Loading...
HomeMy WebLinkAbout2063 HARBOR BLVD - Building Permits -OWNER HANLON - OCT 2 8 1958 DATE 7_23_58 _ JOB ADDRESS 2063 Harbor BUILDING PERMIT NO. 7206 GENERAL CONTRACTOR Owner VALUE $ 50.00 32 LOT TRACT FIRE ZONE DESCRIPTION OF WORK Sign __GROUP TYPE ZONE C2 PLAN NO. PERMITS ISSUED PECTIONS DATE SUBCONTRACTOR DATE _ NUMBER Trenches Forms Steel Floor System Steel Reinforce Chimney Re-Rod / Bond Beam • 1 • Id Frame and Flashing 1/4,2 Lathing, In Out �!, / Plaster, brown coat t '/ L(� • S "Y" Underground soil W/G Pipe Test I ,I!,M of / i 1, ,4 Top Out / lit' i�` _- A. / to Furnace `,(/t/ ,J (�)i 1/I (\' Gas Vents //��' t/ / A /J (I sr , Rough Plumbing Ip' Y /Vs y II[ A/`� N�.' _ Cesspool Septic Tank (1 `' VV /D' 0 Prop. Swr. Line House Con. St. Swr. / I ` J t✓� ; 1 Sprinkling System ,e / re' Lf' Heating Final /I/l /�/ !If' n�y Ph tmbing Fixtures, Final J 1 / a f/1/ J /// \/ t_) d Gas Test / /1,f'/ /f' ,/ onstruction Pole /- /J/ (/ ,. /- Underground Power / / V �.•/ ft///t' Rough Wiring -./1 1-',% , r .I.4-`{ j ' a - Fixtures, Final ''.2 i / '-OCCUPANCY 1 f t ` ' Form 210-5M-1-57 7 7/1/. OWNER HANLON, H. H. AUG a 17QU DATE 5-21i-60 JOB ADDRESS 2063 Harbor Blvd. BUILDING PERMIT NO. 12131 GENERAL CONTRACTOR Owner/Bldr, VALUE S 101.00 • AR No. 115-291–W4 LOT TRACT _ FIRE ZONE DESCRIPTION OF WORK Demolish Res. INSPECTIONS DATE I GROUP TYPE ZONE C-2 U derground Soil U.G. Water PERMITS ISSUED l ':rground Gas — — SUBCONTRACTOR DATE NUMBER G' =head Water and Gas Rough Heating Rough Plumbing (y'«._,«� ✓'-Y�–Go y,('yo,r. Miscellaneous Prop. Swr. Line House Con. St. Swr. Sprinkling System Heating, Final Plumbing Fixtures Final Gas Test Construction Pole Underground Power Rough Wiring re - Trenches Forms Steel Floor System Steel Reinforce Chimney Re-Rod _ Bond Beam Sheathing Frame and Flashing I-"ling, In Out .er, brown coat numbing Fixtures, Final Electric Fixtures, Final A ' Building, Final Q_ 9 . .�/ i60 OCCUPANCY Form 210-5M-11-59 S-B P 12131, 4 lF CITY OF COSTA MESA ►9 BUILDING DIVISION F • _iir `t. ipka . DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER PERMIT ... ,• P01-00190 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 2063 HARBOR BL Status: ISSUED Suite No Applied: 04/09/2001 Issued: 04/09/2001 Vicinity: EL CHINACO RESTAURANT Parcel Nunmber: 42209113 - _-- 2c>,_�i�,-y,__ Yl.�` ISSUED BY: 1_ _ Applicant: DECKER, ROBERT!-)c_ �V ( ' I -Th -----.,..s?:- �_ � �� LI �, Address: 3152 REDHILI.'AVE �� I S (., i ) -',A.-: SUITE-230 jam- �� )�� Phone:_`.(714)427 7100 / �1/ ��w� COSTA(MESA;CA - -- Zip: 92626, �- ( - ' / �� vA , ,,_,Ac.:\ Ovmer�CON.BAY',ENTERPRISES - ��,A���� '�/ /1es v' //./22,--//- .'v� Address 3152 REDHILL AVE '���� ��:I�; // SUITE 230 Phone: (714)427-1100 \ \�4� V \ //vv 1 r COSTA ESA,CA Zip: -�,92626 \ \\ �.� 07 ifea. Contra actor /OWNER-BUILDER ((�� I)/ ( J / //q--7( < V/'v" `_ '{ _ .=- - -� I \ lire/ Address y ,,�� ,I I� ; I7/ r 1,[ ��'- - Phone: �.... �► 7 . ',', l h� /71 ' f - ,, h iil V/1 ')�� �-_ -/ ILO---/ Cr 'n''7P 4 77_7 .7)19" /1"' /, 70)ITP 6, i -(Ir� _ I v� Arch / Eng:I, tiJl L }1 tU%11 .fi IS ii-1 1:h._111` 11 '"i {SII/', : / II AJr tAddress 1 O I - -- -=-- - - -- - .�� _- 1 ,il�! ( ,, \V) ,i )�h�-�� ,Phone --ti �'ti7�/-/�li>7� �((�� Oit' U ,�{) • t F _-._.__1 '�Zip:Q2) ^ i J c_' %a_ ,../iJ( '� t`\ License:' l/f- / ( \%\ ��V", ( SCOPE OF PESTAU A'%. �� SEWER CAP FOR DEMOLITION OF"EL CHINACO RESTAURANT". REF:NMI-00469 f„ v",- �,L�o` 1 �;"� O �, ' , 3 ;, x: X ,iii �1,1.�=w���FF,�, �', r CFEE SUMMARY, 'i a =vc>,1,'.�; .'� 1� �I \\'-'1A AMT\QTY. � '4c: GII � O�O'r%_1�o0 °AMT Qn ' .. i"• O AMT QTY ISSUE FEE i$23:50� ��Leundry'Tub/;Weshe[o o $0.000' ;0��, „�"' Sump �� $0.00 0 Backflow irrigation $0:007///���0 Landscape Irrigation 0, $0.00 0 Swlmmmg,Pool $0.00 0 Backflow Preventer $0.00 // 0`P:Tie`p=\� °-0J 0 �� -$0.00- 0 (Trap Primer 7 $0.00 0 Bathtub - $0.00 0 Pressure:Re ulator � �' ' U g $0:00.7-0 Uimal $0.00 0 Clarifier System $0.00 0 O Process Piping.(per10 ft)-"$0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00-0 Receptors_--,I �n-.1$0.00.20 1\\ Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00\0� Septic-Tank I ; EJ l L f `$0.00 GO U) Wash'Basin $0.00 0 Dishwasher $0.00 O'�1Sewer Cap.forDemo �J$• 9.80),_--1 Wash-Basin Set $0.00 0 Drain, Floor $0.00 0. -=.-`Sewer Connect I') �-'�'$0:00 0--�/t ,.7-Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 \Sewer.Piivate:Line--- - - $0:00j%0� Water Closet(Toilet) $0.00 0 Drain, Roof $0.00 0 Shower - `J- , $0.00�Q Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 Sink, bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $0.00 0 Sink,kitchen $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 ' Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease, Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $33.30 LUMMCN I b I ,YtUTAL I.UNUI I IUNJ 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: r I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. ❑ I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed/f the permit is valued at one hundred dollars($100)or lass.) ❑ 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 DONNE($100,000),IN ADDMON 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.Uc.# Class N Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she Is exempt therefrom end the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is old within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). per-as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions - Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ti ❑ I am exempt�u,'�f r�s$�:� Business and Professions Code for this reason: 'Signature: - r(, f.4 t.- (Date:_ b 9'-9 0/ 'OwdeillD verfied`!%y drivelslicensa.r%: ,Yes 0 No (Driver's License No. 'Ex_pires: �ne 2— Verification of Ownership by(type of document,1.0:-.property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation flue(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire.Department. 4 If an RMPP Is presently required,has Section 25534 of the California Health 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_aPermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No (Section 85850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). _ _ t..fr..._...._ 6 Will Emirpart of the facility Lo be constructed under this permit be_within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If ryes',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 (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. Ignature 01 Legal Owner(s) Date-- � 1/-9 Date . And/Or Authorized Applicant Date CODE I INSPECTION TYPE DAIS' gnLS CODE! JBEPECT10N TYPE PAIL BOW 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 MF r. CITY OF COSTA MESA 4 . s BUILDING DIVISION >:� DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER �. no PERMIT �- #4. B01-00469 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 2063 HARBOR BL Status: ISSUED Suite: Applied: 04/09/2001 Vicinity: EL CHINACO RESTAURANT Issued: 04/09/2001 Parcel Number 42209113 Zoning: • Applicant: DECKER, ROBERT _ ___ _ ISSUED BY: Address: 3152 REDHILL AVE / ic. --- i.r� �jUi-_._- --� -1100 mac= -�, SUITE 230 %,-----;----\ -Phone: (714)427-1100 "�"�" . COSTA MESA,-CA----<) � \• I Zip: 92626 / I / /'-�` '1 . -7,5(.71.------ v "V :7;='-: N Owner: BEACON BAY ENTERPRISES - - - & / '*\,--\ Address 31521REDHILL AVE\,,,_____ _________/ - - 'T /iSUITE 230,r. \�� Phone: (714)427-1 00 � ��; �� `. �<,\ rJ ig .1 i / OWN �4Zip: 92626 ��'"G /� i/ s Contractor: OWNER-BUILDER �`A� ✓1 /Address:// c\�//�� �� ::///,, Phone: : `,'\\ /,r1( Zi i // :License: 0LI, D C� f r Arch /�/ /� r n �-n1 _ BEng:: �i 1 \�r�\ �� Address: 1/ d__-,- -0, -,- Address:o 1� 1 �`l —_� /,/(1 .,/-1/ 1 1 '^(1 r) _'L t/� �. / one l i l I t r `,Phone:` �� �./ phone:' __i �, ) 1 ( I m� �Lioense. V t AZip:_ ° z� p\ Lioerise:' ` . . I \ I � �: -2 . � 0/1t ---- ----- - --- -- - - - -- A (i,i � i- 1 ,LI r SCOPE OFTERMIT— n ;:--;0 ' 1 1; EXISTING SF l'-EL1C INAC /E c� j`+- . , C—' ;_-J I I I �V DEMO BUILDING FOR�EL/CHINACO RESTAURANT-'s i'r �- _!1\ /t _ _ /I'. ; t, 11•� f l / i ll 1 I Iur� I � ___ - / / %� Ir � � `I 1Q1, I rii �� y FEE SUMMARY�/�� �2- 1 ID 1 �PIdn1Check \rir`,,,: t6� $29.15 -�— !�A ` /`4 7; ) _Calc Valuation I' S1 750.00 \ 'Permit. 1 1L' � _ Claim Valuation: 1/ '> $1,150.00 V' $44.85 1 ..,-.- �_S� /� �_ _ / \SMTP Re's: A;� $0.00 il / `1SMIP Com: \\$0.00 i --,a,_. ,p Xi' \\ \ Other:\ x$0.00 I " tS Ipection' $0.00O ComA ,. ���p '%--, 'L5 00 0 ,, ��^i �J '2"cV-,.�---:ri��_, �� V N'\ o Llo-- ° PLANNING'S ZONING 0 �0C/ uSETBACK \\ 4).7 � °C G 0 ^^ ° _ O MAIN STRUCTURCF 0-0 Rear----0-.0 -.4911.--. 0:70=,r - Right 0-102 y ACCESSORY Front 0 Rear//�0 Left _0 Righ,70-0 c" PARKING Existing:--,b--*----,----.., 0�� ('--Ti 1 P or posed © ___1-&('//� 7 �..;\ �- tf -n u Q . • NOTES: CG5rj0�J p ,-/J�., 1-1 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 24464616/00) WORKERS'COMPENSATION DECLARATION: t I hereby affirm,under penalty of perjury one of the following declarations: y'y 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. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) O I certify that in the performance of the work for which this permit is issued,I shall not employ any person In any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOL4ARE($100,000),IN ADDr10N 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.Uc.H Class H Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec,3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm 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 Cede)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 Ucense 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.). 1,es owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044.Business and Professions ' Code:The contractors Ucense 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 Ucense Laws.). ❑ I am exempt und: c. Business and Professions Code for this reason: Y-9 /� rSlgnatr --' • I - (Date:--' 7/9--,U/ 'Owner ID verified by drivers license. ❑yes ❑No Driver&Uce�nse No_ - ( Expire"s: f102-- 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,Op 2,Art 2,Sec. 341,Title 8,Califomla 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: I 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 Califomla 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 Califomla 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). .._ _ —_.an —___.._____ _...._ �. _ ...._ _.. ...._ 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 _ —_..._t._.... .. ....__._ ._._ _... 5 Dais he will the tcAor present a future buildingsoccupant requirer for the work which the subject This application appermit for such construction or motlificailon from the South Coast Air(Duality Management District or from any other air pollution control district or agency? IJP Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ____......_.._st Ai__.._.._._ _._— ___ _. _ _ _ _..__ 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 Califomla 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 at state laws and city ordinances regarding Hazardous Materials and Emissions, Signature: Date: CERTIFICATE OF COMPLIANCE AND AL'THORIZATION.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. 7,4_,,, Sign ure&legaLOwner(s) - • 9111 2 And/Or Authorized Applicant Date gODE• INSPECTION TYPE MI' PALS NOEL INSPECTION TYPE PATE EMU 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 ruOit-------- • 12131 �, 'RGEINI k CC#TA MESA BUILDING-SAFETY DEPARTMENT 9 1-e° P. O. BOX 917 COSTA MESA. CALIFORNIA +- NCE °EP • 1rfNN a R1E`.1 For Applicant to FBI In Completely APPLICATION TOR,PERMIT TYPE ,NT BUILDING BUILDING/4, (3494,' 4 . COSTAE 'LIF. - IA/ For Office Use Only RECEIPT NO. PERMIT,. NO.4 OWNER �' / _�_ II .DLM1!JLl}IL MAILr / .. / "......"71,74.75. _-Y f1 DATE RECEIVE O TH ISSUED ADDRESS / ^ire`s lei I �'Y d I V �' �' C J // 0.4/417e, CITY NE< / UILDING 0OV `3 �� AF ECT TEL. COSTA MESA. CALIFORNIA J J OR 4INEER NO. ADDRESS FIRE Q/�, ZONE q rI PE GROUP CONTRACTOR , ��1 t gyPROVE /I//v�yy, DATE...r- Y�""�J CI, / J ✓per r'(4/J-S r Nii//lA�lgn' / ADDRESS /' \ t ZO ING / 1 ,. ZON . I NO.OF I USE OF NEW {I�I� CITY \/ PLANS u BUILDING STATE TEL. L _ pox Vf SIZELIC.NO. NO. I NNOW OoN LDQS A.eGAL P.NO. ,,.s- y, y5/ OF LOT /� USE OF YARDS ���llll'"' EVES .. / EXISTING BLDG _ APPROVED ALLOWED SETBACK LINE FROM (CENTER LINE ST.) CENTER OF STREET REAR YARD FRONT FT. IN. SIDE YARD I LEFT I RIGHT R.SIDEFT. IN. DESCRIPTION OF WORK L.SIDE FT. IN. NL I °ALTERATIONI II ADDITION I REAR e- FT. IN. REPAIR I II MOVING °DEMOLISH BYFROVED `- (- --/t)) DATE 5-"d_.y • / BUILDING NO. OF w SIZE ROOMS STORIES EXTERIOR WALL 1 ROOF • COVERING COVERING USE OF BU NG AND WORK TO BE PERFORMED I HEREBY ACKNO ! THAT HA READ IS A-' CATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATS THAT THIN-• . +S . •y��.YY= 0 AG: 0 COM. PURPOSE OF ESTABLISHING A PERMIT PEE ONLY. PLY WITH ALL CITY D • j •' :PJ E LA OULATING BUILDING CONSTRU I VALUATION 2 SIGNATURE OF • / /L� 0 C PERMIT FEE $ PERMITTEE 4 $ /o / PLAN CHECK $ AUTHORIZED AGENT S TOTAL FEE 2• 7¢ . 1 ' A '2WOw Z .� T .. Eau • V — K _ WEt . •j os � g q �w 9 �-: � g : U Pr4!H � 1 r a• Y — � a O pW,LLJ O 1 Z JO 122-J .' .., r. CI — ¢ :� ou+ a _ .I f - a-- a V ' ,''- -.,J ( .. 1 ,Li w`-z -_ I� W 1 O • O y P: E.i5 gj W O 1 0 6 cT, ' -c. Cr.;,' ' '-' 1_'tCI) c i- o m u. r�, •`'� N7: i 1,,, '" u i. : Fi tt -, r- I Ef.z Ir I gyp G. I n i :c i ,c a u a�. g >0 1 '_la -� _ I l'1 ' I � 1-- '_� O _ 4 W U G DIIg U =• U _d V 4 CC '<.--;-: cc U I - Cl CJ-c p r, s .Li I :_. 11 , I Yari� w , CL u/, ZS vv",ate dflh_- crIx ` 4.EZ N: n- W t�f. -C 1 y 2 Z _--� � - W W - S'_Q O�S Y ^ c,q JU ' ce - cn \\\\_ill \� -� LL QJ `$' 1-y : 4".W."" ..‘ii._,_. 7.... ____._ . I -- -- – ---- -- — v 60 .I o- - . r 1 , eFe rtt-JJ-- _____- _ ------ -- - -- --- hs1 llAR12)0k hL vi") - - -- - opo } - -- s e, 4. c.,-/z.,/,_nta___P-6. . 0 iiit.- . 0 es 1 4- C'�Y ?k® YL' P — — - - — ------ -- -- --- — -- — --- - - CITY OF COSTA MESA - — — - - -- - -- _ - PLANNING._DEPT. SUBJECT TO BLDG. DEPT. REG. ny(1/r/TP DATF /// k5 - - - BY TOR OP PLANNING