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HomeMy WebLinkAbout234 19TH ST - Building Permits f1 I I- L!4'>' CITY OF COSTA MESA - .- j :„,,7:./ ►' BUILDING DIVISION � i� DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER i PERMIT• B06-01941 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa•mesaAB.IWLDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 234 E 19TH ST ,Status: ISSUED Suite: Applied: 11/17/2006 Vicinity: Issued: 11/17/2006 Primary Occ: R-3 Dwellings/Gong Res<10 Type of Construction: V-N Parcel Number 42627116 Zoning: Applicant: MILLER, MATT Address: 905 S CALICO CI Phone: 714-226-0747 ISSUED BY: ANAHEIM,CA - - Zip: 92804 Owner VOSSELLER, WILLIAM C JR Address 234 E 19TH ST Phone ,�, COSTA MESA,CA - - Zip 92627 e/ - Contractor < ALL-PROvROOFING,. ' - , i N Address: 905 S CALICO Cr Phone: 714-22 1 747'-.. .� ANAHEIM,CA '�` - N • Zip: 92804 ' ' License: 768511 - ' Arch : ' ' Eng: Address: _ Address: , Phone: • t - ' Phone: • Zip: License: - - . . License: ' SCOPE OF PERMIT • TEAR OFF EXISTING ROOF 2 LAYERS OF FELT COVER WITH 30 YR COMP SHINGLES.PLYWOOD SHEATHING EXISTING. FEE SUMMARY Plan Check: , $0.00i � - - r,-Calc Valuation: _ $4,543.00 Permit $111.25 . � tet.. . 'S'Claim Valuation: ' , $4,543.00 ' 'SMIP Res: $0.50 - SMIP Com: $0.00 Other $0.00 Inspection: $0.00 ,.- - - Total:v $111.75 �� PLANNING &ZONING SETBACKS - MAIN STRUCTURE Front ' 0-0 - Rear, - -0 , Left 0= 0 0,,- Right 0-0'/ ' ACCESSORY - Front 0=0 i, '.‘, :''1 'Rear . 0-0• • = Lek 0-0 r .Right . :6-'26 PARKING Existing: 0' ' -Re wired: 0, Proposed:, 0 i! /. - _ . = • • • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 244646(Bee) • WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: 0 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. Nat 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 worms co pensatigO lnsurange carrier and policy number are: / --Oar �/�� Carrier: -`�I/-ter''` (IIC(/ \? Policy Number: //Y••' x r—S / (This section need not be completed ll the permit is valued at one hundred dollars($100)or less.) • ❑ I certify that in the performance of the work for which this permit is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provision of Section 3700 of the Labor Code,I shall forthwith comply with these provlsi ////,�}}}���'� /I/',/ ( Applicant Signature: I•^r A Date: ) 7d WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO I INAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN ADDITION TO THE COST OF.COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under 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.tic.# bO S 'f Class a l 1 Contractor's Signature: vv Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044.Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 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? ❑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 ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this,appplication a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? (J Yes 0 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (II'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 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of L Owner( I y- I/'� A _'t 7I nfE tthoz J —V CODE I INSPECTION TYPE 1 MUOrY.Tr PAIL MAU CODE f INSPECTION TYPE PAIS ffiIBALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing - • 200 Final Re-Roof $$Zf llIO4 I7 � 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 ,501 . CITY OF COSTA MESA • 4 BUILDING DIVISION >4.a1'1P111.Plt i• •-i DEVELOPMENT SERVICES DEPARTMENT PERMIT UMBER ti/jt PERMIT ilt Sb •LL. B 00653 oer� (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 234 E 19TH ST Status: ISSUED Suite: Applied: 04/01/2004 Vicinity: Issued: 04/27/2004 Parcel Number: 42627116 Zoning: Applicant VOSSELLER, CINDY ISSUED BY: I Address: 2344 E E 19TH19TH STST A-B Phone: 949-433-1658 COSTA MESA;CA Zip: 92627 - Owner: VOSSELLER, WILLIAM C JR' Address 234 E 19TH ST - , • A-a - = Phone: _ COSTA MESA,CA,, - - Zip: 92627 , Contractor: - Address: . . - Phone: Zip: ' License: Arch : Eng: - - Address: Address: Phone: - - Phone: Zip: License: License: - t SCOPE OF PERMIT CONSTRUCT 264 SF CARPORT AND 81 SF STORAGE AREA ATTACHED TO THE REAR OF THE CARPORT.ALSO INCLUDES REROOF OF(E) SFR WITH CLASS A ASPHALT SHINGLES;INSTALLATION OF(N)FAU;AND REROUTING GAS AND WATER LINES TO REAR UNIT. • FEE SUMMARY - Plan Check: $136.01 ' _ _ Calc Valuation: $11350.70 Permit: $209.25 -, Claim Valuation: $0.00 SMIP Res: $1.13 SMIP Corn: $0.00 • Other: ' $0.00 Inspection: $0.00 . 4>innt` - Total: $346.39 PLANNING &ZONING SETBACKS ', • � MAIN STRUCTURE Front 24-4 - Rear 76=-2- Left 5-0 ,--- Right 0-0 , _ ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing:' 0 Required: 0 Proposed: 0 • NOTICE: The Work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or If work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(&00) . DECLARATIONS . WORKERS'COMPENSATION DECLARATION: .. ' I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate o1 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,3780 of thq Labor Code,for the performance of the work for which this pBnhit Is issued. My workers'compensatlo Ins ante carrier1. number are: Carrier: `` � Policy Number: (This section need not bepleted if if th�alued at one hundred dollars($100)or less.) • - • I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation la alifomla,and agree t t if I should become subject to the workers'compensation provisions of Section 700 of th Labor C e,I shall forthwith comply with th a pro cions. Li Applicant Signature: - / O Date: 2;-1 WARNING:FAILURE TO SECURE W•-„gt S'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND QVIL RN UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN Ar ON 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# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of 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 WO Id 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.). as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sac.7044,Business and Professions ode:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such p ject with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am xem t under ec. "" �- �' //�� Business and Professions Code for this reason: t4 2-7 0",/ Owneture�i�rc �. 1l Date: (� I J Owner ID verified by driv license. es 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 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,end 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 ❑tt (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 ._ DO ...._ ._ require for —. subject ub . _._ _.. 5 Does or So the CoasttcAir ou present a emen building occupant at for the work which districtIs the or of this a Yesestion e0p Nnii for such construction or modification from the South Air Quality Management District or from any other air pollution control or agency? � LJ No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 8 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes Li No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is Cort gree to comply with all stateiolaws and city agree ordinances relatingcupy to l wldcg construction, any and ho b e iterrnitun?97Pection. et thery u to Mesa to enter upon the for/�'ha�Ion purposes.Iagree not to arupy or allow occupancy of any building authorized byt 'Lit 124 .2 Signature Of Legal Owner(s) Dat And/Or Authorized ApplicantDate Om 8, INSPECTION TYPE PATE INTrnALB CODE( INSPECTION TYPE PAM INitTIAL$ 1618 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 • = = P_ 204 Final Demolition 250 Final Building/Occupancy F/ `� �c 9 CITY OF COSTA MESA 4 BUILDING DIVISION " , DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER /� �� `• PERMIT righ �.+ B04- 041 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 234 E 19TH ST Status: ISSUED Suite: A Applied: 05/05/2004 • Vicinity: ROOF Issued: 05/05/2004 Parcel Number: 42627116 Zoning: Applicant: VOSSELLER, WILLIAM C JR ISSUED BY: Address: 234 E 19TH ST Phone: 949-950-8172 COSTA MESA,CA A Zip: 92627 Owner VOSSELLER, WILLIAM C JR Address 234 E 19TH ST A-B Phone: •COSTA MESA,CA- Zip: 92627 Contractor: ' OWNER-BUILDER 7:Address: - Phone: Zip: License: 000000 Arch . , Eng: • Address: - - Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF EXISTING ROOF FOR UNIT A ONLY.INSTALL ASPHALT,FIBERGLASS COMPOSITION SHINGLES,2 LAYERS OF 15#FELT,CLASS A FIRE RATED.960 S.F. FOR UNIT A. '-" '- - - REF.:B04-00653 FOR CARPORT AND STORAGE AREA. • - ` --FEE SUMMARY Plan Check: $0.00 Calc Valuation: $2,000.00 Permit: $69.25 Claim Valuation: $2,000.00 SMIP Res: $0.50 SMIP Corn: $0.00 . Other:- $0.00 • Inspection: $0.00 Total: $69.75 PLANNING&ZONING. SETBACKS N ' ' MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 , Right 0-0 / ACCESSORY Front -0 Rear 6-9 ,Left 0-0 • Right - 0-0 PARKING Existing: 0 Required:, ; 0 Proposed: b - 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(6ro0) 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 LaLSf Coot for the performance of the work for which this permit Is Issued. O I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I hould be e subject to the workers'compensation provisions of Section 700 f the Labor Code,I shall forthwith comply with these provisions.! // 6 //q� Applicant Signature: r L/[ l/ Date: �/ V 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(S100,000),IN ADDITION TOTHE 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,end my license is in full force and effect.Lic.4 Class x Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to Its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business end 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 Reefs the applicant to a civil penalty of not more than five hundred dollars($500).): I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or Improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempyt m�s ec. Business and Professions Code for this reason: / Signature: e.��rI, -Qat /S/ w Oner ID verified by drivers license. 9 Yes 0 No Drivers License No. /// Expires: Verification of Ownership by(type of docum t'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 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). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this'Application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 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? 0 Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application,have all of the disclosures prescnbed 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 end city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLJANCE 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 comet with all state laws and city ord' ances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-describe�b a Insffa o .os's. a. a not to occupy or allow occupancy of any building authorized by this permit until fin nspe Ion. B ere C' S Signature Of Legal Owner(s) Dat And/Or Authorized Applicant Date COOL x INSPECTION TYPE p_ez IL4IDAL5 CODEI INSPECTION TYPE OAIE MAU 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• A 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy ©ir �yrp CITY OF COSTA MESA a ► BUILDING DIVISION > al •,liar-t• DEVELOPMENT SERVICES DEPARTMENT PERMIT UMBER H: y /� PERMIT !rte MOd_ 0911 (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 • MECHANICAL PERMIT- Job Address: 234 E 19TH ST Status: ISSUED Suite No A Applied: 05/05/2004 Issued: 05/05/2004 Vicinity: C740e- Parcel Number: 42627116 ISSUED BY: Applicant: VOSSELLER, WILLIAM C JR - • Address: 234 E 19TH ST . - Phone: 949-650-8172 _ COSTA MESA,CA. • Zip: 92627 - Owneri VOSSELLER,WILLIAM C JR ' ' Address:' '234 E 19TH ST 1 " - 'A-B Phone: - - COSTA MESA;CA Zip: 92627 Contractor OWNER-BUILDER Address: '- Phone: ' Zip: • License:000000 ' • SCOPE OF PERMIT INSTALL NEW F.A.U.,REROUTE GAS AND WATER LINES TO FRONT UNIT."UNIT A MECHANICAL TO INCLUDE: INST FAU<100K BTU AND,"1 GAS PIPING. ' FEE SUMMARY . . Quantity . N Quantity ISSUE FEE $23.50 --- - „-" " - ' ' Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $14.80 ''1 " Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0 " ' ' Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler ' $0.00 0 Inst/Rep.Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 . Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator - , $0.00 0 Refrig Sys>100 k BTU $0.00 0 - ' Compressors/Absorption Systems Gas Piping " $6.15 1 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace , $0.00 0 -' ' 3 To 15 hp/500 k BTU $0.00 0 1 Hood w/Mech Exhaust '$0.00 0 15 To 30 hp/.1,000 k BTU .$0.00 ,0 VAV Box $0.00 0 ' 30-To 50 hp/1,750 k BTU ' ' $0.00 0 Vent Fan/Single Duct $0.00 0 Over 50 hp/Over 1,750 BTU � $0.00 0 Appliance ' $0.00 0 Boilers Fire Dampers $0.00 0 ' , ' - � Up to 3 hp ' ' $0.00 0 • Smoke Dampers ,'" -- " $0.00 0 - 3 To 15 hp. - ' . $0.00 0 Inst or Relocate Appl Vent $0.00 0 . ' 15 to 30 hp- / $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp) $0.00 0 Air Handlers> 10000cfm - $0.00 0 ' ( Over 50hp $0.00 0 Floor Furnace ' $0.00 0 Other Mechanical Fee Floor or Suspend Heater '$0.00:' 0 - ` .. ,\\ Investigation Fee $0.00 Plan Check Fee ' _ $0.00 - - . _ <., Reinspection Fee - $0.00 i NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void 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 244648(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. ❑ I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: I section need not be completed if the permit is valued at one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California d agree that If//I shouldho/ beco subject to the workers compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provision�(/r� SA- T Applicant Signature: � Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,MD ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class# Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit syy)9dcts the applicant to a civil penalty of not more than five hundred dollars($500).): //p) I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am ex gwp er sac. Business and Professions Code for this reason: / Signature: / `/�/ Date: S/O��0/ Expires: Verification of Ownership by(type of document,i.e.-properly tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 6,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 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 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the Califomia Health and Safety Code been fully complied with? ❑Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application akgermlt for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code), 7 If aermit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given Is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described groper �ornr/ms��e ry ems.I a�Rf3yot to occupy or allow occupancy of any building authorized by this permit untiiinnclliir]�ection. ignature Of Legal Owner(s) ate And/Or Authorized Applicant Date CODE t ITISPECTION TYPE En INITIALS CODE! INSPECTION TYPEU -.r / 1616 Fixed System Final Fire Prevention 206 Final Mechanical /// 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy -1 yT CITY OF COSTA MESA 4 ►° BUILDING DIVISION >:l,,,,,, •,�, DEVELOPMENT SERVICES DEPARTMENT PER IT NUMBER tis i PERMIT • PO4-00311 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 234 E 19TH ST Status: ISSUED Suite No A Applied: 05/05/2004 Issued: 05/05/2004 Vicinity: ISSUED BY: Parcel Nunmber: 42627116 Applicant: VOSSELLER, WILLIAM C JR Address: 234 E 19TH ST Phone: 949-650-8172 COSTA MESA,CA Zip: 92627 Owner: VOSSELLER, WILLIAM C JR Address 234 E 19TH ST- A-B- - - Phone: COSTA MESA,CA Zip: 92627 Contractor: OWNER-BUILDER • Address: Phone: Zip: License: 000000 • Arch / Eng: Address: • Phone: Zip: License: SCOPE OF PERMIT REROUTING GAS AND WATER LINES TO FRONT UNIT.UNIT A • PLUMBING TO INCLUDE: 1 GAS(1-4)OUTLETS,1 GAS REPIPE, 1 WATER HEATER,AND 2 WATER , • SERVICES. • FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0 Backilow irrigation $0.00 0 Landscape Irrigation' $0.00 0 Swimming Pool $0.00 0 Backflow Preventer - $0.00 0 P-Trap $0.00 0 , Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator - $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 . ' Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors - $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor $0.00 0 - Sewer Connect $0.00 0 - Waste and Vent System $0.00 0 Drain,Rainwater $0.00 0 Sewer Private Line - $0.00" 0 Water Closet(Toilet) $0.00 0 Drain,Roof $0.00 0 Shower $0.00 0 Water Heater/vent $12.30 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 2446-40(WOO) r 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 caller and policy number are: Carder: Policy Number: his section need not be completed if the permit Is valued at one hundred dollars($100)or less.) I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California and agree that If I should e me subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisio et ` Applicant Signature: Date: / '$0 T,: WARNING:FAILURE TO SECURE WORK RS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,003),IN ADDMON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST.AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commenting with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full force and effect.Lic.6 Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commenting with Section 7000)of OMsion 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).): /,yFf!!' I,as owner of the property,or my employees with wages as their sole compensation.WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of properly who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). - ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I em extggLI5ler Sgc. / Business and Professions Code for this reason: Signature: iy�/ Date: .-,s O a � / Owner ID verified by drivers license. Yes 0 No Driver's License No. ' .. & Expires: Verification of Ownership by(type of a i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2.Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health end Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or e volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or gency? I0 Yes ❑No (Section 65850.2 of the California Govemment Code requires that the requested information be fumished on applications for non-residential building permits). _ to _ 6 Will any part of the facility _ constructedbe under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 II a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPUANCE 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 a. t • amply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the abo - •escri•t..doper '• • •• 'o pose. agr::not to occupy or allow occupancy of any building authorized by this permit until el ips a 5 Signature Of Legal Owner(s) ate And/Or Authorized Applicant Date CODE f 31SPECTION TYPE QM IBIIDAL@ CODES INSPECTION TYPE QAE IBMlALE 1818 Fixed System Final Fire Prevention 206 Final Mechanical , 1268 Pool Spa Final 208 Final Plumbing 14'A S'L p A G/etJ' 200 Final Re-Roof 210 Final Electrical 1 •. /./ 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 504 CITY OF COSTA MESA " BUILDING DIVISION $y,,,,, -4 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F I %� I PERMIT E04- 8 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 234 E 19TH ST Status: ISSUED Suite No A Applied: 05/05/2004 • Vicinity: Issued: 05/05/2004 Parcel Nunmber: 42627116 Applicant: VOSSELLER,WILLIAM C JR ISSUED BY: Address: 234 E 19TH ST - Phone: 949-650-8172 COSTA MESA,CA Zip: 92627 - Owner VOSSELLER, WILLIAM,C JR - - ' Address , 234 E 19TH ST - - A-B Phone: COSTA MESA,CA' Zip: 92627 - Contractor: OWNER-BUILDER Address: -Phone: " Zip: ' License: 000000 ' • SCOPE OF PERMIT CONSTRUCT 264 SF CARPORT AND 81 SF STORAGE AREA ATTACHED TO THE REAR OF THE CARPORT. REROUTE GAS AND WATER LINES TO FRONT UNIT-,REF.: B04-00653 UNIT A • ELECTRICAL TO INCLUDE:5 LIGHT FIXTURES,3 OUTLETS AND 3 SWITCHES. ' FEE SUMMARY :' Quantity ' , Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 • Res.a/c package , $0.00 -• Standing Section $0.00 ` 0; New Res(1-2 units). $0.00 0 -" . Misc Electrical Equipment $0.00 , 0 ' _ New Res(3+units) ' $0.00 0 . '`) ' . Transformers up to 1 kva/kw $0.00,,, ' . 0 Pool/Spa ' ' $0.00 0 , up to 10 kva/kw- $0.00' 0 Lighting Fixts $5.50 '. 5 up to 50 kva/kw $0.00 " 0 ' Recept Outlets $3.30 3 up to 100 kva/kw $0.00 , 0 Switches $3.30 ' ' 3 ' over 100 kva/kw - .- . $0.00 .0 . Non Res Appl $0.00 C 0' . ,Low Voltage Equipment.' - $0.00 0" ' ; Res Appl `.C�.' $0.00 0 'Low Volt Wiring System/Ckt - $0.000. Service to 200a - $0.00 ' 0 - ' - .Misc:Conduit - $0.00 / 0, / 'I - Service to 1000a . . $0.00 ' 0- , - Misc.Conductor . $0.00 " .0,' Service over 10006 $0.00 ' 0 - Circus"("gen or ride) ' $0.00 " 0 Motors to 1hp '1$0.00 0 ' - ' Circus(mech ride or lights) $0.00 , ' 0 Motors to 10hp $0.00 - 0 t, 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 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 ' 2446-46(6/00) • DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier end policy number are: Carrier: Policy Number: (This section need not be completed I/the permit Is valued at one hundred dollars($100)or less.) ' yI 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 ree that If I sh Id bocci s bject to the workers'compensation provisions of Section 37 'of thbor Code,I shall forthwith comply with these provision < J ,5- (/� Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS' ENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND(XM.LARE(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# Class N Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: d I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,CMI 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 Sub'ects the applicant to a civil penalty of not more than five hundred dollars($500).): I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' • I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). I am exempt uncle Business and Professions Code for this reason: / Signature: 4/ Expires: Verification of Ownership by(type of docu nt,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: • I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title B,California Administrative Code). O As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑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 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 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this.application a.permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 8 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). — — — — ._ ft 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 byCalifornia 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 stale 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 pr r inspP,ctionAu se .I ogre of to occupy or allow occupancy of any building authorized by this permitStil fin Insp on. Signature Legal Owner(s) Dat And/Or Authorized Applicant _ Date • CODE. INSPECTION TYPF PALE IIIIJALS CODE! INSPECTIONTYPS RAIL MAO 1616 Fixed System Final Fire Prevention 206 Final Mechanical 41/ 1266 Pool Spa Final 208 Final Plumbing AV 200 Final Re-Roof 210 Final Electrical p/ • 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 • Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. mamma PERMIT N . .TRACT NO. LOT NO. UNIT NO. '"""�'1'4'Y of COSTA MESA CONSTRUCTION PERMIT A.P.# • I Zone ,23Y E . /9Th Sr )= 348,42 Project Address XI • S Main Building: Accessory Building: .5"--- TYPE OF CONSTRUCTION U NEW ❑ ADD ALTERATION U REPAIR E Z Applicant's Mailing Ad/Qress - �a - - Front - ' R // VMse kr • Phone ❑ CONVERSION ❑ DEMOLISH ❑ OTHER • T• B N Owner's Na e I DESCRIPTION OF WORK/USE OF BLDG. A Rear - I Address `f E 1571, S— - TYPE OF PERMIT U GRADING 0 FOUNDATION U STRUCTURAL I C Right - N Arch/Eng.' License No. K' G Address y2� ❑ TENANT I ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ' S ' Left • - , , . R Contractor's Name 1 V Phone ❑ DTHER Ping. Ref.# Parking Req./Provided E Address(mailing) - 1 PROJECT DESCRIPTION SQ. FT. OCCUPANCY ' planning Notes: - . - M 4 CONSTRUCTION TYPE VALUATION 5� � T City License No. ZONE GRADING CU.YDS. ACRES . g, LICENSED CONTRACTOR DECLARATION I ' I hereby affirm that I am licensed under provisions of Charter ions C mencinRemarks: ERUICE C )mg..A)�E/uP���E with section 7000) of Division 3 of the Business and Professions Code,and J '4t my license is in full force and effect. ELECTRICAL FEES License Class License No. Date Signature ' PLUMBING I FEES Automatic Washer. • Transformer 0 15-50 KW ' WORKERS' COMPENSATION . • my lice • Sink Showers Construction Pole Sub. ❑ 501 KW I hereby affirm that I have a certificate of consent to self-insure or a certificate - - Workers' Compensation Insurance, or a certified copy thereof (Section Cooking Unit Meter up to 100 amps1L�� • p _ Backflow Preventer Service Sink - - - - p - )0, Lab. C.) - HS 5o - alloy No. Company Backflow Irrigation Sewer Cap • ' Dishwasher Meter Clover 100 amps BCertified copy is hereby furnished. Dryers ❑Gas ❑Electric Sub Panel Cer •'fie o 's filed with tit-. Mu Isi•. ' " bathtubs Sewer Connection . Date App cant -...0.4‘.? • e i(i aor!ai' f'-. Fan Motors❑0-1 HP ❑1'h-8 EXEMPTION FR M WORKE-S'U- P-7 • 4.N DEC •RATION ' Clarifiers Solar Collectors ' ' (This section need not be com• et•• if the it is for •,.. hundred ($100) or F.A.U. - less). - Dishwasher • Solar Piping Inc.Solar 09-15 HP 016-15* I certify that in the performa e of the work for which this permit is issued I Fixtures shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank ' •� Microwave Workers' Compensation Laws of California. • Date Signature - + Floor Drains Swimming Pool w/Spa 1 Device Boxes Pole Light NOTICE: If,after making this declaration,you should become subject to the Outlets Range _ l.k- .5)• Workers' Compensation provisions of the Labor Code, you must forthwith • . Floor Sinks Urinal - - s+ comply•with such provisions or this permit shall be deemed revoked. • • - CONSTRVCTION LENDING AGENCYGas Service .Outlets Water Closet _ 2 Switches , Sign '• �/ 1 �r-� I hereby affirm that there is a construction'lending agency for the performance .J of the work for which this permit is Issued (Section 3097 Civ. C.) / Garbage Disposal • Standing Sections. Interceptors Water Heater 3 by Lender's Name, - Lender's.Address - Kitchen Sink - -Water Service _ Generator DO-5 KW 05-15 KW Trash Compactor OWNER BUILDER DECLARATION • • I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash - - - • , following reason (Section 7031.5 Business and Professional Code: Any city or • - county which requires a permit to construct,alter,improve,demolish or repair P-Trap -. Laundry Trays - ' .any structure, prior to Its issuance, also requires the applicant for such permit - _ - - -to file a-signed statement that'he/she is licensed pursuant to the provisions of Roof Drains ' IS She Contractor's License Law (Chapter 9 (commencing with Section 7000) of I Division 3 of the Business and Professions Code) or that he/she is exempt • Reinspection Fee $15 Issue Fee '-$$� —berefrom and the basis for the alleged exemption. Any violation of Section - • 31.5 by any applicant for a permit subjects the applicant. to a civil nalty of not more than five hundred dollars($500). DEVELOPMENT SERVICES REQUIREMENTS: • A I, as, owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 • • •compensation, will do the work, and the structure is not intended or-offered Zoning Approved By Date for sale (Section 7044, Business and Professional Code: The Contractor's I - MECHANICAL FEES Building Approved By' • License Law does not apply to an owner of a property who builds or improves _ Date ��/ym�-�/�� thereon, and who does such work himself/herself or through his or her own Boiler Hood or Type I 0 Application •Issued By Dete �q PT- employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- • Canopy Type II 0 SUMMARY OF FEES pletion, the owner, will.have the burden of proving he/she did not build or im- Duct-Under Ground • prove for the purpose of sale). BUI LDING PERMIT $ , SMI . $ 0 I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System tractors to construct the project (Section 7044, Business and Professions Code: PLAN CHECK $ PERMIT The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ' - 00-100,000 BTU 0100,000 BTU PLUMBING $ ISSUANCE $ -builds or improves thereon. and who contracts for such oroiects Ith a con- + ENERGY P.C. $ ' tractor(s) license pursuant to me Contractor's License Law). I aware that Exhaust System ❑ Multiple❑ System Repair/Alteration PLAN CHECK • 25% $ ' proof of their Worker's Compensation insurance should be p • ded to me. GRADING $ I ELECTRICAL $ ‘47.%-:C) I ❑ I:am exempt under Section B.& P. • •r his reason Firepl/Fact.Blt. ICBG dk Fire Dampers • Sr." • PLAN CHECK 50% $ MICROFILM $ ' Date Amy:. .canerrlefle Slitni71•T _ Heating System& Ducting Registers . - MECHANICAL $ 42,'S I hereby certify that I h ye r- his -ication am:9 ate that the above ❑0-100,000 BTU ❑100,000BT - - - TOTAL FEE $ information is correc I a: e• 0 com• ith all ci . and county ordinances PLAN CHECK 25% $ • and state la.s tela • to •nlding co ction,an• hereby authorize repre- • - ' sentativ•: o h to enter: u•• `e above-mentioned property for - inspect on purlY. // / p q �1 - i Signature /_.-//i i( I!rDate cg"-71t942) • 1 • Drivers' i'�� • Reinspection Fee $15 • Issue Fee • '$ 3 • 01 00011725-00011725 'TOT -42.50 08: '6,rev. 5 88 Whi - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor DATE: 08/10/88 TIME: 14:58 CONSTRUCTION AND PLANNING _ PL\Of PA ' Date Ins ector APPROVALS Permit# I p_ APPROVALS' Permit# Date Inspector , ( 1, Temppiary Electrical Service or Pole .52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. t��l 53. Steel Reinforcement r,) %! - i Electrical Conduit Utility-Undrgrnd. I 54. Forms 1 ' / 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding '1i 5.;Steel�Reinforcement 56. Rough Plumbing & Pressure Test 6: Electrical UF ER Grnd. / 57. APPROVAL TO COVER-GUNITE 7.•Footings . . ;I,.. 58. Electrical Conduit-Undrgrnd. i �' 8. Foundation ' c' /' ;„/ / 59. Gas Pipe, 0 Undrgrnd.,Test 9..Water Pipe-Undrgrnd. � 60. Backwash Lines, P-Trap, 0 Undrgrnd. ., 9 c.10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection _�.'; 62. Backwash & Receptor-Final 12. Sewer Cap 1 63. Heater & Vent-Final - •�.' 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final , • l6. Rough Electric Wiring 4?-7/-88 Q 67. Fencing & Access Approval - 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceilin 69. POOL/SPA SYSTEMS FINAL t9.; Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20, Rough Factory Fireplace APPROVALS Permit# ., 21. Ducts, in Structure 70: Underground Hydro 22. Ducts, Ventilating . ) 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test %: 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26.-T-Bar Ceiling (Structural) 81 Monocoat 75. Dry Chemical 27. 'Frame and Flashing 76. Dry Standpipe - • 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation _I 78. FIRE PREV. FINAL 30. Drywall Nailing '-1 HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat '.' 79. FINAL INSPECTION 32. Electrical Power Meter-Final q-2/-ei }cgek 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing ' 39. Water Service-Final • 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer ' 43. Backflow Irrigation (� , I.. 44. Landscape Irrigation System 45. Sound Attenuation ' 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric'Release to Edison } 50. Gas Release.to Southern California Gas Co ( - 51. CERTIFICATE OF OCCUPANCY • • -- , ' i No. Date • i 5275 FEE RECEIVED COSTA MESA BUILDING DEPARTMENT C` v 3, /9 f2 g 4 4. P.O. BOX 317 COSTA MESA, CALIFORNIA FINANCE 7D�EPppT.. pp '_ FOR APPLICANT TO FILL IN APPL�$IA�F 1 'C7RS'PERMIT ADDREISS,2_ 311E 17hst. BUILDING COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY RECEIPT NO. PERMIT NO. OWNER /Jr, 'est," ^ a-5"-__ S - MAIL ,RE BY DATE RECEIVED DA E In E7 2,3LiF /7T4 f e---5-57 6'.-3---�7 CITY cc t7/7/4.41/56/7 NO. "/ ADDRESS 1 ARCHITECT •u OR ER NOO.. • COSTA MESA. CALIFORNIA FIRE I\ ADDRe...S ZONE Oil I ,6/ 7� CITY LIC, 7o �/ ZON / / PLLANG (TYPE / GROUP CONTRACTOR 'j /V•Y/}�,L//f}(/yam p}� NO, I//ry E//''I///• +`/, A DDRESB� JV S(/'V'/Y �N/J/I✓�N U.L.i 'p 63.4 ABYPROV D DATE I. LEGAL �'j]� I-� CORRECTIONS 11 DESCRIPTION NOT 1 '7 O BLOCK ( A.P.NO. I O 9/ J OIFZELOT (0 .3'� F` ✓rNO.'OF SLOGS. NOW ON LOT APPROVED USE OFf//�I, ' CITY OF - STA MESA EXISTING BLDG.J'�y _id_ . , 11• I . 1 SETBACK LINE FROM �� / / / / PG. DEPT. REG. CENTER OF STREET REAR YARD SUBJECT TO - ,`\ SIDE YARD - RIGHT, 4 LEFT , ` ie , �i DESCRIPTION OF WORK - BY AaDATE ' ' Aar• PI AN Tc tar NEWII ALTERATION ADDITION v/ REPAIN A ILII MOVING DEMOLISH BUILDING NO.OF SIZE ROOMS STORIES . EXTERIOR WALL ROOF COVERING- ' COVERING USE OF NEW'' .BUILDING' . . . e---(00 E00 AI/ZP r"-- PC/ GF-2'Fi f ratc-f-r t 67-71, gG/L(�_re,az _// mae lr// T.' .=Y ACK .. LEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THF/ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ' CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUC. - TION. /���ye,E n VALUATION ERM IT FEE d-Q SIGNATURE OF 6..,;( J// /�/ $ PERMITTEE PLAN CHECK $ /��y.�^./1 AUTHORIZED AGENT 5%20 U TOTAL FEE $�' •'....---- va'"F J 5593 FEE REC/�EIV D r pCOSTA MESA BUILDING DEPARTMENT r/, J/` 17 P.O.BOX 317 - FINANCE D PT. COSTA MESA. CALIFORNIA CITY OF COSTA MESA • FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT BUILDING 2 // iq 5r BUILDING ADDRESS `7 COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY 1 fy� RECEIPT NO. PERMIT NO../ OWNERFL Icirierr4 frov,1fFri K ss 6s MAIL RECEIVED BY DATE RECEIVED DATE ISSUED ADDRESS 21HFfM11 X57- /--/3717 ?'•i�?-S TEL. BUILDING ' CITY (04T' /n ECr/ NO. ADDRESS ARCHITECT LIC. OR VEER . COSTA MESA. CALIFORNIA FIRE ADDRESS ZONE CONTRACTOR NO.• ZONE NO.PLANS OF TYPE GROUP ^/� r '���f✓ CITY LIC.?-o...,�/ OF ADDRESS 30 )//Nl// atr of NO.L/cf6 3/6 BYPROVI.{���r] L ' OAT/ /3 S� U LEGAL LOT l'-----/�/� l DESCRIPTION NO. BLOCK TRACT CORRECTI6N t Fre\ A.P.NO. //0 0 / /...c... APPROVED SA OF / �( NO.OF BLDDB. CITY OF C�•.>;AV MESA O OF LOT ((O X /3 r NOW ON LOT a )L , ;ritr utpr. USE OF SUBJLC I EXISTING BLDG. &L G. DEPT (� { SETBACK LINE FROM I /y r P CENTER oP SrREEr 2 REAR YARD / ��� 4 8Y , . t 14. ,A CH, / DATF�Y, S2 SIDE YARD RIGHT13 LEFT f 1 �L.>N DESCRIPTION OF WORK 1111 X NEW ALTERATION ' ADDITION / REPAIR MOVING DEMOLISH BUILDING NO.OF SIZE G X ROOMS I STORIESI COV EXTEEKING WAL 7�Q)���/yC� COVERING [O�Yj�ROOF shy//V�/EJ BUELDFNGSOEW fifth At00M fddrj/OA, TO Pa/eLhi,v -3,094/1 s" F>.)cEd we" re PH I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUC- TION. VALUATION SIGNATURE OF /Jignaffr PERMIT FEE 'S PERMITTEE C// /••r� ' 1 l (,�/ PLAN CHECK S S AUTHORIZED AGENT TOTAL FEE S 03 vulk '- .1 - , t_2550 • FEE RECEIVED • COSTA MESA BUILDING-SAFETY DEPARTMENT R dLI` 1 419SC • P. 6. BOX 917 C9STA MESA. CALIFORNIA FINANCE DEPT. For Applicant to Fill In Completely APPLICATION RA PPR!TA MESA • TYPE OR PRINT/R - BUILDING i BADUD RES ...QQ -/ ri/ s/ COSTA MESA. CALIFORNIA For Office Use Only ��((//�� ���� ., RECEIPT NO. PERMIT NO._ OWNER -S iVL.G�/" ct, I I , 1-.S vMAIL ' e leerier) ADDRESS 3) /7 `f 51 RECeIV�D_BY DwTF_�GE�D I '//,�..�h/G 0 1-110 'yam,. / TEL. ✓ /y' n."/� 7. //�/s / ' CITY1.4.•1.7- T 14d-1✓G NO ADDRESS BUILDING �✓ ! ��f� T./ / ARCHITECT TEL COSTA MESA. CALIFORNIA OR ' 'NEER NO. j/// - D }/y'� FIRE ADDRESS //.�� �� Q 1,�////J//) ,, ZONE �,,QTYPE GROUPOJ./�J CONTRACTOR ig�✓ L:,/Fle F J dK/pnLto APPROVED ( i - DATEO/�/L A/n J e O ADDRESS /. (.`- = • //�/t' ( ' /!EJONING !�"/ i/ (� +� z 1 NO.OF USE OF NE I r T� CITY l okA t� �1/A. -- L, I PLANE '. BUILDING /ICA[ 11 O V STATE TEL /)� )y' U( }IW O F' LIC.NO. /q� Y spy NOTE ICG se7> DESCRIPTION GAq. 41 J /,�3 I1�.L�' O OF LOT J //1 /3. / I NOW ON/L}OTNO. OF S G.- A.P.NO. // �9 ^I/%/- / S/ USE OF .- - K A, ' 1/ Q YARDS EVES EXISTING BLDG '. - - Y'�'�"L APPROVED ALLOWED I SETBACK-LINE FROM It / a (CENTER LINE ST.) / / , 1 CENTER OF STREET ! O6 REAR YARD S FRONT /�� FT. JO ll` N. SIDE YARD I LEFT /� / I RIGHT a...5 / R.SIDE 5 FT. IN. DESCRIPTION OF WORK L.SIDE 1! LY FT. IN. NEV IX II ALTERATION I II ADDITION I REAR �/ Ol 5 FT. �IIN./_ REPAIR I II MOVING II DEMOLISH I BYPROVS/ q / . DATE -i p-G° BUILDING �iQ� -NO. OF j W l�� 'l '_'/ SIZE ..74r- ROOMS (y STORIES Lv" EXTERIOR WALL ROOF COVERING �'�/ I COVERING . USE OF BUILDING AND WORK TO BE PERFOR D 3///�/lC IP d -„41 q�/.1. �w:. is ttt ee fr e ti 1, , i 6� -\NO P'• GET/T HAVE L Q I HEREBY ACKNOWLEDGE TMAT I Tilt THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT.THE ABOVE IS CO AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION. % / •' VALUATION SIGNATURE OF~',/ y.) id PERMIT FEE $ a- '� PERM ITTEF /,�-� �'- / ,[ — e ' r • $ / PLAN CHECK $ /V ----- Z AUTHORIZED AGENT // o TOTAL FEE $ 7 IL