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119 23RD ST - Building Permits
go~ CITY OF COSTA MESA u ries BUILDING DIVISION Aa Fs AI6 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 1 FOR INSPECTIONS CALL: (714)754-5626 PERMIT NUMBER: BC10-00098 PERMIT TYPE: B_COMBO STATUS: APPROVED Sub Type: RES ALT DATE ISSUED: ISSUED BY: JOB ADDRESS: 119 A 23RD ST CM Suite/Unit: A APN: 42605406 Zoning: , Vicinity: Primary Occ: Const Type: SQ. FT: 98 Valuation: $9,055.20 SCOPE OF WORK: ADD 98 SQ FT TO UNIT A. SCOPE OF WORK IS TO BE TWO NEW CLOSETS AT BEDROOMS AND NEW ENTRY WAY AREA. NO NEW PLUMBING OR BATHROOMS PROPOSED. ELECTRICAL TO INCLUDE 1 NEW LIGHT FIXTURE, 2 OUTLETS, 1 SWITCH. ROOF PITCH IS TO BE CHANGED FROM FLAT TO 7:12. COVER WITH 30 YEAR COMP SHINGLES. OWNER: DOOTSMARD, ESMAIEL CHRISTOPHER Address: 119 E 23RD ST Unit: Phone: 949-633-6879 City/State/Zip: COSTA MESA,CA APPLICANT: MOTAMEDI,SINA Address: Unit: : Phone: 949-331-5839 City/State/zZip: CONTRACTOR: License No. Phone: Address: Unit: Cell: City/State: ZipCode ARCHITECT: License No. PHONE: ENGINEER: DONALD MUNENO License No.C36935 PHONE:714-374-5042 COMBINATION PERMIT FEE SUMMARY Building Plan Check: $117.81 Building Fees: $181.25 Electrical Fees: $27.90 Mechanical Fees: $0.00 Plumbing Fees: $0.00 SMIP Residential: $0.91 SMIP Commercial: $0.00 Bldg Std Admin Fund $1.00 TOTAL FEES: $328.87 —Refer to fee receipts for all fees paid for project HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279 Monday thru Friday-7:00 am thru 7:00 pm. Saturdays-0:00 am thru 6:00 pm. Prohibited all hours-Sundays and the following Federal holidays: New Years Day,Memorial Day,Independence Day,Labor Day,Thanksgiving Day and Christmas Day NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No. 92-28,§ 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. CODE I. INSPECTION TYPE DATE PITS. CODES INSPECTION TYPE DATE ac7—INT�MAL$ /3 1616 Fixed System Final Fire Prevention 206 Final Mechanical -./1 4, *v _) 1266 Pool Spa Final 208 Final Plumbing [_I3" /0-by Nn(7,2 200 Final Re-Roof 210 Final Electrical J 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 • WORKERS'COMPENSATION DECLARATION: Owner ID verified by driense. I�Yes ❑No I hereby affirm under penalty of perjury one of the following declarations: oDriver's License No. j7Expires: (rQP'G.r ❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-properly tax bill or deed): compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. or, 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a number are: 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 Carrier: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp (This section need not be completed d the perm,is valued al one hundred dollars($100)orless) 2 Art 2.Sec 341.Title 8,California Administrative Code). Policy Number: 0 As owner-builder, I will not employ anyone to do work which would ❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of Applicant's Signature Date the Labor Code,I shall forthwith comply with these provisions. Division of Industrial Safety Permit Number: Applicant's Signature Date HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes ❑No ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. 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 LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license is in full force and effect. a registration form for acutely hazardous materials? 0 Yes ❑No Lic.# Class# (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 Contractor's Signature Date 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 CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? ❑Yes 0 No (Section 25534 of the California Health and Safety Code provides that the Lender's Address: 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. Signature Date 4. If an RMPP is presently required, has Section 25534 of the California • OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes ❑ No 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 (Section 65850.2 of the Califomia Government Code requires that the requested • License Law(Chapter 9(commencing with Section 7000)of Division 3 of the information be furnished on applications for non-residential building permits). Business and Professions Code) or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes ❑No applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the Califomia Health and Safety Code). G Q I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec.7044,Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 No 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 6. (If'yes",attach certificate of compliance from the appropriate air pollution sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and p Q. I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of Signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that 0 I am exempt unde the information given is cor - .1 agree to comply with all state laws and city ordinances rela'•g to •. dinryconstruction, and authorize representatives of Business arid, ofessions Co or this'reason: the City of '. a esa •enter upon the above-described property for / inspectio •. s. I -u ee of to occupy or allow occupancy of any building "-V inspectio • s p- i • " final inspection. / Y 7 Orr re of Legal Owner(s) Date `mature Date 9057-46(3/O7) And/or Authorized Applicant Date Iq,Y .!l G. uNrq aHPaBIffEO..,. Non-Priority Water Quality Management Plan Property Owner's Signed Certification Building Permit No.: Ac (o_ 0009 t g / 577 //0o Property Address: I I S /z 2320 sr tci/If 4-16 D et-- Owner's Certification: This WQMP is intended to comply with the permit requirements of the City of Costa Mesa, Development Services, requiring the preparation of a Non-Priority Water Quality Management Plan. The property owner is responsible for the implementation of the provisions of this plan and will ensure that this plan is amended as appropriate to reflect up-to-date conditions on the site consistent with the Orange County Drainage Area Management Plan (DAMP), and the intent of the non-point source NPDES Permit for Waste Discharge Requirements for the County of Orange, Orange County Flood Control District, and the incorporated Cities of Orange County within the Santa Ana Region Stormwater Runoff Management Program. The owner's signed certification will be on file at the City of Costa Mesa's Dev. Svcs. Dept. By obtaining owner's signed certification, the City acknowledges that a copy of the Model Nonpriority WQMP was also provided to the applicant. Additional copies of Model WQMPs are available at City Hall. The Model Nonpriority WQMP and the signed certification will be maintained at the project site in perpetuity. This WQMP will be reviewed with the facility operator, facility supervisor, employees, tenants, maintenance and service contractors, or any other party having responsibility for implementing portions of this Water Quality Management Plan. Once the property owner transfers its interest in the property, its successors-in-interest shall bear the aforementioned responsibility to implement and amend the WQMP. • Pioperty OwnerName:A Elia et o /nri- J Owners Address: I (9 fZ 232,0 sr /146— dot -j- cCity,.State.ZIP: cos, — ti4 tcs Telephone Number. (9t0/ 637- 't' Signature:y_ Date: Cfr-7'/O Prepared by: City of Costa Mesa,Development Services Department 77 Fair Drive,PO Box 1200,Costa Mesa,Califomia 92628-1200 (714)754-5323 Model Water Quality .anagement Plan (WQMP) for Nor. ;iority Projects SECTION 1 —PROJECT DESCRIPTION This Project has been determined to be a Non-Priority Project within the City of Costa Mesa and is covered by this model Water Quality Management Plan. Section A.7.5 of the Local Implementation Plan adopted by the City Council on June 2, 2003 (including any amendments thereafter) requires the development of a Water Quality Management Plan for all projects. This model plan has been developed by the City of Costa Mesa for those Non-Priority projects that are associated with an over the counter permit or have been determined as Non-Priority. Prior to issuance of grading or building permits, the City requires the project applicant to have an approved final Project WQMP. If any of the following conditions are identified as a "Yes' the project does not meet a Non-Priority Project status and a Priority WQMP must be developed and approved prior to issuance of grading or building permits. Proposed Project Includes: Yes No J 1.1 Residential development of 10 units or more v1 2.I.Commercial&industrial development greater than 100,000 sf inc. parking (/ 3.I Automotive repair shop(SIC 5013, 5014, 5541, 7532-7534, & 7536-7539) 4.;Restaurant w/development area of 5,000 sf or more inc.parking(SIC 5812) /5'I Hillside on 10,000 sf or more,on erosive soils or slopes of 25%or more j '6J Impervious surface of 2,500 sf or more(w/in 200 ft.of ESA`) 17! Parking lot area of 5,000 sf or more,or w/15 or more spaces l/ U 1 -Significant Redevelopment"means development that would create or add at least 5,000 square feet of impervious surfaces on an already developed site. Significant redevelopment includes,but is not limited to:the expansion of a building footprint;addition to or replacement of a structure;replacement of an impervious surface that is not part of a routine maintenance activity;and land disturbing activities related with structural or impervious surfaces. Replacement of impervious surfaces includes any activity that is not part of a routine maintenance activity where impervious material(s)are removed,exposing underlying soil during construction. Significant redevelopment does not include trenching and resurfacing associated with utility work;resurfacing and reconfiguring surface parking lots;new sidewalk construction, pedestrian ramps,or bike lane on public and private existing roads;and replacement of damaged pavement. 2 Environmentally Sensitive Areas are shown in Figure A.1-6 of the Local Implementation Plan. The WQMP for a Non-Priority Project must address the following items,which have been incorporated in this Model WQMP: • Routine structural and non-structural Source Control BMPs; identify those that apply to your project. • Provide supporting documentation on routine structural and non-structural BMPs where applicable. • Consideration of Site Design BMPs;and • The mechanism(s)by which long-term operation &maintenance of all structural BMPs will be provided SECTION II-BEST MANAGEMENT PRACTICES SOURCE CONTROL BMPS(Best Management Practices) Routine BMPs Check One Identifier Name Not Comments Included Applicable SC-10 Non-Stormwater Discharges X SC-11 Spill Prevention, Control& X Cleanup • SC-20 Vehicle&Equipment Fueling X SC-21 Vehicle&Equipment Cleaning X _ SC-22 Vehicle&Equipment Repair _ X SC-30 Outdoor Loading/Unloading X SC-31 Outdoor Container Storage X SC-32 Outdoor Equipment Maintenance X SC-33 Outdoor Storage of Raw Materials X SC-34 Waste Handling &Disposal X SC-35 Safer Alternative Products X SC-41 Building&Grounds Maintenance X SC-43 Parking/Storage Area Maintenance X SC-60 Housekeeping Practices X SC-70 Road&Street Maintenance X SC-71 Plaza&Sidewalk Cleaning X SC-72 Fountains&Pools Maintenance X _ SC-73 Landscape Maintenance X SC-74 Drainage System Maintenance X SC-76 Water&Sewer Utility Maintenance X Routine Structural BMPs _ Check One Name ot Included Applicable Comments Provide storm drain system stenciling&signage X Design&construct outdoor material storage areas to X reduce pollution introduction Design&construct trash/waste storage areas to reduce X pollution introduction Use efficient irrigation systems&landscape design,water X conservation,smart controllers,&source control Protect slopes and channels&provide energy dissipation X Incorporate requirements applicable to individual project X features a. Dock areas X b. Maintenance bays X c. Vehicle wash areas X d. Outdoor processing areas X e. Equipment wash areas X f. Fueling areas X g. Hillside landscaping X h. Wash water control for food preparation X areas • i. Community car wash racks X SITE DESIGN BMPS Technique Included? Brief Description of Method Yes No Minimize Impervious Area/Maximize Permeability(C-Factor X Reduction _ Minimize Directly Connected Impervious Areas(DCIAs)(C-Factor X Reduction) Create Reduced or"Zero Discharge"Areas(Runoff Volume X Reduction) Conserve Natural Areas(C-Factor Reduction) X TREATMENT BMPS(Optional) Check One Identifier Name Not Included Applicable Comments TC-10 Infiltration Trench X TC-11 Infiltration Basin X TC-12 Retention/Irrigation X TC-20 Wet Pond X TC-21 Constructed Wetland X TC-22 Extended Detention Basin X TC-30 Vegetated Swale X TC-31 Vegetated Buffer Strip X TC-32 Bioretention X TC-40 Media Filter X TC-50 Water Quality Inlet X TC-60 Multiple Systems X MP-20 Wetland X MP-40 Media Filter X MP-50 Wet Vault X MP-51 Vortex Separator X MP-52 Drain Insert X SECTION III—OWNER'S CERTIFICATION The property owner is responsible for the implementation of the provisions of this plan and will ensure that this plan is amended as appropriate to reflect up-to-date conditions on the site consistent with the Orange County Drainage Area Management Plan(DAMP), and the intent of the non-point source NPDES Permit for Waste Discharge Requirements for the County of Orange, Orange County Flood Control District, and the incorporated Cities of Orange County within the Santa Ana Region Stormwater Runoff Management Program. The property owner will make any necessary revisions to the tables shown in Section II(Best Management Practices) to customize the BMPs according to the proposed project. The City's suggestions as indicated by the checked boxes are guidelines only. The owner's signed certification (separate form) is on file at the City of Costa Mesa's Dev. Svcs. Dept. By obtaining owner's signed certification, the City acknowledges that a copy of this WQMP was also provided to the applicant. Additional copies of Model WQMPs are available at City Hall. The WQMP and the signed certification will be maintained at the project site in perpetuity. This WQMP will be reviewed with the facility operator, facility supervisor, employees, tenants, maintenance and service contractors, or any other party having responsibility for implementing portions of this Water Quality Management Plan. Once the property owner transfers its interest in the property, its successors-in-interest shall bear the aforementioned responsibility to implement and amend the WQMP. CITY OF COSTA MESA o FS. BUILDING DIVISION 77 FAIR DRIVE,COSTA MESA, CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us FOR INSPECTIONS CALL: (714)754-5626 •wane^` PERMIT NUMBER: BX10-00096 PERMIT TYPE B_MISC STATUS: ISSUED APN: 42605406 DATE ISSUED: 06/01/2010 Zoning: , ISSUED BY: BE JOB ADDRESS: 119 23RD ST CM Suite/Unit: Vicinity: REAR OF PROPERTY Primary Occ: Const Type :7? SQ. FT: 0 Valuation: $1,000.00 SCOPE OF WORK: ADD 80 SQ FT DETACHED PATIO COVER AT REAR OF PROPERTY OWNER: DOOTSMARD, ESMAIEL CHRISTOPHER Address:: 119 E 23RD ST Unit City/State: COSTA MESA, CA Zip Code: 92627-1793 Phone: 949-633-6879 APPLICANT: DOOTSMARD, ESMAIEL CHRISTOPHER Address: 119 E 23RD ST Unit: City/State: COSTA MESA,CA Zip Code: 92627-1793 Phone: 949-633-6879 CONTRACTOR: OWNER-BUILDER License No. 000000 Address: Unit: City/State: Zip Code: Phone Cell: ARCHITECT: License No. Phone ENGINEER: License No. Phone FEE SUMMARY Building Plan Check: $0.00 Building Permit: $38.75 Electrical Permit: $0.00 SMIP Residential $0.50 SMIP Commercial $0.00 Bldg Std Admin Fund $1.00 TOTAL FEES $40.25 HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3/18/2010 -PER CMMC Sec. 13-279 Monday thru Friday-7:00 am thru 7:00 pm. Satrudays-9:00 am thru 6:00 pm. Prohibited all hours-Sundays and the following Federal Holidays: New Years Day,Memorial Day, Independence Day,Labor Day,Thanksgiving Day and Christmas Day NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. 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. CODE/ INSPECTION TYPE DATE INTn1ALS CODES INSPECi1ON TYPE DATE INTITIALS 1618 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical . . • • J 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site / I 204 Final Demolition 250 Final Building/Occupancy '7-/3-io ,/j1. fi ( zi WORKERS'COMPENSATION DECLARATION: Owner ID verified by driver's license. ❑Yes ❑No �1 /.� I hereby affirm under penalty of perjury one of the following declarations: Driver's License No(- Expires:)cam/d ❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed): 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy ❑ I hereby certify that no excavation five(5)or more feet in depth into which a number are: person is required to descend,will be made in connection with work authorized by this permit,and that no building stmcture,scaffdding,falsework,a demolition Carrier: or dismantling thereof,will he more than thirty-six(36)feet high.(Chap.3.2,Gry (Tho sedan need not be completed J the permit is valued at one hundred collars(Stoo)or less.) 2,Art 2.Sec.341 Title B,California Administrative Code). Policy Number: ❑ As owner-builder, I will not employ anyone to do work which would ❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issued.I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of Applicant's Signature Dale the Labor Code,I shall forthwith comply with these provisions. Division of Industrial Safety Permit Number: Applicant's Signature Dale HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes 0 No (5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE. INTEREST.AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. 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 LICENSED CONTRACTORS DECLARATION: 500 pounds, or a volume of 55 gallons,or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license is in full force and effect. a registration form for acutely hazardous materials? ❑Yes 0 No Lic.# Class# (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 Contractor's Signature Date 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 CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work fix which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? 0 Yes 0 No (Section 25534 of the California Health and Safety Code provides that the Lender's Address: 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. Signature Dale 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes ❑ No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5. the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes ❑No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Govemment Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits). 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 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes 0 No applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other co pensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec. 7044, Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes ❑No 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 8. (If"yes", attach certificate of compliance from the appropriate air pollution sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and I. as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. LIC NSED CONTRACTORS to construct the project(Sec.7044, Business and Professions Code: The contractors License Law does not apply to an owner of Signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that r ❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: 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 uthoriz �t per until final inspection (/D ' Signature of Legal Ownerts) e Signature dale oe 3057-x6(3107) (� And/or Authorized Applicant Date CITY OF COSTA MESA 0�4- BUILDING DIVISION I. �.�l - 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us flOCIR FOR INSPECTIONS CALL: (714)754.5626 PERMIT NUMBER: BX10-00087 PERMIT TYPE B_MISC STATUS: ISSUED APN: 42605406 DATE ISSUED: 05/18/2010 Zoning: ISSUED BY: BE JOB ADDRESS: 119 23RD ST CM Suite/Unit: Vicinity: Primary Occ: Const Type :?? SQ. FT: 0 Valuation: $1,000.00 SCOPE OF WORK: BUILD POP OUT FOR 2 3040 CASMENT WINDOWS TO MEET EGREES REQUIREMENTS AND ENERGY CODE. MAX U FACTOR .40 AND .40 SHGC OWNER: DOOTSMARD,ELLIOTT Address:: 119 E 23RD ST Unit City/State: COSTA MESA,CA Zip Code: 92627-1793 Phone: 949-633-6879 APPLICANT: DOOTSMARD,ELLIOTT Address: 119 E 23RD ST Unit: City/State: COSTA MESA, CA Zip Code: 92627-1793 Phone: 949-633-6879 CONTRACTOR: License No. Address: Unit: City/State: Zip Code: Phone Cell: ARCHITECT: License No. Phone ENGINEER: License No. Phone FEE SUMMARY Building Plan Check: $0.00 Building Permit: $38.75 Electrical Permit: $0.00 SMIP Residential $0.00 SMIP Commercial $0.00 Bldg Std Admin Fund $1.00 TOTAL FEES $39.75 HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3/18/2010-PER CMMC Sec. 13-279 Monday thru Friday-7:00 am thru 7:00 pm. Satrudays-9:00 am thru 6:00 pm.Prohibited all hours-Sundays and the following Federal Holidays: New Years Day,Memorial Day, Independence Day,labor Day,Thanksgiving Day and Christmas Day 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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. 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. CODE N. INSPECTION TYPE DATE INTmALS CODE! INSPECTION TYPE DATE INIOIALS 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 '7/-3-/0 4,t/nMr2D �' y WORKERS'COMPENSATION DECLARATION: Owner ID verified by driven s'cense. 0 Yes ❑No I hereby affirm under penalty of perjury one of the following declarations: Driver's License Noy.. 1 Expiresx ) -3 l7- _ ❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property to bill or deed): 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy ❑ I hereby certify that no excavation five(5)or more feet in depth into which a number are: person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffdding,falsework,a demolition Carrier: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp (This section need not be completed if the penM is valued at one hundred dollars(Slep)or less) 2,Art 2.Sec.341,Title 6,California Administrative Code). Policy Number: ❑ As owner-builder, I will not employ anyone to do work which would ❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issued. I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California. and agree that if I should become subject to the workers'compensation provisions of Section 3700 of Applicant's Signature Date the Labor Code.I shall forthwith comply with these provisions. Division of Industrial Safety Permit Number: Appgram's Signature Date HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? El Yes 0 No ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST. AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. 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 LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000) of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license is in full force and effect. a registration form for acutely hazardous materials? 0 Yes 0 No Lic.# Class# (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 Contractor's Signature Date 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 CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? ❑Yes 0 No (Section 25534 of the California Health and Safety Code provides that the Lender's Address: 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. Signature Date 4. If an RMPP is presently required. has Section 25534 of the Califomia r OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5. the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes ❑No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Govemment Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits). 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 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes ❑ No applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303 fiv hundred dollars($500).): of the California Health and Safety Code). I. as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other c pensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec.7044,Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by Califomia License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes ❑No thereon,and who does such work himself or herself or through his or her own 8. (If"yes",attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the di.'not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and - A I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. 'LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code: The contractors License Law does not apply to an owner of Signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that 0 I am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Cede for this reason: 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 authori :: by this spection. ', . _.r.r,! 0/ . ( iv J/. . A V I g2110 Signature of Legal Owner(s) • to Signature date 3057-46(3/e7) And/or Authorized Applicant Date 4111 CITY OF COSTA MESA 1111 ,^, BUILDING DIVISION Fi; �I 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • vwiw.ci.costa-mesa.ca.us FOR INSPECTIONS CALL:(714)754-5626 PERMIT NUMBER: BC10-00099 PERMIT TYPE: B_COMBO STATUS: APPROVED Sub Type: RES ALT DATE ISSUED: ISSUED BY: JOB ADDRESS: 119 B 23RD ST CM Suite/Unit: B APN: 42605406 Zoning: , , Vicinity: Primary Occ: Const Type: SQ. FT: 20 Valuation: $5,848.00 SCOPE OF WORK: ADD 20 SQ FT TO UNIT B. SCOPE OF WORK IS FOR TWO NEW CLOSETS ONLY AT TWO BEDROOMS. NO NEW PLUMBIN CHANGE ROOF PITCH FROM FLAT TO 7:12. INSTALL NEW 30 YEAR COMP SHINGLE ROOF. OWNER: DOOTSMARD,ESMAIEL CHRISTOPHER Address: 119E 23RD ST Unit: Phone: 949-633-6879 City/State/Zip: COSTA MESA,CA APPLICANT: MOTAMEDI,SINA Address: Unit: : Phone: 949-331-5839 City/Stale/zZip: • CONTRACTOR: License No. Phone: Address: Unit: Cell: City/State: ZipCode ARCHITECT: License No. PHONE: ENGINEER: DONALD MUNENO License No.C36935 PHONE:714-374-5042 COMBINATION PERMIT FEE SUMMARY Building Plan Check: $81.41 Building Fees: $125.25 Electrical Fees: $0.00 Mechanical Fees: $0.00 Plumbing Fees: $0.00 SMIP Residential: $0.59 SMIP Commercial: $0.00 Bldg Std Admin Fund $1.00 TOTAL FEES: $208.25 "Refer to fee receipts for all fees paid for project HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3/18/2010- PER CMMC Sec. 13-279 Monday thru Friday•7:00 am thru 7:00 pm. Saturdays-9:00 am thru 6:00 pm. Prohibited all hours-Sundays and the following Federal holidays: New Years Day,Memorial Day,Independence Day, Labor Day,Thanksgiving Day and Christmas Day NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. CODE I INSPECTION TYPE DATE INTI11AE9 CODED INSPECTION TYPE QM INTmAE$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 7—/Pr AS 43 1266 Pool Spa Final 208 Final Plumbing 1-1-7-m .4 /.� 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 WORKERS'COMPENSATION DECLARATION Owner ID verified by driv icense. C734s 0 No /I I hereby affirm under penalty of perjury one of the following declarations: Driver's License No., -4 Expires: (A 7-(S ❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document.i.e.-property tax bill or deed): 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: 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 ❑ I hereby certify that no excavation five(5)or more feet in depth into which a number are: person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,a demolition Cartier: (This seam need rot be completed the permit van,enat one hundred clam(SIM or less.) 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). Policy Number: ❑ As owner-builder, I will not employ anyone to do work which would O I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California, and agree that if I should become subject to the workers'compensation provisions of Section 3700 of Applicant's Signature Dale the Labor Code,I shall forthwith comply with these provisions. Division of Industrial Safety Permit Number: Applicant's Signatma Date HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No ($100,000), IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS (Section 25505 of the California Health and Safety Code requires.with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. 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 LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000)of Division 3 of the Business and Professions Code,and 2. Does or will the applicant or present or future building occupant need to file my license is in full force and effect. a registration form for acutely hazardous materials? 0 Yes 0 No Lic.# Class# (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 Contractors Signature Date 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 CONSTRUCTION LENDING AGENCY: temperature and pressure). O I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? 0 Yes 0 No (Section 25534 of the California Health and Safety Code provides that the Lender's Address: 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. Signature Date 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure. prior to its any other air pollution control district or agency? 0 Yes 0 No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Government Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be fumished on applications fa non-residential building permits). 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 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes 0 No applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars(5500).): of the California Health and Safety Code). Ld' I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec. 7044.Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes ❑No thereon,and who does such work himself or herself or through his or her own B. (If'yes",attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the diddinot build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and LS I, as owner of the property,am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. LICENSED CONTRACTORS to construct the project(Sec.7044, Business and _ Professions Code:The contractors License Law does not apply to an owner of Signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that ❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to buildin• cons • ction, and authorize representatives of Business and Pros' for thiserr ason: the City of Cos - Mes- • e -/ pon the above-described property for -- inspection purr•• s. .gree f t to occupy or allow occupancy of any building authorize� is •-rmit it fin- inspection. L-(j7(J /7r�'/ I '/ Signgnate f er(s) Date — l� ] - • - Date 3057<6(107) And/or Aomonxed Appt,cant Date • CITY OF COSTA MESA O pMFq BUILDING DIVISION „w �l 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4656 • www.ci.costa-mesa.ca.us FOR INSPECTIONS CALL:(714)754-5626 4c'*wiaico`� PERMIT NUMBER: BC10-00100 PERMIT TYPE: B_COMBO STATUS: APPROVED Sub Type: RES ALT DATE ISSUED: ISSUED BY: JOB ADDRESS: 119 23RD ST CM Suite/Unit: APN: 42605406 Zoning: , , Vicinity: Primary Occ: Const Type: V-B SQ. FT: 0 Valuation: $5,000.00 SCOPE OF WORK: CHANGE ROOF PITCH ON EXISTING DETACHED GARAGE FROM FLAT TO A 6:12 PITCH. RE-ROOF WITH 30 YEAR COMP SHINGLES. OWNER: DOOTSMARD, ESMAIEL CHRISTOPHER Address: 119 E 23RD ST Unit: Phone: 949-633-6879 City/State/Zip: COSTA MESA,CA APPLICANT: MOTAMEDI,SINA Address: Unit: : Phone: 949-331-5839 City/State/zZip: CONTRACTOR: License No. Phone: Address: Unit: Cell: City/State: ZipCode ARCHITECT: License No. PHONE: ENGINEER: DONALD MUNENO License No.C36935 PHONE:714-374-5042 COMBINATION PERMIT FEE SUMMARY Building Plan Check: $72.31 Building Fees: $111.25 Electrical Fees: $0.00 Mechanical Fees: $0.00 Plumbing Fees: $0.00 SMIP Residential: $0.50 SMIP Commercial: $0.00 Bldg Std Admin Fund $1.00 TOTAL FEES: $185.06 --Refer to fee receipts for all fees paid for project HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279 Monday thru Friday-7:00 am thru 7:00 pm. Saturdays-9:00 am thru 6:00 pm. Prohibited all hours-Sundays and the following Federal holidays: New Years Day,Memorial Day,Independence Day, Labor Day,Thanksgiving Day and Christmas Day 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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. 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, CODE S. INSPECTION TYPE DATE INTI11ALS CODES INSPECTION TYPE DATE INTmALS 1816 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 WORKERS'COMPENSATION DECLARATION: Owner ID verified by driv icense. Yes ❑No I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. i.e.-property tax bill or deed): 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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: 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 ❑ I hereby certify that no excavation five(5)or more feel in depth into which a number are: 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 Carrier: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Gm (Thssedoon neednot be completed✓the permits valued al one hundred dolars(St00)or leu) 2,Art 2,Sec.341,Title B,Califomia Administrative Code). Policy Number: 0 As owner-builder, I will not employ anyone to do work which would O I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of Califomia, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of Applicant's Signature Date _-- the Labor Code,I shall forthwith comply with these provisions. Division of Industrial Safety Permit Number: Applicant's Signature Date HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes ❑No ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST.AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. 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 LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license is in full force and effect. a registration form for acutely hazardous materials? ❑Yes ❑No Lic.# Class# (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 Contractor's Signature Date hazardous materials equal to or greater than a weight of 500 pounds. or a volume of 55 gallons, or 200 cubic feel of compressed gas at standard CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? ❑Yes 0 No (Section 25534 of the Califomia Health and Safety Code provides that the Lender's Address: 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. Signature Date 4. If an RMPP is presently required, has Section 25534 of the Califomia OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes ❑No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? ❑Yes ❑No issuance,also requires the applicant for such permit to file a signed statement Thal he or she is licensed pursuant to the provisions of the Contractors (Section 65850.2 of the California Govemment Code requires that the requested License Law(Chapter 9(commencing with Section 7000)of Division 3 of the information be furnished on applications for non-residential building permits). Business and Professions Code) or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes 0 No applicant for a permit subjects the applicant to a civil penalty of not more than (If'yes",the facility must meet the requirement of Sections 25534 and 42303 fivefivetyridred dollars($500).): of the California Health and Safety Code). Ire I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec. 7044.Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes ❑ No thereon,and who does such work himself or herself or through his or her own 8. (If'yes",attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not fid or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and /I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. ICENSED CONTRACTORS to construct the project(Sec.7044, Business and Professions Code: The contractors License Law does not apply to an owner of signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contracto(s)license pursuant to the Contractors license Laws.). certify under penalty of perjury that I have read this application and state that ❑ am exempt under sec. ...---othe information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and .%• Code for this reason: the City of Costa M-.- + en = pon the occupancy nyproperty for inspection purpo�r. ee :oto occupy or allow occupancy of any building authorized by L'- mit ai inspection. Signa o mal Owners) Date Signature Date 3057-46(3107) And/or Authorized Applicant Date el' sCITY OF COSTA MESA % A. BUILDING DIVISION r„' �1 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT E00-00790 RP i SO (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 119 23RD ST Status: ISSUED Suite No Applied: 08/09/2000 Vicinity: RIGHT SIDE OF HOUSE Issued: 08/09/2000 Parcel Nunmber: 42605406 Applicant: CIRO ALBAMESE ISSUED BY: C) /// Address: 142 JERILEE LN Phone: (714)637-5728 AHANHEIM,CA Zip: 92807 Owner SPENCE, CHARLES Address 119 23RD ST Phone: COSTA MESA,CA Zip: 92626 0°♦ ' Contractor C A ELECTRIC Sj` 6 '`, � Address: 142 JERILEE LN • I ,J Phone: (714)637-5728 0 AHANHEIM,CA Zip: 92807 License: 557341 SCOPE OF PERMIT INSTALL TWO 100 AMP SERVICES AND ONE 100 AMP SUB-PANEL.SUBJECT TO FIELD INSPECTION. 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 $0.00 0 up to 50 kva/kw $0.00 0 Recept Outlets $0.00 0 up to 100 kva/kw $0.00 0 Switches $0.00 0 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 Wring System/Ckt $0.00 0 Service to 200a $61.00 2 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 1 hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $30.50 1 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $115.00 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No.92-28,§1,12-21-92) EXPIRATION: This permit shall automatically expire and become void it 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: 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. EI have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed it the permit is valued at one hundred dollars($100)or less.) O I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws• California,and:•ree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these..• isi•ns. / Applicant Signature: .a a a ! . a /-P._. /�Date: /�'6 C. 9 a --fiel-C-O 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 underprovisions 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.N_ S?.P 4 I Class* C I a Contractor's Signature: C Q -. Date: $� '1'aoaa CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: 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.). O I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors Licenso 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 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: 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). ❑ 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 ❑No (Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No f , (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? LJ Yes LJ No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑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 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. COirst.t aratur Of Legal Owner(s) Date And/Or uthorized Applicant Date CODE ti INSPECTION TYPE 12AIE INTRIALS CODE* INSPECTION TYPE PATE (NTRIALB 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 `oS p 4144 CITY OF COSTA MSA 4 :ah.C. 74 CALIFORNIA 92628-1200 P.O.BOX 1200 .e. ). : `mv. I` `go/_ i V d DEVELOPMENT SERVICES DEPARTMENT •,ry`OtRORP1Ee‘9�a April 17, 1998 To: Building Safety Division Media One Code Enforcement Newport-Mesa Unified School Dist. (2) Communications Pacific Bell County Clerk Police Dept. - Ping. & Research County Planning and Dev Services Sanitary District Engineer County Registrar of Voters Sanitation Division Office County Tax Assessor Southern California Edison Company Engineering Division (2) Southern California Gas Company Fire Admin. - Training Officer State Board of Equalization Fire Prevention U.S. Post Office-AIS Irvine Ranch Water District U.S. Post Office, Adams Avenue Mesa Consolidated Water District File (2) Recently, a permit was issued at the address listed below ("old address"). It was noted at the time that this property still uses "1 /2" for the second unit, which is an archaic numbering system in the City of Costa Mesa. The City's new computer program for building permits does not allow this form of addressing. Consequently, the address has been changed to the following, consistent with the current addressing system: OLD ADDRESS NEW ADDRESS A.P. NUMBER 119 & 1 19'/ 23rd Street 119 A & B 23'd Street 426-054-06 Your cooperation in this matter is appreciated. Sincerely, CAROL C. PROCTOR Associate Planner cc: Anthony J. Candelmo Occupant 119 23'd Street 119% 23'd Street Costa Mesa CA 92627 Costa Mesa CA 92627 77 FAIR DRIVE Building Division (714)754-5273 • Code Enforcement(714)754-5623 • Planning Division (714)754-5245 FAX(714)754-4856 • TDD(714)754-5244 ,OBJECT PROPERTY INFORMATIG..- 1) Property: 119 23RD ST, COSTA MESA CA 92627-1793 C007 4 APN: 426-054-06 Use: WAMERSIALsrfeerEP County: ORANGE, CA Tax Rate Area: 15044 Total Value: $165,000 Census: 632.01 Prop Tax: $2,092.02 Land Value: $155,000 Map Pg: 31-E1 Delinq Tax Yr: Impry Value: $10,000 New Pg: 889-B2 Exemptions: Assd Yr: 1997 Phone: % Improved: 6% Owner: CANDELMO ANTHONY J Mail: 119 23RD ST; COSTA MESA CA 92627-1793 SALES INFORMATION IMPROVEMENTS LAST SALE PRIOR SALE Bldg/Liv Area: 1,628 Transfer Date: 10/28/97 12/18/95 #Units: Sale Price/Type: $156,000 FULL #Bldgs: 2 Document#: 537364 563314 #Stories: 1 Document Type: GRANT DEED GRANT DEED $/SF: 1st TD/Type: $213,500 $155,900 VARIABLE Yrblt/Eff: 54 55 Finance: Total Rms: Junior TD's: Bedrms: Lender: HOMECOMINGS FIN'L Baths(F/H): NETWORK INC Seller: BAZILE JUNE E Fireplace: Pool: Title Company: FIRST AMERICAN TITLE INSURANCE C Bsmt Area: Transfer Info: Construct: SITE INFORMATION Flooring: Air Cond: Improve Type: Lot Size: 46 X 135 Heat Type: Zoning: g 2 - M 0 Lot Area: 6,216 Quality County Use: 185 Parking: Condition: Bldg Class: D Park Spaces: Style: Flood Panel: 06059C-0046E Site Influence: Other Rooms: Phys Chars: Legal: L39 TR114/SELY 46.02 FT Comments: SOLD 10/89 FOR$255,625 AS VACANT LAND Copyright© 1996-97 Experian Page: 1 of 1 04-,_,..„.4, CITY OF COSTA MESA C9 I Ark ^s' CALIFORNIA 8262&1200 P.O.BOX 1200' ''1 Nivy09 4 �' A "• :.. '. L` DEVELOPMENT SERVICES DEPARTMENT April 17, 1998 To: Building Safety Division Media One Code Enforcement Newport-Mesa Unified School Dist. (2) Communications Pacific Bell County Clerk Police Dept. - Ping. & Research County Planning and Dev Services Sanitary District Engineer County Registrar of Voters Sanitation Division Office County Tax Assessor Southern California Edison Company Engineering Division (2) Southern California Gas Company Fire Admin. - Training Officer State Board of Equalization Fire Prevention U.S. Post Office-AIS Irvine Ranch Water District U.S. Post Office, Adams Avenue Mesa Consolidated Water District File (2) Recently, a permit was issued at the address listed below ("old address"). It was noted at the time that this property still uses "1/2" for the second unit, which is an archaic numbering system in the City of Costa Mesa. The City's new computer program for building permits does not allow this form of addressing. Consequently, the address has been changed to the following, consistent with the current addressing system: OLD ADDRESS NEW ADDRESS A.P. NUMBER 119 & 119Y 23rd Street 119 A & B 23'd Street 426-054-06 Your cooperation in this matter is appreciated. Sincerely, CAROL C. PROCTOR Associate Planner cc: Anthony J. Candelmo Occupant 119 23rd Street 119'% 23rd Street Costa Mesa CA 92627 Costa Mesa CA 92627 77 FAIR DRIVE Building Division (714)754-5273 • Code Enforcement (714)754-5623 • Planning Division (714)754-5245 FAX(714)754-4856 • TDD(714)754-5244 Costa Mesa Building Department 24BUILDING APPLICATION FOR PERMIT 111 EAST 20th STREET . ' `.'� - - COSTA MESA, CALIFORNIA -- - - .- ' FOR OFFICE USE ONLY FOR APPLICANT TO FILL IN Receipt_No.. ermit,No. ••S Address//y4-//9 _et, _hSE's.T. i /3G Y `S�.v Costa Mesa, California R eiv l/b�y Date Recd. to IIs/sued) Nearest f� t,- . /2-3-4 —/4A-SJ.`� Cross St. .4/k -p0RT AV.D, Build"k i Addrp'ss i • Owner pzi r,.. ee:,,p vd/,e ' Costa Mesa, California I Mail ' Address no A,,,, r4f,,A 5.7: JAW. Nearest •1 : /+ .Tel. Cross St. CRYt CT,Q- 41eSA No. Zont ,./..) I No.of I Type / I Group�, Architect or Lic. Plans ✓ I Engineer No. Approved by Date Address ' CORRECTIONS '/ City Lic. itractorafP/X42. AWES No. Address 2.20 £ ..4Moc4 o05% C• 1U, ' -LeDescription I No. .lyyl ,p I Block I Tract/�i' (Attach Metes and Bounds) /)3_. 4151-- No.of Bldgs. I, ' Size of Lot frex 4.7e— I Now on Lot t%di - - -- - -- .-- 0 Use of I No.of I No.of .1°S a Existing Bldg. Families Rooms �/' Setback Line from Rear Yard -- - - - "' -4:--t__J)", - 2 Center of Street ,SQ Side Yard _ ,.�(.1 y DESCRIPTION OF WORK "-- 4 lr i 01/7/ N New I X AlterationI I Addition I // , * ,\ �� 1 Repair IMoving I I Demolish I ��F' K in /'l) Building 90 9 9 No.of v/tom .LC Size ?a6 0 Rooms . Stories / C0 � S<-7/0 --•terior Wall I Roof ::// e; tering rj'e Covering p f _.,e of News !® G� APPROVALS Building 2 p Foundation Location Inspector-( Date �1 F-�/n-4.-t Forms,Materials, �iJ .2oAr20 CabeACe f'pp" Under-Pinning Frame: Fire Stops, Bracing,Bolts I hereby acknowledge that I have read this Application Lath. Int. an&state that the above is correct and agree to comply Lath. Ext. with. all City Ordinances and State Laws regulating . building construction. Signature of /_A O/ � Plaster, Int. Permittee h ® /'O _ /� �t,L Plaster,Ext. Authorized Agt. /p�j�G�� Masonry Reinforced valuation Permit Fee $ V y 320 60 Plan Check $ f.— Bond Beam $/3 Total • Fee $ .57 FINAL Yore, 204 G14 1M 12-53 Y 1010.* C C - a J 20 a . . . - a , a • • . _- Street PLOT PLAN Show location and distances from • property line and between buildings. OWNER CORNAIR, Jack ✓ DATE 5-14-54 6 —St) JOB ADDRESS 9 & psi -ird St. BUILDING PERMIT NO, 242 GENERAL CONTRACTORftCardinal Hones VALUE $ 13,320.00 LOT APN 118-O44-19 BLOCK TRACT 2 Residences GROUP I TYPE �V_ ZONE C-2 FIRE DISTRICT #2147 - / PERMITS ISSUED INSPECTIONS .c.,.; DAT / SUBCONTRACTOR DATE NUMBER Footing Trench //1/1--4-4 �h/\(� .`. Foundation Forms and Grade>toto� Garage� r� /4.r.". lrryy/ Rough Framing" �`N /6 .i , Plumbing,Rough to Slab it . 1 bss-1 re-- CaRfb� 5 STV 2 6 b Plumbing, Rough Complete .5,vf-, • c r4/ / - -,- Temporary Pole �7 Wiring,Rough ZL� Ido L.,to-- O-Ce;/ lir 3 03 Heating,Rough I 1/0/S • r � Heating, Final /"6 :©j/ Sewer /O enLe aff Septic Tank or Cesspool Y i,„‘7,1'4 2/ ", r, ces£/6 /MAW /7 Lathing iN�L,_e_r-f 1 f 9 ' //7 2 ; Plastering laze-t..r,ti )�/�'i Ir -.Ze*) Go.try7ti-L��CnIt c 8/Q�� Il,t/YS Plumbing,Final,Fixtures Compl�eter/a/ g Ac' G /� _ Plumbing,Final Gas Test /(/la) /l1lJ t 44V adept. /"_r,._ St/3 -3-5c .-e-7e,-/C Wiring,Final 7,-4-1 4- LI J eat c O _� 8/ -J^ie >eL/S Occu ancy //-.S^C/ Form 210 GH 151 12-53 OWNER CORNAIR, Jack V DATE 5-11-74 1' JOB ADDRESS / / % 1 119- 23rd St. BUILDING PERMIT NO. 242 GENERAL CONTRACTOR Cardinal Homes VALUE $ 13,320.00 LOT AP# 118-0144-19 BLOCK TRACT Residence �In�� GROUP I TYPE V ZONE C-2 FIRE DISTRICT #2117 INSPECTIONS ' DATE SUBCONTRACTOR PERMITS ISSUED j DATE _ NUMBER Footing Trench //I t 5 5 .—.r Foundation Forms and Grade to Gara e , t All - Rough Framing i7ir.Li` ����1I77 - ' Plumbing,Rough to Slab /H 4 Plumbing,Rough Complete �� t+ Qr(�.e_ '-- - . 1O _ / V s 41 ,S 4 Temporary Pole J Wiring,Rough ��'G -aA Jro6e tt--,Aie / d7► Ar ,3o 3 Heating,Rough Heating, Flnal4pAkLei. tI .iy Sewer N 0 AI-e. Septic Tank or Cesspool 7Gc-1i_ LU d a..._ 7®.r Lathing52Le#ow•IsT/47�y ye Septic Plastering/spwr.._cog=)u", A _ .__ - � N a Plumbing,Final,Fixtures Complete al o its .s Se C Plumbing,Final Gas Test 1.3-14s. W-h % Crt ter .e , ,._ 8/ 1- -,((/ 7-1.1.--,J1hViring,Final, -4SAF L CO 1.9k a --•1.--..4-• 5'• 1 i-J }"4'-/tel Occupancy BGG eb I �� . Form 210 G-H 1M 12-68 COUNTY OF ORANGE 2 Sf 0 7 BUILDING DEPT. Permit No J 636 No.Broadway Santa Ana,California Application for Building Permit Phone:Kl 2-6211 AND FOR A Certificate of Use and Occupancy • /� ,Q Date.. T ii /1J7 1. OWNER'S NAME -OQ& O. Eirc��. TD_(.-(„tom PHONE• MAILING ADDRESS l./ C-- 23 Co A46-54 CITY r A� Name Name L.~/ute Pg/J e- C4'/✓�l7. co, (Architect or Engineer) � .4,} (Contractor), Address Address 0 p 2 r et/eOS 4.[ e- City City .�_(Jr 4 Alb e6 E r State State �L 3576f Lic. No {.Phone z '�" Lic. No Phone ........ PROPOSED USE:. s. — E7ter/or 0.57l40:ny 04 L ) 2. JOB LOCATION / ig C 3 e- Ca T 4 MEW W (House No.) (Name of Stree�)� (Town or School District) 3. LEGAL DESCRIPTION: Loti5,C.35 r 01Nw7sr'"Blo3c Tract //y (Metes and Bounds Description—Use reverse side of form) 4. CORNER LOT ( ) INTERIOR LOT ( X) THROUGH LOT ( ) y SLOPE OF LOT ( ) 5. SIZE OF BLDG.:.2L x 3_3 AREA- SIZE OF LOT- 3 rX AREA• I / / 6. HEIGHT OF BLDG - 1 CEILING HEIGHT- D NO. OF STORIES....L 7. NO. FAMILIES J Size of Smallest Bedroom- Size of Kitchen 3e S. EXTERIOR WALL CONSTRUCTION-----.!5..4.44 e T INTERIOR WALL COVERING €ttwAC L 1(q� (Frame, Stucco, Etc.) (Plaster-Drywall, Etc.) 3 9. SETBACKS: Front Yard From Center Line of Street Nearest Side Yard Rear Yard Distance in Feet Between Bldgs. on Same Lot 10. A COMPLETE PLOT PLAN IS REQUIRED, SHOWING ALL STRUCTURES AND USE OF EACH. 11. For (a) Footing: Width Depth in Ground Width of Wall Accessory Bldgs. and �� Similar (b) Size of Studs V y /Spacing i./ "CC Material of Floor Structures: (c) Size of Floor Joists- Spacing "CC // ' C (d) Size of Rafters- ' X 4 Spacing 2 1 12. VALUATION OF PROPOSED WORK: Including all labor, plumbing, electrical wiring, heating, fire sprinklers, painting and sewage disposal $ 6-810 . 13. I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION IN THIS APPLICATION IS CORRECT AND THAT THE CONSTRUCTION WORK WILL CONFORM TO ALL LAWS OF THE COUNTY OF ORANGE AND THE STATE OF CALIFORNIA APPLICABLE✓ THERETO.H //� Signed- V1tLi rl ad .4 Plans Filed B 9.4.... Qicion„v` yt+)er) (Authorized Agent) FOR DEPARTMENTAL USE ONLY FEES: CH CKING BY Bldg. Permit - $ S '01) GROUP APPLICATIOefrfea HEALTH Plan Check - $ .1 o'Qet, TYPE V ZONING �i___-. FIRE Total - - - $ 4.-a� DIST. MARSHAL Receipt No. - • - PLANS AND P �� MAP ^ S SPEC'S STATE Paid to SHEET NO CORRECTIONS ENGINEER n Date — !F ;n VERIFIED CAL PERMIT IS VEm4.Y©. ' UrAEPUTY : COTYBUDATE 9- g' '� . -5M2-G1