•
9792 FEE RECEIVED
COSTA MESA BUILDING DEPARTMENT /o-.S.
P.O. BO% 317
COSTA MESA. CALIFORNIA "'�"•^ A •
FOR APPLICANT� TO FILL IN APPLIICCATTIION' ERMIT
AB SS (y+NG ask ,•-23
/v„ ,. BUILDING
EJ ��/
,
COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY
1 rie e� RECEIPT NO. PERMIT NO.
OWNER / Q��//,`,
MAIL �/� I 41144.
_ /� .Rfr�71VZ. BY onTE�GOECEI 5S / p<y�rl5X L/
ADDRESS n . yf..,L LLQ Z. /O// oV / O{'�/,`f//Y d`/
TEL. BUILDING 2-f r- i
CETYa[L( .14J NO. ADDRESS G 22 \
ARCHITECT Nin
, - LIC. COSTA MESA. CALIFORNIA
OR ENGINEER
�`'' FIRE
ADDRESS may. A 11.,Cyyt.d',"`t ZONE .
ZONE NO.OF TYPE G P
t ITY LIC. PLANS 'gal�
CONTRACTORTO4 _ _ •_ ANO. A ("A- . e.t.a
ADDRESSS y 1 I `A- Allr
TEL. APPRO EDBY G •;•r
DATE /o / 0 "�
LEGAL. LOT ��\\ • f CORRECTIONS
DESCRIPTION O --).0 CY' BLOCK
A.P.NO. // [I ^ / ��d Q fi
SIZE Tic J �(� NO.OFBLDGS. i APPROVED
OF LOT I ,�Y/�`� I NOW ON LOT
USE OF - CITY OF STA MESA
EXISTING BLDG. j�or jrl ^ `�I;
SETBACK LINE FROM ^ 'TEAR
+ PLANK t G DEPT.
CENTER OF STREET /-CC + ' EAR YARD j t ° � JECT TO DG. DEPT. REG.
+ bl1 + ATE /O /Ds-S7
SIOE YARD RIGHT ftLEFT f
DESCRIPTION OF WORK BY
PLAN TECH. _
NEW ALTERATION ADDITION
REPAIR MOVING DEMOLISH
SIBUILDING I ` J .,C ROOMS STORIES
EXTERIOR WALL ROOF
COVERING COVERING
USE OF NEW
BUILDING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL
CITY ORDINANCES AND STATE LAWS REGULATE BUILDING CONSTRUE
TION. VALUATION (Cl^(+ PERMIT FEE S C/
PERMIT REO tIYY1I/l.•44--�•A�''�" -A
PERMIT EE I v
PLAN CHECK 5
S
�.,5.:. �. 5c� C5 TOTAL FEE 5 (5T -
"°MF
AUTHORIZED AGENT t.{2-%
' COMPLAINT INVESTIGATION
by
__� 4 O J
- Date /aO-64
Received
`�/Y)k,a . q I '� i1 o7//g
Made byf� Q� Vain)
/ Lry�L.1t2��1� Q�� Address •off/I p_ L/ �/il. .t- •h.No. //
I Against //�,/�x//j� a� )Lar✓/ �v-�""W`-' * Address 0 216 ` +, r G1 W��AUDI
Directions: (,'('F, f SL ntil) I[JrC A a)- ��/3 �4cQimJ/n ) O .&t'-cflltw
Nature of Complaint: • _. /i .1.-- L 1== G.i _I-- ' t - - ! l' f4.--. A oft-gaLti_
l it.au c .l&Q8-u 9-n) id a-tt.a.. ' • , r , ,_,,,) da.irrx • /4' ' h, a
to ...t_; , t- W.)_#14- ca_ 11a L.t, n c) 1 Q�Qt���.
gQ , f' I ( Cite) WA C . `�-�
ot taken: .
�. ��J�/h /�. /moi .��44
�i/,% - /�' L _ - moi i. .a moi ✓�et sf Ale' sarii�i _
Complete: Yea Complainant Yec By: \
Interviewed:
No No Date:
♦ . _
•INTERNATIONAL TESTING CORPORATION
FOUNDATION ENGINEERING • TESTING • INSPECTION
I j I I _I
TELEPHONES GA�IId 262-7550 SM
500 - 6173 CHERRY AVENUE • P. O. SOX R, LONG REACH I. CALIFORNIA
REPORT ON CONCRETE TEST CYLINDER
Identification No. P-358-1275 -1321
For: Anthony bros. Pools, Inc .
Architect: MacIntosh
Contractor: Anthony Bros. Pools, Inc.
Structure: Swimming Pool L. Van Dewolker, 216 E. 22nd St
Costa Mesa, California
Sample from: West Wall
Mix: 1-2-3 Pea Gravel 2000 P.S.I. @ 28 Days
Nater, gal. /sk. cement: 6
Admixture: None
Slump :
Cylinder No. 7 Days 28 Days
LV-1 LV-2
Date placed: 11-12-58 11-12-58
Date tested: 11-19-58 12-10-58 'h lY,
/ ,
COMPRESSION TEST ---
V \\
Total load, lbs. : 37,250 81, 750 �}
Lbs . per sq. inch: 1,320 2,890 V�
�1+
RECENEO
Cylinder made by : H. L. Sweet cof DEC 15 ;_1.• it-L.,
9
. Cylinder delivered by: H. L. Sweet
ofCltit" Iv
CliBwldilosl3 Capt•
Cylinder received on: 11-19-58
INTERNATIONAL TESTING CORPORAATION '
b L