Loading...
HomeMy WebLinkAbout240 22ND ST - Building Permits it 7 r CITY OF COSTA MESA • , 4 � BUILDING DIVISION j'. > • DEVELOPMENT SERVICES DEPARTMENT PERMIT MBEA F t �. v., PERMIT . BO 01506 fi' (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.cBtLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 240 22ND ST Status: ISSUED Suite: Applied: 09/04/2003 Vicinity: Issued: 11/14/2003 Parcel Number: 42607120 Zoning: Applicant: TRESTIK, SCOTT J ISSUED BY: Address: 240 E 22ND ST Phone: 949-515-3573 COSTA MESA,CA Zip: 92627-1812 Owner: TRESTIK, SCOTT J Address 240 E 22ND ST Phone: COSTA MESA,CA Zip: 92627-1812 Contractor: Address: Phone: Zip: License: Arch : ANDRADE ARCHITECTS INC Eng: LOVELACE ENGINEERING Address: 24981 DANA POINT HARBOR DR Address: 6496 WEATHERS PLACE SUITE 120 Phone: 949-248-2681 SUITE 200 Phone: 858-535-9111 DANA POINT,CA SAN DIEGO,CA Zip: 92629 License: C918971 92121 License: 39734 SCOPE OF PERMIT CONVERT 463 SF OF EXISTING GARAGE TO HABITABLE SPACE.CONVERTED AREA TO BECOME AN OFFICE AND BATHROOM. LIVING ROOM WILL INCREASE IN SIZE AS A RESULT OF THE INTERIOR REMODEL.TWO BATHROOM RESIDENCE WILL BECOME A THREE BATHROOM RESIDENCE.CONSTRUCT NEW 470 SF ATTACHED GARAGE(31SF OF WHICH REPRESENTS DEMOLITION AND REBUILD OF REMAINDER OF EXISTING GARAGE). 2400 SOFT.(37%)BLDG. 680 SO.FT.(11%)PAVING 3,353 SOFT.(52%)OPEN SPACE FEE SUMMARY Plan Check: $372.81 Calc Valuation: $42,951.30 Permit: $573.55 Claim Valuation: $0.00 SMIP Res: $4.30 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $950.66 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 34-0 Rear 28-0 Left 5-0 Right 5-0 I 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 2446-48(6/00) DE ARATIONS ...,'`- xWORKYERS'COMPENSATION DECLARATION: - I heretiy 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: Cartier. 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.If 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 o the p pert , m EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The c tract rs LI n e 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 purs nt to he C ntr ctors License ws.). fe I am exempt d r 0-11 Business and Professions Code for this reason: Signature: / Expires: CM 3/6'y Verification of Ownership by(type of document,i.e.-property tax bill or deed): r I / 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 ❑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 end 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 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? 0 Yes U 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 Irom 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 end Emissions. Signature: Date: CERTIFICATE OF COMPLI CE • r AUDIO' 'TION 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 t all st: : laws a • cl y ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property fo specti. purpose-.I .gree not to occupy or allow occupancy of any building authorized by this permit unfit I/ 1G�Goq IAnaalture Of Legal Owners) I bate( And/Or Authorized Applicant Date OODE I INSPECTION TYPE OATS IN/HMS CODE. jl{SPFCTION TYPE MI MALS 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 Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval ///A 203 Final Sign 222 Final Site ©� /p- 204 /' 204 Final Demolition 250 Final Building/Occupancy .' CITY OF COSTA MESA BUILDING DIVISION ).: DECLARATIONS • WORKERS'COMPENSATION DECLARATION: ' I hereby affirm under penalty of perjury one of the following declarations: O 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: Cartier: '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($1 Ddpp0),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706OF 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 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 properly who builds or Improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 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). ❑ 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? ❑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 ....... oes 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 ❑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 control district or agency? U Yes jJ 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 (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 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 (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. Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date 4 CODE I INSPECRONTYPF DAIS IffmlAL$ ;ODE t IDSPECTIONTYPE IJr>.'.. 1616 Fixed System Final Fire Prevention 206 Final Mechanical �i' 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 • CITY OF COSTA MESA 4 44 ° BUILDING DIVISION • DEVELOPMENT SERVICES DEPARTMENT P ' IT NUMBER 1 ' r PERMIT gtbifron'on.4* • M03-00600 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR D •IVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 240 22ND ST Status: ISSUED Suite No Applied: 11/14/2003 Issued: 11/14/2003 Vicinity: Parcel Number: 42607120 ISSUED BY: Applicant: TRESTIK, SCOTT J Address: 240 E 22ND ST Phone: 5-3573 COSTA MESA,CA Zip: 92% 812 Owner: TRESTIK, SCOTT J \ Address: 240 E 22ND ST Phone: = -515-,573 COSTA MESA,CA Zip: , 12627- 812 v \ Contractor OWNER-BUILDER Address: %. gyp: L' ense:000000 :COPE OF PERMIT CONVERT EXISITING 465 SQ.FT. .ARAGE TO HABITABLE SPACE.CONVERTED AREA TO BECOME AN OFFICE AND BATH:00M.TWO BATHROOM RESIDENCE WILL BECOME A THREE BATHROOM RESIDENCE.CON• RUCT NEW 494 SQ.FT ATTACHED GARAGE.REF:B03-01506. 1 ALT.DUCT SYSTEM. FEE SUMMARY D :ntity Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $0.00 0 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 $0.0% 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0 %0 0 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $r.00 0 Compressors/Absorption Systems Gas Piping '0.00 0 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace 4.0.00 0 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 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 $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 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 0 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 NOTIC : 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 2446-48(8/00) 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: Cartier: Policy Number: (This section need not be completed it the permit is valued at one hundred dollars($100)or lest.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person iri 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 15 UNLAWFUL AND SHALL SUa1ECr AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND COLLARE(5100.000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed 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). Lenders 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(5500).): ❑ 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 th property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The ntra tors ' ense 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 purs nt t the C tractors License Laws.). I am exempt nde ec 7D9L I Business and Professions Code for this reason: 7f( nn c 7 Signature: ,,� Expires: 1 V//M cf 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 then thirty-six(36)feet high.(Chap.3.2,Gip 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? ❑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 ere required to register acutely hazardous materials with the Fire Department. 4 If an RMPP Is presently required,has Section 25534 of the Califomia Health and Safety Code been fully complied with? 0 Yes 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 Li from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 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? 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 COMP ANCE4ND AU►%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 comp y ith al tate las nd city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described propert/1.r insp: eon pu o_es. agree not to occupy or allow occupancy of any building authorized by this permit I final og rine r''-O Leel Owner(s) I bate /S And/Or Authorized Applicant / Date ' CODE I INSPECTIONTYPE PATE MI : . CODE( INSPECTION TYPE PATE JIII: . 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1— 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 1 I� 1 S1' I 201 Final Block/Retaining Wall 212 Final Fire Pr ntion 1 1 4 202 Final Factory Fire Place 220 Final nning ApprovII \yl\ 203 Final Sign 222 mal Site 1 204 Final Demolition 250 Final Building/Occupancy CITY OF COSTA MESA 4. 440 .t9 BUILDING DIVISION >: DEVELOPMENT SERVICES DEPARTMENT PER NUMBER � PERMIT 03-00568 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 240 22ND ST Status: ISSUED Suite No Applied: 09/04/2003 Issued: 11/14/2003 Vicinity: Parcel Nunmber: 42607120 ISSUED BY: Applicant: TRESTIK, SCOTT J Address: 240 E 22ND ST Phone: 949-515-3573 COSTA MESA,CA Zip: 92627-1812 Owner: TRESTIK, SCOTT J Address 240 E 22ND ST Phone: COSTA MESA,CA Zip: 92627-1812 Contractor: Address: Phone: Zip: License: Arch/ Eng : Address: Phone: Zip: License: SCOPE OF PERMIT CONVERT EXISITING 465 SQ. FT. GARAGE TO HABITABLE SPACE.CONVERTED AREA TO BECOME AN OFFICE AND BATHROOM.TWO BATHROOM RESIDENCE WILL BECOME A THREE BATHROOM RESIDENCE. CONSTRUCT NEW 494 SQ. FT ATTACHED GARAGE.REF:B03-01506 1 BATHTUB, 1 WASH BASIN AND 1 TOILET. - 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) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $9.80 1 Dishwasher $0.00 0 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) $9.80 1 Drain,Roof $0.00 0 Shower $0.00 0 Water Heater/vent $0.00 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(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: Cartier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($700)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($10Up00I,IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed 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.ft Class M 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). 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 •p pe • am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The co r.ct•Lsse 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 tot e•• ac i se Laws.). —1'am exempt u d r I: . - �tJ I ) Business and Professions Code for this reason: Signature: V {{ / 'Expires: Ng 3/i Y Verification of Ownership by(type of docu ant,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation live(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? ❑Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑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 en RMPP is presently required,has Section 25534 of the Califomia 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 control district or agency? 0 Yes ❑No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑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 prescnbed by California Health and Safety Code Section 42303 been made? 0 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: ' Date: r CERTIFICATE OF COMPLI• • • AUTHO• ON OF ENTRY:I certify under penalty of perjury that I have read this application end state that the information given is correct. I agree to comply wit :II st. e laws an• ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for I -/:c(i• • rpose :gree not to occupy or allow occupancy of any building authorized by this permit until final irrpepist//GJ 2 S!nature Of Legal Ow-er(s) Date–, ' t. And/Or Authorized Applicant Date CODE I INSPECTION TYPE OAIE INIIIIA $ CODF INSPECTION TYPE DAM mai. 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 CITY OF COSTA MESA o r� .,.. BUILDING DIVISION I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT E03 0794 J o tri (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.VSCTRICAL PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 240 22ND ST tLtt Status: ISSUED Suite No Applied: 09/04/2003 Vicinity: Issued: 11/14/2003 • Parcel Nunmber: 42607120 Applicant: TRESTIK, SCOTT J ISSUED BY: Address: 240 E 22ND ST Phone: 949-515-3573 COSTA MESA,CA Zip: 92627-1812 Owner: TRESTIK, SCOTT J Address 240 E 22ND ST Phone: COSTA MESA,CA Zip: 92627-1812 Contractor: Address: Phone: • Zip: License: SCOPE OF PERMIT CONVERT EXISITING 465 SQ. FT.GARAGE TO HABITABLE SPACE.CONVERTED AREA TO BECOME AN OFFICE AND BATHROOM.TWO BATHROOM RESIDENCE WILL BECOME A THREE BATHROOM RESIDENCE. CONSTRUCT NEW 494 SQ.FT ATTACHED GARAGE.REF: B03-01506. 5 LIGHTS,7 OUTLETS,3 SWITCHES. FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 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 $5.50 5 up to 50 kva/kw $0.00 0 Recept Outlets $7.70 7 up to 100 kva/kw $0.00 0 Switches $3.30 3 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 $0.00 0 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 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 244648(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 far 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/s valued et 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 CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE($10o,000),IN ADDmON 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.x Class a 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 Coe). 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 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 Ate pr perry,a EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:Thew act s Licens 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 purse t to t e Contr tors Licg(fsLe s.). ~I em exempt d s //s'1( Business and Professions Code for this reason: 1 r//(,I/ ,3 ney• /l p `1/f /091 Ownerr ID ID verified b drivers license. Yes ❑No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,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 ❑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 ❑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 ❑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 LI 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 ❑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 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 prescnbed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No B (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 s •- TION 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 ste laws : • ity ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for in;p c• pu•• 1 agree not to occupy or allow occupancy of any building authorized by this permit unjiytinaf'gspgction. Sigel tura Of Legal Owner(s) DDate/(//! And/Or Authorized Applicant Date g0oE 1 INSPECTIONPAIS 11110AL5 CODE It R{SPECTION TYPE DATE (MTU 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing / / 1 flr-- i. 200 Final Re-Roof 210 Final Electrical l f 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 CITY OF COSTA MESA _. 4 BUILDING DIVISION Y %l ____ `• DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER t p% PERMIT J• PERMIT 603-00047 Stx•PoaaRo (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.cBaUILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 240 22ND ST Status: ISSUED Suite: Applied: 01/09/2003 Vicinity: RESIDENCE AND ATTACHED GARAGE Issued: 01/09/2003 Parcel Number: 42607120 Zoning: Applicant COFFEY, BRIAN ISSUED BY: Address: 2428 NEWPORT BLVD UNIT 5 Phone: (949)722-8846 COSTA MESA,CA Zip: 92672 Owner: TRESTIK, SCOTT J Address 240 E 22ND ST Phone: COSTA MESA,CA Zip: 92627-1812 Contractor: THE ROOFING SPECIALISTS Address: 2428 NEWPORT BLVD UNIT 5 Phone: '(949)722-8846 COSTA MESA,CA Zip: 92672 License: 734068 • Arch : - - Eng: . Address: Address: . Phone: Phone: Zip: License: License: SCOPE OFPERMIT REROOF:T/O EXISTING COMP SHINGLES,REPAIR/REPLACE SHTG AS NEEDED, 1 LAYER 30#FELT,APPLY"30-YEAR ELK COMP SHINGLES."29 SQUARES - - - • • FEE SUMMARY Plan Check: $0.00 -- - - - Calc Valuation: $3,875.00 Permit: $97.25 Claim Valuation: $3,875.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $97.75 - 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 • 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 2446-48(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. 1'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'com nation Insurance carrier and policy number are: / I C/in 59 Carrier: / n'{t- Q.)4 9 Policy Number: 165 -Z0o 3 (This section eed not be compleed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work f 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 Cali ' ,and Agpae f I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provis' n C l// Applicant Signature: Date: (-46_0 3 WARNING:FAILURE TO SECURE WORKERS'COMPS A N COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITIIXN TO TH 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 undert provisions f Chapter 9(com,mencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# � 2Lk., / Class N re-31 Contractors Signature: /� ^' Date: 1 --(1?—0-12 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,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: O 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 end 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 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 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 WIII 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 ❑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 law 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 p '.oses.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. fATP egal Owner(s) DDat An."'thorized Applicant Dae CODE E INSPECTIONTYPE DALE LNTITIAL$ COOED INSPECTION TYPE grim IMRIAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final L� 208 Final Plumbing 200 Final Re-Roof (l/'O? //I-) " 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 • PROJECT ADDRESS: 240 22ND ST UNIT: CITY 'OF COSTA MESA — BUILDING PERMIT PERM NO: P 049130 OWNER'S NAME: BOfW./JUNGREN ADDRESS: SAME AS ABOVE PERMIT NO; P 049130 PLAN CHECK NO: N GOVT: N SUPP : N CONSTRUCTION TYPE: PERMIT TYPE: PLU PURPOSE: OTH 714 /650-5603 ARCH/ENGINEER: REO.NO.: JOB DESCRIPTION : WATER HEATER REPLACEMENT SQ FT : ADDRESS: UNIT: CLAIM VALUE: CALC—VALUE: GROUP OCC : / PERMFITEE: NOCK PLUMBING (714 ) 895- 1246 ADDRESS: 11610 SEABOARD CIR COMMENTS: MAIL—IN PERMIT STANTON CA 90680 *-**3E******3t*******at*xtt*3* u*1E****dr***cit*cit**-*if*%*year**::dr1r****•****IH*-**********3QXx*** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under orations of Chapter 9(commencing with Section ZONING S ERT E B QAUC IR S EMENTS 7000)of Division 3 of the Business and Professions Code,and my license Is in lull force and effe CITY UC.: 050386 STATEUC.:511971 /2 CLASS: C-36 Date:R— Z6 ^— QD Signature: '—C"'N"f - 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 ICJ 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 . .1DD.: 116 /99290 EXP.DATE: 03/01 /91 ANY: STATE PARKING REOk PROV: PARCEL: 41218228 ZNE: REF NO: Li Certified copy Is hereby furnished. 0 Certified copy is f}id with the city 'di Division. PLANNING NOTES> ti Date: l —Le — 70 Applicant: �/�fj~iG4 ********************************************### *****it* *******************i:-i(#* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (Rus section need not be completed if the permit a for one hundred(5100)car 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: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 B Y : ca / �� UN which this permit is issued(Section 3097,CW.C). *******************************************iFrrx it*************D*******i:*sE‘,;�re ik* LENDER: ******************************************************************************* ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N OWNER BUILDER DECLARATION: I hereby affirm that l 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: My city of county which requires a permit to construct,alter,Improve,demolish,or PERMIT 2,00 repair any structure,prior to Is issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed 25% pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN 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 any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500). ISSUE FEE 3,00 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 for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 2 , 00 3 , 00 0 . 00 5 ,00 10 . 00 —5 , 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--> COLLECTED : 5 . 00 OVER/SHORT : . 00 Improvement se sold within one year of completion,the owner will have the burden of proving he/she did not build or improve forthe purpose rpOse of Sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK Of l. I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 5 , 00 ❑ 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 sjth a contractor(s)license pursuant to the Contractors'State License Law).I am aware '******************************************************************************* that proof of their Worker's Compensztion insurance should be provided to me. IND IV IDUAL F E E BR EAKDOWN ❑ I am exempt under Section: B.8 P.C. for this reason: . TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: Owner PLU 1 WATER HEATER AND/OR VENT 2 . 00 2 . 00 Ido hereby certify 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 state codes and the requirements for a permit for construction or modification from the Air uality Management District.Residential construction applications are exempt from these provisions. Date: Applicant: I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction and hereby uthorize representatives I this city to enter upon the above-mentioned property for inspectioninpurpus s. v Date: /—zB —n Signature: Driver's License or Social Security x: 01 0D079S79-03070879 T 0 T :7.1.13 1641-46 White—Building;Green—Code Enforcement;Canary—Applicant:Pink—Revenue;Goldenrod—Assessor DATE: 10/01/90 TIKE: 14:54 CONSTRUCTION AND PLANNIN( - & 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 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, 0 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 (ZZ�J L[W 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. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co • 51. CERTIFICATE OF OCCUPANCY No. Date OWNER CLARE BUILDERS, INC. DATE I2-29-75 JOB ADDRESS 240 East 22nd Street BUILDING PERMIT NO. 40918 GENERAL CONTRACTOR Hood 8 Associates DESCRIPTIONoiWORK Res. w/att. gar. AR+ ':n. 1 I5-122-33 LOT TRACT FIRE ZONE VALUES 35,400.00 It�',""^,TCTIONS Signature Date TYPE V GROUP I Ya J ZONE H-1 SOIL r - ,' 4 -7L SUBCONTRACTOR PERMITS ISSUED GAS ..0 I I WATER 2 S?O- PlumbingDote Number Signature GUMSIN .a -ow i -.q- �b b ROUGH PLUMBINE ' a•2a•76�,�(���G�r Ac /42-76, 45 7! PROP. SWR. LINE ❑ HOUSE CON. IS n3 ;•12.-A. S.E. a-/i-76 (ofSam� SPRINKLING SYSTEM,' e 3 �f MISCELLANEOUS -� �i ROUGH HEATING AND AIR CONDITIONING C55 .2-2'.71. TEMPORARY SERVICE OR POLE J/?--) i"g '1% UNDERGROUND 0 POWER IP' RLL OC-s ROUGH WIRING237( Heating and Vent. TRENCHES ❑ FORMS n STEEL REINF. ...,6. a,� /N�j 0.1_9..v.0.1_9..v. Apar)T/ FLOOR SYSTEM e 'Ly. ^ BOND BEAM I I STEEL REINFORCE E SHEAT HINOe//NSL LA;nom AG 3"0 a 2• .7 ie.-1 tea FRAME AND FLASHING 1•/- C6 LATHING - IN ikl". OUT IFr L[i 3•40'''174 PLASTER, BROWN COAT 4- CA-29.74, ST 'URAL, FINAL le Ctrie w HE ,G, VENT., REFRIG. AND A.C., FINAL O . i i-1K T . [02.16.9 3 - -a/Le-G PLUMBING, FINAL AND GAS TEST SC-- /4 7L� . A.-s-- 76 311177 ELECTRIC, FINAL Q\C-- �- t/7/i BUILDING, FINAL /f��iiC4 e�77- 1i�..... PAIf1 .k 4t)9.16 SFr. 1 7sr:fSroo 059* irhtr74.,O 8 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 •41P IC TION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Use Ink Only R- ii. . r V DATE RECEIVED ATE ISSUED ADDRESS j' E 1.2„74 L--, s '„ r- I /l /A- 4' -7. P MIS •re OWNER (r _ r I . - a A.P. NO. Z. ZZ- ._ �l MAIL //jj /� BUILDING Z' 22 r.. c ADDRESS PD r 50 X 3/ 4 ADDRESS y,�� ,) U�� CITY s �N TEL. -/3Ss NPTR CY- 'TiaT293 BLOCK CONSTRUCTION NEW ADD ALTER REPAIR MOVING ogimouSH LENDER BRANCH �' OWNER tet% /4/Ida” Affel ADDRESS •, r / tl ' V LUE ARCHITECT TEL • 1fr 2 '�f . _ ,c... S ><`� OR EN (NEER �� 4 �tr�� e , FIRE / T • ADDRESS Jo Q C Ali All JA/S7r tO/* f/5 ZONE TVP J GROUP.Y' AYPROV /2 /� CONTRACTOR -,a� i G - BY �/ DATED `-/ ADDRESS • /PJ sir/ a - TE20 NO.OF USE OF NEW ` I' NO p 1 PLANS `L BUILDING IA) A..�. GAS• N. 1-4 CITY �If S T LY NOY'�il .1's� ,\ g STATE t7 2 2 / CITY. YMAIN NED YARDS APPROVED LIC.NO. LIC.NO. MAIN BUILDING ACCESSORY :UILDING i.LI SIZE ^ NO.OF BLOCS l, • (FROM C/ //T pp11EE // • OF LOT .�jj�/,/ X �oz g NOW ON LOT ,4GS11 -ONi VFT 1str4� FT. Q 1 USE OF �- M y F EXISTING BLDG R.-SIDET. FT. CA Sy I Separate permits are required for L.SIDE 6-Fri. FT. h electric,plumbing and heating work. 'J/ WREAR G\ FT. FT. (-, USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& A0 t ((��e, ,,/ // MAIN BLOCS. ACCESS,BLOCS. `i / £2 ,(p//Alt/ T-ct6 ��1�1�C�n- C.U.P.# DATE io APPROVED ,APPROVED6/769 ! L _// / ' a f D FOR SPMA e '1dJIR• ' E TS • w 0 I hereby acknowledge that I have read this application and state n a that the above Information is correct and agree to comply with m 0. all laws regulating building construction, end I shall not employ Z any person In violation of the workmen's compensation laws of ifi C Mthe State of California, rif /�� o I hereby certify that I am properly licensed as a contractor under /168 SQ. FT. • �7/[. a 0 the State of California Business end Professions Coda, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m CI Chapter 9,and that such licenses era in full orce and affect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: m ��N�.VVVII am exempt from the rotations of the State f Calif la Business VALUATION PERMIT FEE $ and Professions Cod , Div' on 3,Chapter �� w n PLAN CHECK f n Permittee of /1/ ' 5�oa • o Permittee L S 0D TAX S Zia 1-Lt V Authorized pent TOTAL PAID $ ^ f Q 9ib "Ft' ?9-75FM ;DO 071 z.*::* 145.^0 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — Use In Only RECEIVED BY DATE RECEIVED DATE ISSUED BUILDING '� ADDRESS g� ,/�//��//a��Ole ����,�// • o �wW glife& .) / PERMIT NO. OWNER • A.P.NO. MAIL A "iv ADDRESS ADDRESS ��!!�� . ��ss .• ��jj�iVV TEL. TRACT I LOT BLOCK CITY NO. CONSTRUCTION NEW 1ADD ALTER REPAIR IMOVINfi r1Fmru IsH LENDER BRANCH � ������r�f/ OWNER ����%'�L�(/ /2 , ADDRESS air �-1�y VALU$ -c `• ARCHITECT TEL. USE (�/� �/( OR ENGINEER NO. FIRE ADDRESS ZONE TYPE GROUP APPROVED CONTRACTOR � BY DATE ADDRESS TEL. ZONE INO.OF USE OF NEW PLANS BUILDING CITY NO. F STATE CITY YARDS APPROVED YARDS APPROVED LIC. NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING w SIZE INO.OF BLDGS. (FROM C/L STREET) L OF LOT NOW ON LOT FRONT FT. FT. Q USE OF N., EXISTING BLDG. &IDE FT, FT. V) F—. Separate permits are required for L,SIDE FT. FT. electric,plumbing and heating work. -- W REAR FT. FT. USE OF BUILDING AND WORK TO BE PERFORMED F DISTANCE BET. BET.MAIN D AMAIN BLDGS. ACCESS.BLDGS. /f/-. C.U.P. ATE VAR. A Q (((���{((///✓✓✓ C.U.P.# APPROVED '7 APPROVED >4 __BY DATE C4 w • . 0 I hereby acknowledge that I have read this application and state U, C that the above information Is correct and agree to comply with w 4 all laws regulating building construction, and I shall not employ Z any person in violation of the workman's compensation laws of 2 _, the State of California. m 3 I hereby certify that I am properly licensed as a contractor under SO. FT. N the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: an, exempt from the provisions of the State of California Business VALUATION PERMIT FEE $ ���.. a end Professions Code,Division 3,Chapter 9. U, m PLAN CHECK $ m Signature of o Permittee $ TAX $ U fU Authorized Agent TOTAL PAID $ J{/fs /. l CITY OF 'OSTA MESA PA. . FEES N° 14 0 77Fee Payment Receipt c Project Address) .0-) L ,-�r-t-- c-��' Park Area ---2 A. P. No. // 1S —1c2,2 — 3-S Building Permit No. 7 � „/, n Owner's Name I -/ . 41! �SIT _. �j� Mailing Address • L - c_. 1-7(.;.„ /�`,,--2— Ld/ ' ' FEE /` Single Family * No. of Units / @ S455.20 = 7 i.5"..2-0 Multiple Family ** No. of Units @ S321.32 = // —Total Fee J / ' - •02n Planning Department Approval Da / J — "- — J By Cil�,"E Applicant's Signature / 4 . — A. • City Ordinance 72.44 / ** City Ordinance 72.45 ••• City Resolution 74-124 It tn� White-Planning;Canary-Planning;Pink-Finance;Goldenrod-Applicant CMF 0174-26 L OSnOpj J SII