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Home My WebLink About355 19TH ST - Building Permits� (774) 754-5273 • Fax (774) 754-4856 • www.ci.costa-mesa��DING PERMIT �� FAIR DRIVE, COSTA MESA, CA 92626 .lob Address: 355 E 19TH ST Suite: Vicinity: HOUSE AND GARAGE ROOF Primary Occ: R3 Type of Construction: V-N Parcel Number: 11729419 Zonin9: npplicant: SIMMONS, DEBORAH Address: 2163 PACIFIC AVE UNIT 14 COSTA MESA, CA R0840718 Owner: JONES, BRUCE L Address 355 E 19TH ST COSTA MESA, CA Contractor: HIRSCHMAN, RP AND SONS INC Address: 9582 HAMILTON AVE' SUITE 281 - HUNTINGTON BEACH, CA Zip: 92646 - Arch : Address: Zip: Phone: License: Phone: 949-631-9280 Zip: 926227 Phone: Zip: 92627 Phone: 714-960-8329 License: 781923 Eng: Address: ISSUED BY: Status: ISSUED Applied: 06/09R006 Issued: O6/09I2006 Phone: License: - SCOPE OF PERMI7 TEAR OFF (E) ROOF MATERIALS, INSTALL 2 LAYERS OF 3QIF ASTM FELT UNDERLAYMENT AND REROOF WITH 30 YEAR PRESIDENTIAL COMP SHINGLES ON ATTACHED HOUSE AND GARAGE, APPROX 33 SQUARES. REPAIR AND REPLACE SHEATHING AS NEEDED. FEE SUMMARY Plan Check: $0.00 Permit: $237.25 SMIP Res: $1.36 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 , Total: $238.61 PLANNING 8 ZONING SETBACKS MAIN STRUCTUR� Front 0- 0 ACCESSORY Fmnt 0-0 PARKING Existina: o Calc Valuation: sis,5ea.00 Claim Vaivation: sis,sea.00 Rear 0.0 Left 0-0 Right 0-0 Rear 0. 0 LeN 0• 0 Right 0-0 Re uiied: 0 Pr000sed: 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, 1241-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 780 days, or it work is suspended or abandoned tor a period of 180 days. INSPECTIONS: In order tor the work authorized under this permit to be considered legal, such work musl comply with all applicable codes, and all raqulred Inapeetlone and final epproval must be obtained. Failure lo obtain inspections and tinal approval will result in ihe expiration ot this permit. FOR INSPECTIONS CALL: (714) 7545626 zaawe (5roo1 WORKERS'COMPENSAnON DECLARATON: I �ereby eflirm under penalry ol perjury one oi Ihe following dedaretions: '' ❑ I heve end wlll melntain a certllicata ot consent to selt-Insure lor workors' campensation, as provided lor by section 3700 0l t�e Lebor Code, tor the peAortnance of t�e work lar which this permit is issuatl. �I have antl will maintain workers' compensation insurance, es reQuired by section 3700 oi ihe Lebor CoOe, lor Ihe pertortnance ot ihe work for which Nis pertnit is issued. My worker�%cympeps� on I^u�n� c�ar7per end poliry numbar ere: ry '�/��J/7��% /�, Cartier. �'�i�.� - J LY Polity Number: //�.��t7�L�-�feS ��U/ (Th/s secHon need not be cort�pleted i1 the permi! is valued at one hundred dWlers ($100) or less.) ❑ I certity that in Ihe pedortnence oi tha work lor which this permit is iuued, I shall not employ any parsan in eny manner so as to hocome subject to the workers' compensatlon laws ot Calltomia, entl agree that If I should pecame suD�act lo the workers' compensatlon provisions of Sectlon 3700 of the LeDor Code, I s�all Iorthwith compty wit� ihese Dr � /�//� v�.�,�,�n // Applicant Signeture: 4LV��/ /� Ow Date: �O /% /�� WMNING: FAILURE TO SECURE WOiiKERS' CO�dP NSATION COVERAGE IS UNIAWFUL AND SHALL SUflIECT AN EMPIAYEp TO CRIMINAL P NALTI 5 AND GVIL FlNES UP TO IXJE HUNDRED THOUSAND OIXLARE �5100,000), IN ADDfTION TO THE C04T OF COMPENSATION, DAh1AGES AS PROVIDED WR IN SECfION 31W OF THE LABOR CA�E, IMEREST, AND ATiORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereDy ettirm that I am licen f� v' lons of Chapter 9(cnmmencing with Section 7000) ot Division 3 of the 8usinass an�j Pr fe�lons Code, and my license is In lull larce entl eNect. Lic. k �oC � / Clau a (i.� contreaors Slgneture: � �,[�/1'J ii1/9-Vi/J oate: /i �� CONSTRUCTION LENDING AGENCV: ❑ I hereby aHirtn that there is e cnnstruction lentling agency for the peAormance ot the work lor whic� this pertnit is issued. (Sec. 3097, Civil CaCe). Lentler's Name: Lentler's AOdress: Signature: OWNER-BUILDER DECLARATIONS: Da�e: I hareby etlirtn fhet under penalry ol perjury thal I em EXEMPT FROM TME CONTRAC70RS LICENSE LAW for t�e following reason (Sec. 7037.5, Business end Professlons Code: Any ciry or county which requires e permit to construct, atler, improve, demalish, or repair any sWdure, prior to ils issuanco, also requires the epDlicant for such pertnit to lile e signetl slatement t�a� �e or she is Iicensetl pureuant to the provlsions of Ihe Contractors lJcense Lew (Chapter 9(commencing wilh Section 7000) ot Divislon 3 ot ihe Business end Professions Code) or thet he or she is e:empt t�erefrom and the basis lar the ellepe0 exemption. Any Nalation ol Sectlon 7031.5 by eny epplicant for a pertnit sub�ecis the applicant to a clNl penalty ol nai more than five hundrad dollers ($500).): ❑ I, es owner of the properry, or my employees with wages as t�eir sole compensation, WILL DO 7HE WORK, antl the sWctura is not intendetl or oflered tor sale (Sac. 7044, Business and Professions Code: 7he Contractors License Law does not appy to an owner ol property who builds or improves lhereon, and who does such work himsetl or herself or Ihrough his or her axn employees, pmvided Ihat such impmvemenis are not inten0etl or oNered for sale. N, howaver, the builCing or improvement is sold within one year ot completion, the owner-builder will have t�e burtlon oi provinq that he or sha tlitl not build or improve for Ourposa ot sale.). ❑� I, as owner ol ihe properry. em E%CLUSIVELV CONTRAGTING WITH LICENSED GONTRACTORS to consiruct Ihe pmject (Sec. 7044, Business entl Professions Code: The contractors License lew Ooes no� epD�Y �o en owner of propeny who bullGs or improves iheraon, and who contracts tor such pmject with a coniractor(s) license pursuant to the Contractors License LewsJ. ❑ I am axempt under sec. Business and Professions Code for this reeson: SlgnaWre: Date: Owner ID venfied by drivefs license. ❑ Yes ❑ No Dnvefs Ucense No. Venfication ai Ownership �y (rype oi daument, i.e. - propeRy tax Dill or deetl): DIVISION OF INOUSTRIAL SAFETY PERMIT CERTIFICATION: Ezpires: � I hereby certily ihat no exwvetlon Ilve (5) or more feet in depth into w�ich e person is requlred to descend, will Oe matle in connec�ion wllh work euthonzetl by this pertnit, end Ihal no building slructure, scaHoltling, falsework, or demolition or tlismantling ihereof, will he more than thirty-six (36) feel �igh. (C�ap. 32, Grp 2, Art 2, Sec. 341, Title B, Calibmla Atlministretive Code). ❑ As owner-builder, I will not employ enyone to tlo work w�ich woultl reQuire a permi� fwm lhe Division of Intlusirial Salety, as notetl ebove, unless such person has e pertnit to do such work Irom the division. ' Signature: Date: Division oi Intlustrial Safery Permit Num6er. CERTFlCATE OF COMPLIANCE AND AUTHORIZA710N OF EMAY: I cenity under penalry of perlury that I have read this epplication and state ihat the information given is cnrrect. I agree to comply with all state lews entl ciry ordinences relating to builtling construction, end emhorize representa�ives of ihe Ciry of Costa Mesa to enter upon t�e eDove-descnbed proOeRy for inspection purposes. I agree noI to oaupy or allow accupancy ot eny building authorized by Ihis pertnit until finel insDection. COOE1. INSPECTIONTYPE peg �y1QJ�$ 7616 Fized System Final Fira Prevenfion 1266 200 201 202 203 Pool Spe Final Final Ra-Rool �/.L D �ff" Y- Finel BIocWRetalning Well Final Factory Fire Plece Final Sign 204 Final Demoli�on COOE 1 INSPECTION TYGE 206 Final Mechanical 208 Final Plumbing 210 Final Electncal 212 Finel Fire Preventlon 220 Final Planning Approval 222 Final Site 250 Finel Building/Occupancy P�iTi I[�L6 i��i COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. 90X 917 C06TA MEBA. CALIRORNIA For dpplieanf �o Fill In Complefiely TYp& OR PRINT BUILDING '/�� / %� � Y A�DRES3 � COSTA MFSA CALIFORNIA 1 ARCHITECT — fS/// L rtt tctt;tivtu ,�/ FEB 1 19&2 p FINANCE OEPT. CITY OF COSTA MESA APPLICATION FOR PERMIT BUILDING For Offlce Use Only aece�rr No. rqrs,p^it tlo�� ( Y RECEIVED BY OAT6 qEC61VGD I D9TIf 19@ D Z.-e/ 2 ' /- 6 'z� o E'6S �ss i y � COSTA MESA. CALIFORNIA FIRE ADORE66 ZONING ' ZON NO. OP 1168 OP NCW( q7'y � • �' I P4N9 � BUIlDINO BTATE � TEL. LEaAL /� LIC. NO. NO. DBBGqIPT10N /:/ OF LOT I S I�o. oP aLDo9. '/ ,� ) ,__/ NOW ON LOT � A. P. NO. � U6E OF / YARDS EVE6 EXISTING BLDG �L `'+ pppROVED ALL 1NEo B6TBACK LING PROM y'�/y -� O (�MCR LANC eT.l / C6NTew OP srneet ✓ G ` REAR YARD� FRONT FT. �/ � SIDE YARD I LEFT O I RIGHT �� R. SIDE ^ FT. DESCRIPTIOId OF WORK • __ � q-�_ ,�„ �� EXTERIOR WA1,.�, ROOF COVBRING S/GfCCD COVE � U6E OF BUILDING AND WORK TO' �I HEHEBY AGKNOWLEDG¢ THAT 1 HAVE R6AD 'IHIe APpLIGT10N ANC BTAiE TXAT THE ABOVQ 19 LOPREGi ANO 110R¢6 TO COM• PLY WITX ALL CIiY OJtDINAMCEB AND BTATB LAWB 116pUlATING B�IILOINO CONBTRLLCfIJJN. / S � 'AUTHORIZED AGENT — / ni,�iC no�an��d�U /L NL-BXOWN-UNOEp�VALUATION IB POH TH! OF EBTABLl9HING A PERMIT pEE ONLY. q f� PERMIT FEE � qryM• ' \ `f_� o � PLAN CHECK $ �I� _