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Home My WebLink About151 19TH ST - Building Permits4Q aCITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT B98-00919 PERMIT PERMIT NUMBER (714) 754-5273 • Fax (714) 754-4856 BUILDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 151 19TH ST Status: ISSUED V�j� nn Suite: Applied: 05/28/199T"V -Vicinity: REAR SIDE YARD Issued: 05128/1998 Parcel Nunmber: 42523417 Zoning: Applicant: KRUIDHOF, RON Address: Phone: Zip: Owner: BUTCHER, JEFFREY EWART Address 159 E 19TH ST, - - ' Phone: ' COSTA"MESA,CA Zip: _ 92627 Contractor: A B COSNTRUCTION_. - - N_� Address: 2809 FLANGEL ST ' Phone: 562 421-6790 \\ LAKEWOOD, CA Zip: 90712 - License: 683522 Arch./ Eng - Address: - l Phone: - Zip: , - License: -- - SCOPE OF PERMIT 'DEMO EXISTING SHED IN THE REAR SIDE YARD, AOMD FORM ATTACHED TO PERMIT, NO ASBESTOS. FEE SUMMARY Plan Check: $0.00 _ Jl.... Calc Valuation: $1,600.00 Permit: — $51.25 ' ; - Claimed Valuation: si oo.00 Other: _ $0.00 ; Inspection: $0.00 Total: $51.75 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 ,, - Left. 0-'0 - -Right 0. 0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 " PARKING Existing: 0 Required: 0 Proposed: 0 NOTES c 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 WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 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: Center: Policy Number: (This section need not be completed If the permit is valued atone hundred dollars ($100) orless.) ❑ 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 C91119mia, and agthat if I should become subject to the workers' compensation provisions of Section 3700 o1 the Labor Code, I shall forthwith comply with these pro io s. (/ // /] Applicant Signature: O "t Date: WARNING: FAILURE SECURE WORKERS' COMPENSATION o6VERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER RIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOU ARE ($10 LODo). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Lic. N Class 1l Contractor's Signal re 1L 71 Date: n _ CONSTRUCTION LENDING AGENCY: ❑ 1 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). Landers Name: Lenders Address: Signature: Dale: 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 cry or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such Improvements are not intended or offered for sale. If, however, the building or Improvement is sold within one year of completion, the owner-builder will have the burden of proving that he or she did not build or Improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a conlractor(S) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or dead): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 hereby certity that no excavation five (5) or more feat 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 e permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .................................................................................................................................................................................................................................................................................... 2 Does or will the applicant or present or future building ocapant neetl to fie a registration forth for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fre 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 o1 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). .................................................................................................................................................................................................................................................................................... 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. .................................................................................................................................................................................................................................................................................... 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No .................................................................................................................................................................................................................................................................................... 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plicatlon 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 I] No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building pernits). ........................................................................................t'h'i....................................................................................................................................................................................... fi Will any part of the feclliry to be censtructetl 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 Califomia Health and Safety Cade). .................................................................................................................................................................................................................................................................................... 7 If a permit tram the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ retrad ❑ No .................................................................................................................................................................................................................................................................................... 8 (If yes", emech cenificate 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. ature Of Legal Owner(s) . /y Q ate .Yo Jr:' � ! — l nd/OrAt forized Applicant Date COL-L INSPECTIONTYPE DATE 9RIDAu8 CODES INSPECTION TYPE 12M INTRIALS 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 244646 - CITY OF COSTA MESA BUILDING DIVISION � DEVELOPMENT SERVICES DEPARTMENT 898-00920 �• PERMIT PERMIT NUMBER (714) 754-5273 • Fax (714) 754-4856 BUILDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 151 19TH ST Suite: Vicinity: Parcel Nunmber: 42523417 Applicant: KRUIDHOF, RON Address: Owner STEINER, MICHAEL -A TR Address 1560 SUPERIOR #A-2 COSTAMESA,CA Contractor: A B COSNTRUCTION- Address: 2809 FLANGEL ST, - Zoning: Phone: Zip: Phone: Zip: 92627 - Status: ISSUED n' Applied: 05/2811998 Issued: 05/28/1998 Phone: 562 421-6790 LAKEWOOD, CA Zip: 90712 License: 683522 - Arch / Eng Address: - Phone: Zip: License: - SCOPE OF PERMIT T/O EXISTING 8. REROOF WITH COMP. SHINGLE TO MATCH EXISTING ROOFINF, (9 SO ONLY) FEE SUMMARY , Plan Check: $0.00 Calc Valuation: $900.00 Permit: $32.00 — Claimed Valuation: s9oo.00 Other: $0.00 ' Inspection: $0.00 Total: $32.50 SETBACK$ MAIN STRUCTURE Front 0.0 Rear 0-0 ACCESSORY Front 0-0 Rear 0-'0 PARKING Existing: 0 Required: 0 NOTES: PLANNING & ZONING Left 0-0 Right 0-01 Left 0-0 Right 0-0 Proposed: 0 EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 160 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) 7545626 DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain workers' compensation insurance, as required by section 3700 Of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy number are: Carrier: Policy Number. (This section need not be completed /t the permit is valued et we hundred dollars ($100) oriew.) ❑ 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_Qql1forma, and agree that U I should become subject to the workers' compensation provisions of Section 3700 of the Labor Coda, I shall forthwith complywith Nese J/ pr �' L, A Applicant Signature: I Date: WARNING: FAILURE E ( SECURE WARNERS' CO T E CO COVERAGE IS ON. DAMAGES AND SHALL PROVIDED FOR I N EMPLOYER 6O CRIMINAL PENALTIES ANp EST, AND A UPN ONE HUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, pAMAGES AS PROVIDED FOR IN SECTION 37090E THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby offimn that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of DlNslon 3 of the Business and Professions Code, and my license is In full force and effect. Lia K Class 0 Contractor's Signature: Date}6 -.-1- 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 dry 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 Cade) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure Is not Intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or Improves thereon, and who does such work himself or herself or through his or her own employees, provided that such Improvements are not Intended or offered for sale. If, however, the building or Improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Cafe: The contractors L)oens , 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.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivels license. ❑ Yes ❑ No Driver's Lori No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 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, fatsework, or demolNon or dismantling thereof, will be more than thirty-six (38) lees high. (Chap. 3.2, Grp 2, Art 2, Sac. 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 divislon. Signature: Date: Division of Industrial Safety Permit Number. HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 WIII the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, Or 200 cubic feet of compressed gas at standard temperature and pressure). ....................................................................................................................................................................................................................... ....................................................... 2 Does or will the epplkant or present or hrure bulltlinp xcupent need to file a reglstrsUon forth for acutely hazardous matedals7 ❑Yes ❑ No (Section 25533 of the California Health and Safety Code- with some exceptions, requires registration with the Costa Mass 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 o1 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 01 the California Health and Safety Code provides that the Costs 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..- It an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No .................................................................................................................................................................................................................................................................................... 5 Daes or will the applicant or present or future building occupant require for the work which is the subject of this application aenmit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? M Yes 8 No (Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). .............................................................................................................................................................................................................................................................................. 8 Will any per of the fadliry to be constructed under this permit be Within 7000 feet from the outer boundades of a school? ❑ Yes ❑ No (If yes', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). .................................................................................................................................................................................................................................................................................... 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑ No .................................................................................................................................................................................................................................................................................... 8 (II yes", attach ceniiicate of compllence from the eppropdete air pollutlon control officer). CERTIFICATE OF COMPLIANCE: I verity that under penalty of perjury the information given above Is correct. I agree to comply with all state laws and dry ordinances regarding Hazardous Materials and Emi21cris. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I tertity 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 dry ordinances relating to building construction, and authorize representatives of the City of Costa Mess to enter upon the above-descdbed property for Inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final Inspection. (jl Sig re Of L gal Owner(s) ^ r Tte( If 11 And/Or Auth 'zed Applicant T L Q Date CODE 1. INSPECTION TYPE pA¢ MMA CODE INSPECTION TYPE gAff ILRITIAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 206 Final Plumbing 200 Final Re -Roof r 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 Builtling/Occupancy 2"646 J COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 317 COSTA MESA. CALIFORNIA fOR APPL/CANT TO f/Ll /N COMPLETELY TYPE OR PRINT BUILDING ADDRESS COSTA MESA, CALIFORNIA EE RECEIVED n PIA N!` nGAT APPLICATIONEFOR PERMIT CIT'gu1LiNGMESA FOR Off/CE USE ONLY ` I RECEIPT NO. I PERMLT NO._ 9/•E/\H �% OWNER (.' (7/�(Jl )(�) /� iii CA MAILGI _ S' RECEIVED BY DATE RECEIVED I DATE ISSUED ADDRESS � S^/ — BUILDING i _ Q f- W -(v4) J / QQ TEL. CITY c%700. / r'oc. NO. ADDRESS ARCHITECT LIC. COSTA MESA, CALIFORNIA OR (NEER NO. FIRE ADDRESS ZONE TYPE OU - STATE & APPROVED CONTRACTOR LIC. NO. BY a DATE ZONING ADDRESS LEGAL LO3 I I I 20I I OFN DESCRIPTION NOT BLOCK C TRACT -SL/ PLANS I�I BUEILD NGEW A.P. NO. )-q- I ABYPROVED /1 , DATE V G �6 SIZE �T NO. OF BLDcs. (Now YARDS 'P / S OF LOT V oN Loi REQUIRED ALLOWED USE OF (CENTER LINE BT.) EXISTING BLDG. - FRONT FT. IN. SETBACK LINE FROM 6 CENTER OF STREET REAR YARD IIY R. SIDE ® FT. IN. / SIDE YARD (LEFT (RIGHT v L. SIDE FT. IN. DESCRIP ION OF WORK ' REAR FT. (. IN. NEI' I II ALTERATION I � �( \ II ADDITION I 171 II REPAIR' MOVING DEMOLISH C BUILDING NO. OF V SIZE G> ROOMS STORIES i EXTERIOR WALL ROOF 12 COVERING J COVERING U E OF BUILDING AN TO BE PERFORMED FORK %1 L v I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PLY WITH ALL CITY ORD( N BT TE LAWS REGULATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. YD BUILDING CONSTRUCTIO / VALUATION / q SIGNATURE OF ' / PER ITU E - <� PERMIT FEE $ $ 4 • N PLACHECK $ AUTHORIZED AGENT C ✓✓�" 11111 TOTAL FEE 5