HomeMy WebLinkAbout546 BERNARD ST - Building Permits., a
�-flWNER � SMALL� DONALD F• DATE 12—�-56 �
JOBADDHESS 566•Bernard-St. BUIIDINGPERMITNO. NI1O3O
GENERALCONTRACTOR Armad�e, Inc. VALUE $ 7�320.00
_ AP115-301-22
LOT ' 13 BLOCK A TRACT 553 Res. Y�St.t.. �8i'•
G, /p I& J TVPE V ZONE �1 FIRE DISTRICT (lO%j
PERMITSISSUED
INSPECTIONS — DATE SUBCONTRACTOR DATE � NUMBER
Foundation Forms and Grad
Rough Framing ��o�to I�
Temporary Pole
Wiring, Rough
Heating, Rough
Heating, Final
l,�Sewer, Hause ��� Si
Septic Tank or Cmepool
Lathing,ln� �
Plv^'ering
pi ,ing, Final, Fixtures
Plumbing, Final Gas Test
Wiring, Final
OecupanCy
FORM 210 9M 10�0!
�JJ
_/L
2/9-SZ I 7S 6. S --
_ q-� 37 _x 3 s�i —
,_�G.r/I 7�s/_.�
� -:
(714) 754-5273 �• Fax.(714).754d856 �• www.ci.costa-mesa.�. +�LDING PERMIT n�FA1R DRIVE, GOSTA MESA, GA 92626
546
Job Address: Sd8 BERNARD ST
Suile:
Vicinity: CARPORT
Primary Occ: U
Parcel Number: 42210211
Type of Construction; VN
Zoning:
Status: ISSUED
Applied: 04/22/2005
Issued: 04/28/2005
Applicane JOHN MOREHART �
„ - - � � � - . � . ISSUED�BY: �
Address: 726 E 16TH ST � � . . . . - _ .
� � "�� . ' ' Phone: � 949-548-2720 �
. -� ,., ,
COSTA MESA, CA� -' - � ' Zip: � 92627 � .
� ,
� � .
Owner: 126 PROPERTIES CCC � � _ - • ' � �
Address • 126 E 16TH ST � ;" � � ". _ - � ' - . �
� . , �- � . , /�_'� � Phone: 949=548 2720 _ ; �� �� � � � '.
� � �COSTA MESA, CA �!- j � Zip: 92627 _ � _ �
. ,,-, � ��:. ,E
Contractor. OWNER-B,UILDER �
Address: �
. � , • Phone: '�A��.' . � .
, Zip: � _� _ _ �, License: • 000000 . �'��
= Arch : . . ,- , i' . l' .,, _ � . -Eng:. .
'Address:_. ��,.'r� � � _ , " � �- " - � - ��Address:� - ,
. .. . . ,' � .. - Phone: � - -
� ', Zip. . . , � � . .� � License: � . .
�
, „ .— "�'�, -` SCOPEAE PERMIT:-':'-;':� • •
CONSTRUCT�201SF DETACHED CARPORT - � • - � � - ' � ' � -- �
SEE MM-OS-15 FOR 1' ENCROACHMENT OF CARPORT POSTS INTO RE�UIRED LEFT SIDE SETBACK.
CARPORT ABUTS THE LEFT SIDE OF THE HUSCROFf HOUSE. � '- ��� ��`'
. FEE SUMMARY,-
Plan Check: $0.00 Calc Valuation:
Permit: $0.00 � Claim Valuation:
SMIP'Res: $0.00 �- •
SMIP Com: $0.00 � � � �
Other: �� $0.00 � � � �r. � �
Inspection: $0.00 � ' � � - _ - ' �;' �; '�j .
.. : .
.� .
Total:`�^ SO 00 � � ; ' _' � ° � � �'i �� . ��''
��/' - -^ PLANNING &ZONING � � �:� -
SETBACKS '�,���� �'�� �,� -<� �� � , ��, �,; . �
�-;�
MAWSTRUCTURE Front`�23-.0 -, : Rear 29•0 " � Le8 ,5 0;:�,,,:i Right, 0-�0 �
• . _ , . _ � .- . ..�� .
ACCESSORY . Front 0- 0 � Rear- � 0- 0_ _, Left 0_0 .�, ,:=;�! ,Right � 0- 0
_ _ - _ . _ _- � y-�..
- ...�- .� -� .
Phone:
License: � ,
. $3,336.60
$0.00
�
NOTICE: The vrork authorized:by this.permit shall comply with�all�applicable handicap access:requirements under Califomia�statutes and related
regulations. (Ord. No..92-28, § 1, 12-21=92) �
EXPIRATION: This.permit shailreutomatically:expire�and�.become void if work is�not:commenced,within'180�.days,.or if work Is�.suspended�or ebantloned
for a period �oY 180 days.
INSPECTIONS: In.orderforthe vrork�euthoiized.under this�pertniPlo�be:considered.legal,:such work�must�.comply with�ell�epplicable codes, and all
reqWred.Inepeetlona�and�final�.epprovafmusTbe.obtainad.;Feilure to obteln inspedlons�end'ffnal�.epprovel.wllfresult in the�expiration-ol ihis.permlt.
!(7,14f.754-5626
2a4B�48 (0�00)
WOflKERS' COMPENSATION DECLARATION: ' �
I hereby aHirtn under penalry ai perjury one oi the lollowing Oederetions. �,' •- -� '�� .� � ' .
❑ I have end will meintain e cenificate of wnsent to selt-Insure for workers' compensatlon,,es proWEetl lor Ey sectlon 3700 of the Labor Catla, far the peAortnance of Ne
work tor which this pertnit is issuetl. • � • •
❑ 1 have and will maintein workers' compensetion inwrance, az requiretl by sectlon 3700 of ihe Labor Code, lor the pertormence of Ne wwk lor wNch 1hLa,pertnit is Lssuetl.
My workers' compensalion Insurance carrier en0 pollcy number ere; . '
Cerrier: Pplicy Num6er:
�(This �sec(ion need not be rnmple(etl i! t�e pe�mit is va/uetl et one huntlretl tlallers (8 f00J or less J � �
fa 1 Ferlity tFiat in the perfo nce 1 tha work tor wNch tNs permit is issuotl, I shell noI employ eriy peison in eny menner so es t e��y99P ine s ct lo the wwkers'
lompensation laws ol alifo '. �ap e�ey Ihat If I shoulE become sub�ect to lhe workers' compensatlon pmvislons of Septlo �7�0 0l t=bor Code, I shell fort�wi[�
cromPly vrith �hese pr visi // v/ /` FJ�Q
WARNING: FAI�URE TO SECURj y76N�R5' COMPFNSATION COVEMGE IS UNLAW FUL AND SHALL SU6IECT AN EMPLOVER TO CRIA4�NALTI� AND CML FlNES UP TO ONE HUNDRED
TLIOUSPIJD DOILARE (5100. �� N AOIXiION TO TME COSi OF COAIPENSATION, OMNGE9 AS PROVIDED FIXi IN SECfION �/OB OF TH COD INTERE5i. AND FTTORNEYS FEES.
�
LICENSED CONTRACTORS DECLAHATION:
I hereby eflirm t�et I em licensetl untler Drovisions of C�epter 9(commendng with Sectlon 7000) ol Division 3 of the Business enC Prolessions Code, end my license is In tull
lorce and eflect. Lic. a Class M
Contractofs Signeture: Date:
CONSTRUG710N LENDING AGENCY:
❑ I hereby ettirm Net thoro is a construction lentling a8enry tor Ne portormance of I�o work tor which t�is permit Is issueO. (Sec. 3097, Civll Catle).
Lender's Nflme: Lentlefs AtlEress:
Signecura: Date:
OWNER-BUILDER DECLApA710NS: '
I hereby afllrm that unAer penalry of per�ury Nat 1 em E7(EMPT FROM THE CONTRACTORS LICENSE LAW for ihe tdlovring reeson (Sec. 7031.5, Business arid Pmfessions
Code: My dry ar counry which reqWres a pertnit to construct, elter, imprwe, tlemdish, or repair any strucW re, pdor lo ita Issuence, elm reqWres the appliwnt tor sucl� pertnil
lo file e signetl statement that he or she is licensed pursuant to the provisions ol the ConlrecbB license Lew (Chepter 8(commencing with Sectlon 7000) W DNision 3 oi Ne
Business end Professions Cotle) or that �e or she is ezempt iherefrom anC t�e basb tor the ellepetl exemption. Any Wdatlon ot Sectlon 7037.5 by any eppllcant tor e pertnil
su6�ects the aOP����� �o a clvil penalry W not rtwra Ihan iNa hundred ddlars (3500�.): .
❑ I, as owner ot the property,pr my employaes with weges es Iheir sde compensetion, W ILL DO THE WORK, antl t�e swccure Is rrot imerWetl or ottered fw sele (Sec.
7044, Business and Pmtessions CoEe: 7Te ConUactore LJcense Lew Ooes not epDty �o an owner oi property who Duiltls or improves ihereon, entl who does such wwk
himself or herselt or through.his or �er own emplayees, provitleU Ihet such improvemems ere nat intendetl or oHered lor sale. H, however, the bulltling or imprwement is
�old �wjithin ane year af completlon, the owner-builder will heve t�e burden of proWng that he or she tlid not Duild or improve for purpose of sele.).
j,.ac'dwner ot th erty, am E%CWSIVELY CONTRACTING WITH LICENSED CONTRACTORS to consiruct ihe prO�Bct (Sec. 7044, BuSiness end Professions
Cotle: The racto License Law does not apDN m an or.ner oi property who builtls ar impmves thereon, end who comrects br such prqject wl/ contractor(s)
license p uani to �f:ogtracbrs License Laws.). �
Business end Profe55ion5 Code lor �his reason:
ID verifie drlver's licen5e. V ❑ No
��tion ot nership 6y pype ot tl ent, i.e. - pmperry teu bill or
DIVISION OF INOUSTRIAL SAFETV PERMR CEHTFICATION:
❑ I hereby certity thet no ezwvatlon tive (5) ar more leet In tlepth into which e person Is requlred lo descend, wlll be metle In connectlon with work euthoAzed by this
pertnii, end Ihat no Duiltling siructure, 5caffolCing, lalsework, or tlemolillon or tllsmantlinp Ihereol, will 6e more then thirty-six (38) feet hlph. (Chep. 3.2, Grp 2, Art 2, Sec.
341, Tule B, Califomia Administretive Cade).
❑ As owner-buAder, I will not employ enyone to do work which would require e permit Irom the Division al IndustAel Selery, esTateC ebove, unless such person �es e
permit to do such work tmm Ne tlivision.
Signaiure:
Division of Intlustrial Selety Pertnil NumDer:
2
3
Dete:
ARDOUS MATERIALS AND EMISSIONS CERTIFICATON:
WIII ihe eOP�icant or presam or luture bullding occupanl naetl to flle entl certity e Business Plen lor emerpency response to releese or Ihreetened releese of e ha�Mous
meterlel7 ❑ Ves ❑ Na
(Section 25505 of t�e Gelifomia Heelth antl Salery Gotle reduires, wi�h somo ozcoptlons. Ihet e Business Plen be flled with the Casto Mesa Fire DeOertment Dy every
businoss w�ich has et any one time during a reported yeer e quantlty of hazardous metorials equel to or greetor Ihen e weig�i o1500 pountls, or e vdume oi 55 pallons,
or 200 cubiC fBel of tompressetl gas eI slantlard Iempnreiure Bnd pmuure).
.............'_"......................._..._"""""'............"'_"_.._.._....._.._—.............._................._................................................................�......_.T. _._._.............._
Does or will the epplicant or present ar tuNre builtling occupant neeA to lile e regislration form tor ecutoly hezerdous matedels7 ❑ Yes No
(Sectlon 25533 oi the Celitomia Heellh antl Sefery Cotle, wlth some exce tlona, wqulres repistretion wil� tha Coste Mese Fire Deponment by each business which el eny
one lime has on hend e quentiry ot acutely hazerdous meterlels equaPto or preater then e weight ol 500 Dountls, or e volume oi 55 gnllons, or 200 cubic leet of
compreuetl gas at stendard tempereture entl pressure).
................................................................................................................................................................................................................................................................................................................................_._................._................._
Does or will the epplicant ar present or future buildinp occupant noeC to D�eparo en FiMPP (Risk Manepement antl Preventlon Progrem lor acutely harardous materials)?
(Section 25534 ot the Calitomia Heelth and Selely Code pwvides that Ihe Costa Mese Fim Depertment may n
Depariment of en RMPP by businesses which are requlred to register ecutely hezerdous materlels wit� t�e Flre
..........................................................................._"_"............_�._...._.................._......................_...................................................................
It an RMPP Is presenily requireE, �es Section 25534 0l Iha Calitornie Health entl Setory Catle Deen lully complia
.............................._..._.._................._.. ....__�_..-...._........_.............._............................._....................................
Does ar will the applicanl or present or fuWre CUIltling occupant require lot t�e work whlch is the 6ubJeC� ol �hi5
fmm Ihe South Coast Air Oualiry Management Dlstrkt or trom eny o�her air pollution contrd tlistdcl or egencyl
(Section 658502 01 the Califomie Govemment CaCe requires that the repuestetl inlormetion be fumis�etl on ep�
.... .. ........... ........................................._....__.........................................................................................................................................
W ill any pert ot the laciliry lo Ee conslrucied under (hl5 permlt De wlt�in 1000 leet trom Ihe outer houndanes of e
pf yes", the facility must meet the requirement ol SecGons 25534 antl 42303 0l the Celibmia Heelth end Safety
.........................................................................................................."_'_................................._...........................................................................................
the preperetion, certlticetion anC Iiling with the Flre
ment.
............................................................__..........__....__.-._......
7 ❑ Ves ❑ No
.. ................................._.._........__._..—.._.....—.
�ation a ertnit lor suc� construIXion or motlificatlon
s 8 No
ns tor non-resitlentlel huildirp permits).
If e pertnit from �he Sou�h CoaSt Air �uaAry Manegemenl Disinc� ot ather air pollutlon conUol di5idct or agancy �s raquuea ror tne wonc wnlcn is ine suD�eq rn w5
application,�hava all ol the disclosuras presctlbetl by Celifornia Health antl Setecy Code Sectlon 42303 �een metle4 ❑ Ves ❑ No
_ ....... ......................._"_". ..___........"_'.................__......................._....._._._._.................. _
(If yes", enach certificate of compliance iran the appropriate air pollution contral oHicer).
GERTIFICATE OF COMPLIANCE: I certiy iha� untler penalry oi perjury the inlormetion 9iven ehove is correct. I agree to comply with all state laws and ciry ortlinences
regarding Harartlous Matarials and Emissions.
SignaWre: _� �� Date:
CERTIFlCATE OF COMPL
correct I agree to compy
above-descnbed D�aPeM
E AND AUfHOR ON OF ENTAV: I certily under penalry of perjury ihat I have reatl �his application end stat� that Ihe intortnation given is
all state la �s � oMinances relating to builtlinp construction, anC euthodze represantatives of the Ciry o osta Me§a to enter upon the
�Dection p e, ree not t cupy or allow occupancy ol eny builtling authorized by this permit u il f mspectio (`�—
� /
] (s)"'r..�._ � t�_ _�-
�.un. e�� ,.�.on n„nne�n� Date �
CO�E I,' INSPECTONTYPE '
1616 Fixetl System Flnal Fir
1266 Pool Spe Finel
200 �Final Re-Rool �
201 Final BIocWRetalning well
202 Final Fectory Firo Plaia
203
204
Finel Sign
Final Demdition
- _ � �jE ' • ��$ ' ' fQyg� � INSPECiqN TYVE
' 208 Final MecheniCel
208 Final Plumbing
� ' ' 210 Final Electdcal -
212 Flnal Flre Prevantlon
220 Final Plenning Approval
� � 222 Finel Slte
250 FInalBullding�Occupenq
- QAg N�LB
(714) 754•5273 • Fax (774) 754-4856 • www.ci.costa-mese.ta.us 77 FAIq DRIVE, COSTA MESA, CA 926?6
BUILDING PERMIT
JobAddress: 546 BERNARD ST
Suite:
Vicinity: � CARPORT
primary Occ: U
Pafcel Number: 42210211
Applicant: JOHN MOREHART
Address: 126 E 76TH ST
COSTA MESA, CA
owner: 126 PROPERTIES LLC
Address 126 E i6TH ST
COSTA MESA, CA
Contrector: OWNER-BUI LDER
Address:
Arch :
Address:
Zip:
i-15 FOR 1' ENCR�
ABUTS THE LEFT
$0.00
$0.00
OF
Type of Construction: VN
Zoning:
Phone: 949-548-2720
Zip: 92627
phone: 949-548-2720
Zip: 92627 �
INTO
FEE SUMMARY
ISSUED BY:
SIDE SETBACK.
Calc Valuation:
Claim Valuation:
Slatus: FINALED
Applied: 04/22/2005
Issued: 04I28I2005
$3,336.60
so.00
NOTICE: The work authorized by this permit shall comply with all applicabla handicap access reQuirements unde� Californla stalutes antl related
regula�ions. (O�d. No. 92•2B, § 1, 12-27•92)
E%PIRATION: This permit shall automatically expire and become void ii work is no� commenced within 1B0 day5, or if work Is suspentled or aDandoned
lor a period of 1 BO days.
INSPECTIONS: In order for the work authorized under ihis permil lo be tonsidered legal, such work must comply wilh all applicable codes, antl all
requlred inapeellona and flnal epproval must be obtainetl. Failure lo obtain inspections and linal approval will resul� in the explration ol Ihis permit.
FOR INSPEC710NS CALL: (714) 7545626
... „ �„�„
WORKEPS' COMVENSATION OECIGRqTION:
� -- � ..
I �erooy anirm untlar ponAlty o� perlury one oi Ine lollowing dgclarelions: � �
❑ 1 neve entl will mainiain e cenihcale W consenl lo seq.�nsure lor workers' componsation, es O�m'beE tur Ey seclion 3700 0l Ihe Labor CWe, br the petlormance ol Ihe
wprk tor which Ihis permil is issuetl. ,
❑ I nava anE will mainiain workors' cnmpen5e0on insutance. as repuiretl 6y 5ection 3700 o11�e La�or Cotle, br Ine petlormanca ol ino work tor wn¢n tnis pennii is issued.
My wUrMerS' COTpensaiion Insurance Wrr�er antl pd�cy numoer a16:
Carrior. Policy Numb.rt:
(TN5 secbon nenJ nof Ge �pmplpfod d t�e permrt ia velued el one bun�retl tlollais (S �00J or IbssJ
❑ I certity tnat m �ne partormance ol Ine work lor w�ich t�is Dermil is issuetl, I shall nol employ any person in any manner so as lo Decome SUEject to tne workers'
compensa�ion laws ol Celnomia, antl eg�ee Ihal tl 1 shoultl become sub�ect lo Ihe workers' Campensalion pwvisions ot Ser,iion 3700 o11he L'abor Cotle, I s�all IOrihwith
comply wiln Inese vrovisions.
Apphcam Signalwe: De1a:
WARrv�nG� FulllRE TO SECURE WOFKERS' C(M�PENSAiiON CpvEMGE IS uNUWFU� u+0 SNnLL SU9IECT Ml EMPLOVER TO CFIM�N�I. PENN TIES utlD CIVIL FINES UP IOONE HUNDPED
TIqUSFND pOLURE �St00.tpp�, Irv ADDILION i0 TME CUST OF COMPENSATId1, DUMGES �S PROVIDED FOR IN SELI iON �lM OF THE LABOR COOE, IMEREST, AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I bemoy aflum t�al I am licensetl untler provisions ot C�apter 9(commencing wil� Seclion 7000) ol Division 3 0l tne 0usiness
torce and enect. lic . Class •
ConuecWr's Sipnuwrn: Daie: !-
�.,. .
CONSTRUG710N LENDING AGENCV: �-.�
❑ I he(eby dninn IOaI It�Ote is a conSimCLan lenaing agonCy tOr Ihe pettormante ul �hp work (Or w0ith INS pB�InA.is
Lenuer's Nama: Lender's Atltlress: �'• ��'�' ' '�' - `
Si9namre: .�' __, .. .':�
OWNER-BUIL�ER DEC�pRAT10N5:
I nereoy atlirm Inat untler penaliy of perjury 1�aI 1 am EXEMPT FROM Tl/E CONTRACTO
Coae: Any aiy or coumy wnicn requires e Oennit to Construct, elter, impmve, tlemdish, or
io tnc a signetl vetnmem inal ho or sne is licensea pursuam �o Ine prowions W �ne Cont
Busmess antl Piolessions Coda) or tnat ne ar s�e is eaempt Inerelrom'erM �he b�sis b�
suo�ens �ne epDl�cant to a civil penatly ol no� mora tnan hve nuntlriC'dollan (55001.1:
❑ I. as ownor ol Illn p�openy, or my employ9os with wOges ei tlillf fOk fAfnpanialion
• • �7
LICENSE LAV
70<4, Businnss entl Prolossions Cotla: 1 he Conlraqors LiCarqo Lew OOBa nd epply lo an OWner,ol prope
nimselt or her5eli or IOrough his or har own employees!prOvitletl Ihai auch ImprOvemenb et�'�.rot NlMdeO
solJ witnin one year ol cam0letion, Ne owner�builtler will have ihe burOen d,praving t�et M or ahe Eid rql
❑ I, as owner M me p�o0ony, am El(CWSIVELY CO/fTRACTNG WIT/l LICENSED COMRACTOR81o'cc
Gotle: Tne Comlanuts Ucensn �aw tloes nol ap01y lu Bn owner oi Omperty Wlw builtl9IX hrWvw� Vieieai
li[nnse Fur5uenl to ine ConiraCtOn Litsnse L0w5.)! . ! ` ' � '� .'%
❑ I am a.empl untle� yoc. �' �' � 1 Businoss anG Prdusions CatlO tor Nis rcason:
SignaWre: %. - °: � t' .� � ...) �'-.. ' �
� i
Ownor ID ventietl Dy tl�rver'9 Ycense. "�%,Q Vae1 � No � �� Drirela Liconse No. �
!. r:�,_. _ 1 �. ',� ��� ..�
Verincation of Ownerenip py (t�pa_d mament,�i:e. - D�M �aa DAI or Oeetl�: `
DIVISION OF INDUS
❑ I norany cnniry i
permiL an0 Ihai
3a I, iille B. Cal
❑ As owner�Duilai
oermlt Io Oo su�
$ipnature:
olvrs�on ol Indusviali
h iro eicavauon hve (5) or m
o puiltlmg slmclure, scaHoldi
qnia Aaminisvabve Code).
'Lwltl'not employ enyone Io
wqM 6om Ine tlnrs�on.
• � �-i�
„ .�
Satgn pBrmii NumbBr
'�J E::'.��
� taet In Eopl� inlo w�ith a pei
..�aleework, or tlemo4lian a d
.. l / . ;. �
� WOA1 Wlllpl'WWIC IpQY1fB 8
1 '' .. • :/
�
• , r .
a
e
�
�
my license is in Iull
° �' � � �.` �'. f
r�ths tollowing reatan (SeC.,7031.5, Business an0 Prolessions
Niot.tu its issuance; elw �eptiires Ihe applicam br sucn permil
:Mpler 9(mmmen�kq wllh Seclion 7000� ot Division 3 at the
�. Mr violetion ol Satlqq 7031.5 by any apP��cant Ior e permit
��.� l -���.i
K, ena me s�mUura G nd intenaed or ofleretl lor sale �Sec.
ry�w�o Duiltls oi improvea Iheroon, antl wbo tloes such woM1
Ot otleretl lur sale. It, MwevOr, Ihe builtling or impmvxment is
builtl or improve br,purpoee ol sala.).
�
insimct t�e prolncl (Soc, 704�, Business antl Pro�essions
�, and wno coNratla �a.%pIO�BCi wi�ll d COnVeCI4��5)
I
i
Dalo: �
Eapuas:
tles[nnd, will be matle in conneciion with work aut�Onzetl by Ihis
will Ue more ihan ihitly-sis 136) leet high. (C�ap. 32, Grp 2, An 2, Sec.
1he Division al InCusVial $elety, as no1eG eEove, unless such pe�son �es e
Oata
i W ill Iha ap0licanLM piaaonl o�hiWro bWding occupant neetl to lile enE conity e Business Plan lor omergenty response to mloxse or I�rea�enotl relaese ol e hezertlnus
malanaY! ❑ Yu ! 0 No %r� �
i5ection 25505 C1 Ilie CalAomia NealM,antl Sefely Cotlu mquires, wil� some ezcoptions, t�al e Businass Plan be lilotl with ihe Cosle Mesa Fire Department by evury
ousiness whicn fies el eny ono tlme tlurin9 a �aponoa yonr a puanlity ol nazarCous inaleuals opuul Iu or g�eatei Inan a weiyhi ol 500 pounas, or a volmne ol 55 gallw�s,
ur 2W cuoic teet ofeompressetl qae at stantlartl iemoa�ature nna pressure).
......_....._._._.__.__ ...............�T."".�....._......_...................................................._........._.._......._............................................................._....._.._._....................._.... . _.................. ._....._..._.._.__.................._..........
2 Uces or will Ihe apDlkant d D�esent�or tufure builtling occupam nuetl to Lle a regi5lrulion form lor acWely Oaiartlws maierials? ❑ Ves ❑ No
ISecbon 25533 0l Rp Celitornia�Healih and Sa�ely Cotle, wnh some erteplions, ieqmres regislretion wnn Ina Costa Mesa Pire Depanmem by eac� �usfnnss wnich at Einy
unu �mre nes un nanA 9.q��enliry ol acutaly haxartlous mxtenals equal to or grealer t�an e woigni ol 5W pa.ntls, or e wluma ol 55 gallons, or 2tq cubic tuei of
compresseo gas el slBnWrtl IemperaWre antl prassure).
.._ ..........._ ................_""......_.........__.........._.....__..........__.._.........�._._.......____.............._._._...__.._...........""_"_____.._........_.....___...._._....._.....�.._...__'__......___..........._._........_...._.................__.
3 Uoos or will Ihe applicanl o� OroseN oi W W ie Dmltling ppcupam nuetl to p�a0are en RMPP (Risk Managemenl antl Prevanlion Vrogram lor atutoly hazar0ous matenalsl7
�}« ❑�lu
�Snciinn 25534 ot 1he Calibrnia Healm antl Safery Catle pmWtles Inal Ihe Costa Masa Fua Dopanmem may require ��e prepaietion, cetliliwlion antl �iling wilh Ihe Piia
Uepdttmbn� ol en RMPP Uy busmesses which are repmfetl lo rBgiSier etulely �aZartlous melunels wilh Ihe Rre DepaRinenl.
. _.....__ ....._.._ . . .................... . .. _....... ... ....._....... . .,. .. ... ..., . . _ ... .., .. ...
4 b an Nldf P is piespnlly rb0����etl has Secnon 25534 ot i�o California Heaiib and Salery COCe �een lully comphetl wi��7 ❑ Vo5 ❑ NO
........................_......................,._..... . ........_..............._............................................................................................................................. . ...... _ .... ....... . ... ... ..... .. . ....__... ... ...... .....
5 Uuas or wtll Ine upUhcnm or presnnl or IUW re builaing oCCupaN repuire for �he woik whith i9 IM1e sub�oCi OI iMs a�pli�;��ion eperm�l lor such conslmcliun pr �motliticalion
trom Ne Sautn Cuesi An Uualny Managemoni Dis�nc� or Imm eny o�hei air O011uli0n coMrol tlisvicl o� agoncy? LJ �oa LJ No
ISecuon 65BS02 M uio Cabiomia Govemment Code ruquime me� ino rapuosiotl mlormauon be tumis�etl on a0�lication5 br nomresitlential Ouiltling permns).
..........._ ................................... .......................... ..............__...........................................................................__........................._....._............................,.._.........._........,....... .........._....._.. ..........................__...__................._._......._
fi W ill uny par: ol Ihe lactlny tu ba conslm[tetl unCer Iqis pormil bn wiihin 1000 feet iwm IOa outer bountlerias ol a schoplV ❑ yes ❑ No
tll yes", tne ta�abty ��ust muet inc repuuemeni of Seaions 25534 entl a2303 0l I�e Cahtomie Meal�h antl Salety Gotle).
__.._............_..._..._ . ............................................................................................................._.....___._..........._................................_..._...._.._.___.......__._.................._.._._.........._................_.......__........._........................._......
7 il a Garmit Irom Inb South CoaSi Air Qualny Managemem Dislrict or omer air OOIWtion ConV01 tlislnCi Or agenty is reQuiretl lor fhe work which rs itia subject of Ihis
aVu��cauun, neva all ot tha tlisclosuros pwscribea by Caiifomla Health and Salery Code Sectian ap3p7 been matle? [] Yes ❑ No
.._..... ...._ ............._...._._..._..._.................._.........._.........................._...._......._..._........................__._.._................"'_—__.___.._............................_.._...._............_....................._......'_'.............._._..._......_.............__...........
fl (If ye5', u11aG� coni�ictllo o� compliance I�om Inu aOPropnale eir pOIlNion LOntrd oMice�).
CEfil'IFICAT[ OF COMPLIANCE: I ceroty Inat unUer ponally ol perjury Ihe inbrmation gwan ebove is mnea. I aqreo to compy with all stale lews enn ciry nwinenr.as
regarmng Hazartloys Mawnals nnd Emissions.
Signawre: Gato:
CER7IFICATE OF COMpL1ANCE AND AUTTIORIZATION OF ENTRV: I cetlity untler Denolty ol potlury t�al I have read rtiis epplicaUon antl siata mat Ihe mbrmatinn giveu is
Cortocl. I BgrU9 �0 Comp�y qilli 911 slaie laws Bnd Cily o14inBncBs re�aiing Io builtlinp conSVUGlion, en0 2Wnoriz0 rep�esanlalrvos ol I�B CM1y ol Costa Mesa lo entoi upon I�B
abwe�tlesc�i�etl propony tor inspection Durposes. I egreo noi to acupy or allow acupency ol any builtling aut�orixetl �y Ihis pormit until hnal inspoction.
Signalure Ot Legnl Owneqs)
AnC/Or Futnunzetl ApO��cant
�pDE �. �NSVECTIOA iYPj
1616 ,�SF�.iaeU System Flnal�Fin Preve
72E6/, Pod�S�MN�'��a »(� �r.r,.•\
2�0:��*C,�Ffrel��Re�Rocil "1.."= �-""
hr..j:.�>rJ
201."„� Final BIocWR�taininy Wall
F . ��. �,. �;a
202 ,y�:F,�el Pectary Firo Plars �'^�
\ =� �., ti L,, , . . .
203 \ Fiiul srpn��-r�i�• : ,,;�.. .
�UVy�. . ���'-r�.a.
20a FHW DOmditlpj �+..��+,��
Q�jE INTITI�LS
;i�'',;.✓' "` ��. �'x
'.:/ t . ..': .
F. 'tl F`?'� ,
_. . '�...__ __./" 1.. . i
y
SOOE � INSPECTION TYiE
"_.: .
z�o .,
I
212 ,
r..
Y20 .
>. '
22Z ,
1
Build�ng�Occ�pency
„ Costa Mesa Bnilding Department 4�� APPLIpCATION FOR PEItMIT
� 111 EABT 20th STREET � p U I L D l N G '
� '� COSTA ME8A, CALIFORNIA .
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
ReceipS No. �Pej mit No.
BuI1dM9 �--j�/ ( �G,Q)3 �`j
Add�eseJ 7(4 / �
Received by Date Rec'd. Dah lasued
Costa Mesa. California i I � I /�. —. r
Nearest
or
of Lot .
of
iting BIdS
iack Line
r
�
No.
� I I �5-3 al a-
•�No. of Bldga /
� Nowon Lot
No.of No.of �
i1/G I Famllles� I Room��
� Rear Yard,,��—
Sfde Vard �' = .S
ON OF WORBai�-� . S, o�
3tion I I Addition I
�g I I Demolish I
No. of � ,
COStB,
7 _ �-J
C2,lifoTnlA�
:ring � Coverin ' ApPR(�VE�.S
a.�e of New
Buildirtg Foundation Location Inspeetor
Forms, Materials,
Under-Pinning
Frame: Fire &tops,
9raci�g, Bolia
I hereby acknowledge that I have read this Applicatlon
and state that the above is rnrrect and agree to comply Lath. Int
witli all City Ordinances and State Laws regulating
huilding fonstru 'on. - Lath. Ext
Signatureaf ' �
Permittee �'y^� Plaster, Ini
Authorized Agt. Plaster, E�ct
Valuatlon Permit Fee $ r2� — Masonry Relnforced
Plan Cheek $ O” gond Beam
: � 3� To��
Fee $ � � FINAL
o.. nne a_an vwrt e_vs
2
Date
W
—G
�
O
�
�
Sfiow locat(on and d(stances from
`j property Ilne and between bulldings
1
�
S
w
�
0
1� .
0 5
6t b
�y :.
o,
.-,