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Home My WebLink About2011 CHARLE ST - Building Permits - - UNITS A,R,C,t,t,?,G,H OWNER GORHAM, CHARLES H. DATE 7-7-61 JOB ADDRESS 2011 Charle Street BUILDING PERMIT NO. 111660 GENERAL CONTRACTOR K. W. Koll Construction Co. VALUE $ 37,806.00 AP.No. 115-292-39 LOT TRACT FIRE ZONE DESCRIPTION OF WORK 8-unit Apt. hjrig INSPECTIONSAQSQ4„k/ 4080 L/ rilt.iTE I GROUP H TYPE V ZONE R-4 Ta>'xP rground SOIli'J/G/U.G. Waters _ _ _ SUBCONTRACTOR PERMITS ISSUED L='7:aground Gas DATE NUMBER Overhead Water and Gas Rough Heating ,L u/ 91-6--Q / �_ !' t ._ ..:! ' - — • 3e 8'5 _ Rough Plumbing / .�,..ti . Ii. 1-i76a/ _3 ore ^') Miscellaneous- .i / _J � � Prop. Swr.'LinertIuuse`Ob�St. Swr. ',(f¢9/jar 2� ( /0/0-/9-Ci .�/ SC4 Sprinkling System �T( Heating, Final ,( a/ /-J-CJ. r $•L Plumbing Fixtures 44_ 1 Final Gas Testis A_ga.ow Construction Pole L tip Underground Power ` � � Rough Wiring /J q. tr.er'f y �2' / )` y Trenches (/Forms /.'Steel j 74 c . "VA-- l i t' IP Floor System ij Steel Reinforce Chimney Re-Rod P.c./1 Bond Beam 1 Sheathing Gj ,,.C.. A Ca ^( I �f Fragile and Flashing 14 / / ll'l, l Zr,;;V'*??'''.;�g, In Out ,gr �Py 2 R `-4/ I' Itter, brown coat 9y--S�/ /CI- '-/O -(/ �,' Plumbing Fixtures, Final S /2.-..7.5-..&/ Electric Fixtures, Final /24/4/ , Building, Final ,6U /'3 /'o' I OCCUPANCY `� I . n Form 210-5M-11-59 S-B P UNITS A,B,C,D,E,F,G,H pan FOR SPECIAL REQUIREMENTS 14660 • LAVNbRY OWNER GORHAM, CHARLES H. DATE 7.1.47,h61 61 JOB ADDRESS 2011 Charle Street BUILDING PERMIT NO. 31661 GENERAL CONTRACTOR K. W. Koll Construction Co. VALUE $ 1,961.00 AP.No. 115-292-39 LOT TRACT FIRE ZONE DESCRIPTION OF WORK Det.utility room INSPECTIONS f,i// DATE I GROUP J TYPE III ZONE R-)I Wf-'1-irground Soi1791{ U.G. Waterh/v litnt.6e. PERMITS ISSUED I ls=_ rground Gas SUBCONTRACTOR DATE Mind_ �J Overhead Water and Gas Rough Heating y" / // / '" �/ I- J�L Rough Plumbing )n.2''�uyr_'i vcr ✓w t,'s 7_/�_6/ 3o Sc ; � :/ CITY OF COSTA MESA - t � BUILDING DIVISION >1 "1 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4. IK. . PERMIT i +41' P06-00573 (714)754-5273 • Fax(714)754-4856 • www.ci.coste-mesa. Y.f'UMBING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2011 CHARLE ST Status: ISSUED Suite No Applied: 07/21/2006 . Issued: 07/24/2006 Vicinity: Parcel Nunmber: 42209214 �/-� Applicant: ANTHONY, PATRICK \lf Address: 1556 S ANAHEIM BLVD ISSUED BY: V STE F Phone: 714-758-7725 ANAHEIM,CA - " - Zip: 92805 Owner: CULLEN, CONNIE L TR . - Address ,8606 SOLANO CIR#1003C - Phone: HUNTINGTON BEACH,CA Zip: 92646 Contractor: PACIFIC COAST COPPER REPIPE COMPANY ,' Address: 1556 S ANAHEIM BLVD . STE F Phone: 714-758-7725 , ANAHEIM,CA Zip: 92805 License: 661428 SCOPE OF PERMIT ' . COPPER RE-PIPE - ' • FEE SUMMARY , AMT QTY - AMT QTY , AMT QTY ISSUE FEE $23.50 ' ' - Laundry Tub/Washer _ ' $0.00 0; " . \Sump Pump $0.00 ',0 Backflow 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 " _$0.00 0 Drinking Fountain $0.00 0. Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00. 0 Expansion Tank $0.00 0 Sink,commercial . $0.00 0 Water Re-pipe - ' $9.80' 1 Gas Earthquake Valve $0.00 0 Sink,Floor ' ' $0.00 0 Water Service ,$0.00 0 Gas(1-4 outlets) $0.00 0 Sink,kitchen $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 - _ ..Sink,service/mop $0.00 - '0 .. _ OTHER $0.00 Gas Repipe ,. $0.00 0 ' ' Spa(private) ' $0.00 0' - VIOLATION $0.00 Gas Service $0.00 0 , Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 " • TOTAL CALCULATED FEES: $33.30 'COMMENTS/SPECIAL CONDITIONS ' -'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 24464a(rvoo) DECLARATIONS • WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain e 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 main in 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'c nsa�rnn insure ardor nd policy number are: _ -7 n Carrier: 1 /r-(' Pi t� Polity Number: --/V, -77 ((This section need no be completed) the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performancea work for fah this•: Ls issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Califo ,a*d ag e t•:t if I shouts e subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisi / Applicant Signature: ./ Date: 17 '-' ``,,-Z T 0 6. WARNING:FAILURE TO SECURE WORKERS'COMPEN W ON COV -•GE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(SI C0,000).IN ADDITION TO THE COST OF gm, PENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed updeyprovisions otChapter 9 r�r''a'mencin. ' ith Sect• .r)of Division 3 of the Business anylrofes iops Code,and my license is in full lorce,antl effect.Lit.% f (p (il �j),jj• / [Class 4, —. C/�_✓✓ S•• Contractors Signature:^ NI/ Datei�� V- a L CONSTRUCTION LENDING AGENCY:--- 0 GENCY❑ I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: I 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 fore permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500).): ❑ 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 drivers license. ❑Yes 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: ❑ 1 hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(38)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 Safely,es noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 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 end pressure). ....bu .____ 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 ❑No _ 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this is plication aaermit for such construction or modification from the South Coast Air Duality 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). 6 Will any pan of the facility to be constructed under this permit be within 1000 feet Tr7CnT the outer boundaries of a school? 0 Yes ❑No (It 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 Duality 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 Safely Code Section 42303 been made? 0 Yes 0 No 8 (II 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 ' under penally 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 ordina. building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection p es.I agr:.• of to••• ,r allow occupancy of any building authorized by this permit until final inspection. Sign re a j�wner(s) �/ Dat 0 • CO d/ :rized ••- 1 / L Date . CODE 1, NISPECRONTYPE PAIL IXT1116$ CODEt INSPECTIONTYPE Pit¢, MI= 1618 Fixed System Final Fire Prevention • 208 Final Mechanical ^ xL p 1266 Pool Spa Final 208 Final Plumbing I-d�-GSC IJnl 200 Final Re-Roof 210 Final Electrical 201. Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition • . 250 Final Building/Occupancy 1.. ` -- ' CITY OF COSTA MESA 4 S-\ BUILDING DIVISION }4 •,;. ,� DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER F t tis PERMIT J 001411te P06-00592 (714)754-5273 • Fax(714)754-4856 • www.ci.costa•mesa.cs.MBING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2011 CHARLE ST YL Status: ISSUED Suite No Applied: 07/27/2006 . Issued: 07/27/2006 Vicinity: Parcel Nunmber: 42209214 Applicant: ANTHONY, PATRICK Address: 1556 S ANAHEIM BLVD _ _ - __ ISSUED BY: STE F -.- Phone:'--714-758-7.725 - ANAHEIM CA '-/: -- ,-Zip: 92805 - Owner CULLENICONNIELTR t • ' -. : �:':,\ Address 8606 SOLANO CIR#1003C> _' _ - r ' i -_�� ` ' /HUNTINGTvON-BEACH,-CA:.-i Zip: 92646 --�� Contractor. PACIFIC/COAST COPPER REPIPE COMPANY \/ , Address: 1556 S ANAHEIM BLVD �- A v\ - v /i , /,,/� STE,F��- Phone.; 714-758-7725 \'i\v / .'7 A -V ANAHEIM,CA Zip:192805 ,_ _ _ .�- •v),. `I) i J' //,2* _ �License661428>_ - l \ / / 1 4C---/:- �_ - SCOPE OF PERMIT- 22 1 i,-- / COPPER;RE-PIPEFOR 7 UNITS AND 1 WATER HEATER. �. ,:/ - , \V '(/ SUPPLEMENTAL-PERMIT FOR PO6-00573. C' \ A I: , f. _; G/ cip-i-- -- - - - -FEE SUMMARY ,,.. V - AMT OTY.1.. _- J \L./A L AMT' ,..QTY, `. \ AMT QTY ,ISSUE FEE . ' $23.50 '- = / -'Laundry Tub : $0:00 0- - -. - Sump Pump ' ' - 0 $0.00 ,Backflow irrigation i '� $0.00 0`, Landscape Irrigation $0.00 `0`,,- / Swimming Pool ' . $0.00 .0 Backflow Preventer ' $0.00 0 P-Trap - $0:00 L0',. Trap Primer $0.00 0 Bathtub � .,,) $0.00 0 is z.' :I Pressure Regulator, -;$0.00;'.0;,+;t Urinal I-, ' _`$0.00. .. 0 ClarifiekSystem ' - $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 I. • - ` Receptors -• - ' -- -$0.00 ,i 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,Ra nwater \\, �V. $0.00 0'; Sewer PrivatecLine_ $0.00 0 Water Closet(Toilet)'em, $0.00-( 0 Drain,Roof ` - / \$0.00 0; Shower '':.--.,-",_.'•• $0.00$0.00 0 Water Heater!vent /$12.30 1 Drinking Fountain-' \$0.00 Oi, Sink,ba[ -'"` '' •r'`t$0.00 0 Water piping Inst or Re Expansion Tank $000. 0' Sink commercial , $000 - 0 Water-Re-pipe :$68:60 7 Gas Earthquake Valve ' $0.00,:-..k0;,, _Smk Floor . $000 -=10 Water.Service `, ) :$0.00 0 Gas(1-4 outlets) ' $0.60„\.„ 0 1 C-L F, Sink kitchen`' ti• , 50.00" "0 ?'%Water Softener'v, x,. .$0.00 0 Gas(Over 4 outlets) /$0 00 A 0� < Sink,service/mop „, . $0.00 0 ;OTHER/,- : ' .'$0.00 Gas Repipe .�\ /2,50.00-v NO"-:::- <-,,, -Spa(private)� ' $0.00 0 j VIOLATION �. / $0.00 Gas Service , .� $0.00/, ,0'"-7 Spa(public)= $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,011) $0.007 .0 "-..�� _ - ,REINSPECTION, $0.00 0 Interceptors(Sand Au -)' :-to $O 00 0",H - > _ ,( , A'"�2' /,z N�'� V (- r``� --- T- , TOTALCALCULATEDFEES: $104.40 (COMMENTS YSPECIALCONDITIONS - % --� / 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. 1/ 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: 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 A 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 worker,'co pensetion I suren a carrier and policy number are: Carder: 5fc--ehC Poli�ber:--l5'�79 t(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 w s unit is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Califomia, agr a th if I sh come subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: D ie:--- 7-...7 7-0 G WARNNO:FAILURE TO SECURE WORKERS'COMPENSATION ERAGE 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 rngT OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: 1 hereby affirm that I am license der p visio of Chapter• /mmencing with Section 7000)of Division 3 of the Business§q1 Pro epssions Code,and my license Is in full force and effect.Lic.# Class N. (� 6 _Contractors Signature: `/ Date: 7- cZ7-o6 CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors Ucense 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 properly,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 drivers license. 0 Yes 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,and that no building structure,scaffolding,talsework,or demolition or dismantling thereof,will be more than thirty-six(38)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the 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 ❑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 ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? DI Yes DI 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? 0 Yes ❑No (If"yes".the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which Is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agr:. • o. cu•,or allow occupancy of any building authorized by this permit until final inspection. Sign./ •• Lei ner(s) , / Date /�a._ tea-. 7 a n G F ^ Tut •rized Ap:of '' -,. Date WOE I INSPECTION TYPE OM MALS CODEC INSPECTION TYPE IMIE Ifs 1616 Fixed System Final Fire Prevention 206 Final Mechanical . 1266 Pool Spa Final 208 Final Plumbing 9/-00% /a L / 200 Final Re-Roof 210 Final Electrical ,,/_� - - (W 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 .4--- A- 11.60 FEE RECEIVED T • COSTA MESA BUILDING-SAFETY DEPARTMENT �� JUN 7 051P. O. BOX 917 COSTA MESA. CALIFORNIA FINANCE DEPT. P. For Applicant to Fill In Completely APPLICATI&NYF& GRiATMESA ' TMPERq�p 'g`} l'C'l� BUILDING SGL-t'//Pz' F C BUILDING ADDRESS PO i, s4 0 r` C `- 1' - COSTA MESA. CALIFORNIA For Office Use Only Chj a /es / 7 1 I RECEIPT NO. I PERMIT NO OWNER COe-- MAIL tJ / r RECEIV�D'BY• DA RE D . D T ISSUED ADDRESS'S/70 /70/T/ �•' r• /C I -�,'/I / 7- / ` AA TEL. BUILDING CITY G'os!`O. /�/G'�Q . NO.Q/�/O ADDRESS / ARCHITECT TEL' 0-• • COSTA MESA. CALIFORNIA OR ENGINEER• .te ✓4/74-s NO-_�/Q .4 1111!! ' a / l ADDRE-- ' .5.aO or 0 FIRE /ZONE TYPE It GROUP_/4 .ct:r14 OWAPPROVED BY • DATE ADDRESS S.-5S /C7 C en 71/0 ZONING g_a..--)T,�. ZONe/ HO.OF UU88 OFILDING Y NEW �> I CITY I I (� I PA LNS2 I B LEGAL • (Y/ /% ..1 /9(-•3WL'/ -Jt.L(/ / 3 • y DESCRIPTIO OF LOT I SOP O A\ �, 7 NOW ON LOTS•- aaL.. / ^ /f1-/{--11-4-J n-�L J Q A.P.NO. �I `J �` /l �lJ+ USE OF YARDS ALLOW EXISTING OF BLDG APPROVEDEVEOS ED /SETBACK UNE FROM pis CI (CENTER UNE ST.) CENTER OF STREET FEAR YARD /SC) FRONT fid FT. ,� ' A • IN. SIDE • I LEFT 1/44;0 I RIGHT AC;0 R.SIDE /2/IST. /.--JCC// ' IN. DESCRIPTION OF WORK 7 FT. ( 1N. L.SIDE // NEW I • ALTERATION I II ADDITION I R . : it �FT. �/ -I IN, REPAIR I I MOVING I (DEMOLISH I 6;'"ROV�• /��.(y."yLy/ �DATEg /�IyG('{(7 / UJ SIZE BUIL.DING //6ye RNO. OF OOMS `'5 a STORIES • 4 - "' J 11 i l l tiJ w EXTERIOR •y ROOFCO/l' .OP - TT!! �R ^ }TI 1�+ COVERIN• CCO I COVERING s .`I ' V I; iA h}• 7H US OF BUILD( G AND WO-K Tp BE P8R'O'MED 7�A�[�} (7 •4 at " I O PIM() I rI _ --_ O ./ Co/.7-67/rL CT/On O as ru//cI/•n--.s acCC. 7, /n -,.c VAR. No. I APPROVED _=1 - - I HEREBY ACKN•• LEDGE HAT I HAVE READ THIS APP CATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE a AND STATE - THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OP ESTABLISHING A PERMIT FEE ONLY. In PLY WITH . I ORDIN -S aLJ ATE 15 RIM) TING R� BUILDIN• OHS -i CTI•N. / i / F-LUATION SIGN RE OF i- FC PERMIT FEE $ •�'� Ist PER TTEF /{� )/J[/ _ o $ ,J �" �� PLAN CHECK $ (J • 3 C .f` L'UTHORIZED AGENTY TOTAL FEE , r 7 C 0 b Special Requirements:, 1. Installation of adequate screening around the parking area by the applicant, at his expense, under the direction of the Director of Planning 2. Two for one usable off-street parking_under the direction of the Director of Planning - 3. Installation of residential sidewalks on Charle Street the full width of this property by the applicant, at his expense, and also concrete driveway approaches, underthe direction of the City Engineer. ,,..,_ FEE RECEIVED / - 14661 r ;- JUN 7 1%1 COSTA MESA BUILDING-SAFETY DEPARTMENT .FINANCE DEPT. P. O. BOX 3i7 COSTA MESA. CALIFORNIA CITY OF COSTA MESA For Applicant to Fill In Completely APPLICATION FOR PERMIT fl OR Br NT BUILDING �TT /1 C64C`,-,C.�- BUILDING ADDRESS `�- COSTA MESA. CALIFORNIA For Office Use Only L Y / I RECEIPT NO. I /6-IJ T.C/NO.1 OWNER �// a ries N. �O/'/')QIYJ w/78 7 7175-6 s�A�(V G�/p/(/ MAIL / O dADDRESS /�/ C� RECEIy&pjov I °V' - W I / 1 6 C I TY`�••T 0 /Y/ C-34 N `/76024. BUILDING ADDRESS ARCHITECT ENGINEER j�e 2 e V CTno. 0 S TN LO~ OR .•r7/n0 COSTA MESA. CALIFORNIA ADDRE63� e Po a C r-/0 FIRE J� kZONE TYPE/// GROUP CONTRACTO5A kV.,OWorX,/r c APPROVED _f` DATE ADDRESS./4- 1•--.4--LC /2/a CG rn / /a ZONING /// 7 /A/� ZONE 1 NO.OF USE OF NEW �,(� CITY �'C7.t3� /Q I ' CSS C? �` %�7 `/ (I/fPLL//Axa �BUILDING y� MIL.//T /1/ /� NO/ ‘-see DESCRIA �PTIoINal. ) 7 / SIZE `/JQ/O �/ 1674'7 � 6• `J INOW 0ON LOTSV A.P.NO. `� c- /� �� OF LOT/`/- /� V / USE OF YARDS EVES EXISTING BLDG ��(/. 1. APPROVED ALLOWED CENTER LPINE SE FROMEET // • . O REAR YARD/ v ICER LINE ST.) er ars 'r FRONT /y/ FT. 73-e-471 �., - ,I/` IN. SIDE YARD I LEFT /S.O I RIGHT /`-3' s0 R.SIDE / 9- FT. / ` 1 IN. DESCRIPTION OF WORK L.NEW I tLTERATION II ADDITION I REARS RFT. ' IN. REPAIR �•.-I� I� ROOMSG I SII DEMOLISH STOR ES BY `7 I �e �`DA DATE 9//‘ / BUILDINGyIA NO OF P / / ( �/ I COVERE� /p� II/NC1.O LLL .A/�COVERIROOF �O//r/ C'0 V USV T// -/7N�ANDLWPRKr,BE PF pR� ED r/ ,�/ r cora 4%1 c' //ooFn c�.Y ) ilre-ri, I Occe.'JOr'y 7 o A Ts/ 1 HEREBY ACKNOWLEDGE A AT I HAVE READ IS APPLICATION T E AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND ACRE TO COM- - RPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL C •RDINANCES ANDE WB r•ULATINO / • BUILDING COdird. �r / VA ATION SIGNATURE • - /. '� ' - (•L PERMIT FEE $ 17� PERMITTE• �// / // a S� 5v / Y PLAN CHECK $ `/ _ AUTHORIZED AGENT ITOTAL FEE $ 11,,2 . 0