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Home My WebLink About2367 ELDEN AVE - Building Permits I ' CITY Ok COSTA MESA• 4 i ►.@ BUILDING DIVISION F �i 8 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER' to IIPPNII !II PERMIT r1 9 -'°r puma se B04-01629 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 2367 ELDEN AV Status: ISSUED - Suite: Applied: 09/17/2004 Vicinity: ROOF Issued: 09/17/2004 Parcel Number: 43927212 Zoning: Applicant: R C I ROOFING COMPANY ISSUED BY: Address: 1923 CHURCH ST - -. Phone: (949)650-1079 COSTA MESA,CA - Zip: 92627 - \ Owner KLASSERT,JOEL - . Address 2367 ELDEN AVE - % - Phone: . ', COSTA MESA,CA • - -Zip: 92627-1558 - � - - SContractor: ' �'IRC I ROOFING COMPANY ' II Address: 1923 CHURCH ST- ' , - - Phone: (949)650-1079 COSTA MESA,CAS Zip: 92627 - License:7 704392 Arch - Eng: - Address: Address: • Phone: - • Phone: - Zip: License: , License: SCOPE OF PERMIT TEAR OFF EXISTING ROOF.INSTALL 2 LAYERS OF 30#FELT,30 YEAR DIMENSIONAL,COMPOSITION SHINGLES AND REPAIR/REPLACE SHEATHING AS NEEDED. 13 SQUARES INCLUDES'ATTACHED GARAGE. / - ' FEE SUMMARY ' Plan Check:- - $0.00 - Calc Valuation: $1,944.00 Permit: $69.25 - -_-- --- — - Claim Valuation: , ; $1;944.00 SMIP Res: $0.50 .. SMIP Corn: $0.00 • i�_ /, Other $0.00 Inspection: ', $0.00 Notal: $6975 % ' / `_, ,PLANNING &ZONING _ l., SETBACKS MAIN STRUCTURE-,Front 0-.0 ;,, - Rear. 0-0- - Left_ 0-0 - ",Right -'0-0 . r / 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 it 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 end 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(SW) DECLARATIONS k WORKERS'COMPENSATION DECLARATION: i 1 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 Labor Code,for the performance of the _ work for which this permit is Issued. ja.-�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. r----My.workers'compensation Insurance carrier and policy number are: `Cariec'� Policy Number: ��(_ThI ecaon need not be completed it the permit is valued at one hundred dollars($100)or less.) I certify that in the performa-ce 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' compensatlo • •�:,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith corn lywi --hese,provision . a �TcantSign: ure:aer Date:_ — _O WARNING:F •_ 'CORKERS'COMPEN GE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(6l00,000),IN ADDITION TO THE COST OF r.• -a_, TION,DAMAGES AS PROVIDED FOR IN SECHON 3706 OF THE LABOR WOE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I h ereby afljrm.that.l.-•• ••- nderr/i�rop l s Chapter 9(commencing with Section 7000)of Division 3 oLthe Busines nd��'° sions Code,and my license is in full force-andeffect: c:N'^"' On L rCGlGlass• -v'1 Dont`r�cta�rs.Sig :lure: "--` • - `uetee-•- CI—(7 — 0`•/ CONSTR TIUC ON LENDING AGENCY: • r------____ . O 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 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 toe civil penalty of not more then 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,em 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: 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 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 ermit for such construction or modification from the South Coast Air Duality Management District or from any other air pollution control district or agency? D 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 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). 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 B (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 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 ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described pro for Inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. fatur•, e Of Legal Owner(s) , -(7 -0Det e� • .•.,i. orized AppllcehC Dat ClINSPECTIQNTYPF EMMA - CODE INSPECTION TYPE PATE ILLS 1616 Fixed System Final Fire Prevention 206 Final Mechanical • 1266 Pool Spa Final /� , 208 Final Plumbing 200 Final Re-Roof q—a -04 210 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'BuildinglOccupancy —. ' • • 9 CITY OF COSTA MESA 4 BUILDING DIVISION f 'gin a DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER �" PERMIT IB02-00425 -`*POnarso e`• • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.a.usNG PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDIJob Address: 2367 ELDEN AV Status: ISSUED Suite: Applied: 03/27/2002 Vicinity: REAR YARD Issued: 03/28/2002 Parcel Number: 43927212 Zoning: 1� Applicant: REYNA, MIKE ISSUED BY: CCS Address: 10 SAN ANDRES _ - ((// - = -,Phone: 949-589-3660 _ RANCHO SANTA MARGARITA • Zip: 92688 ; - Owner KLASSERT, JOEL � -,v ' \ Address J2367 ELDEN AVE ` — - • i ./, v `. - Phone: /COSTA MESA,CA - Zip: 92627-1558 Contractor: "/ - . Address: ' �' -- . ' Phone: " • • Zip: ; Licenser - - - Eng: Address: - - �V ` - Address, . Phone: _ �j A� Zip: - % License: , ' License: SCOPE OF PERMIT / 8'6"x 10'SQ.FT. PATIO COVER._, " , _. .t: . FEE SUMMARY - - Plan Check: - $33.12 - Calc Valuation: • -$1,305.72 Permit: $50.95 - i Claim Valuation: • 50.00 SMIP Res: , $0.50 ;SMIP Com: $0.00 • ' Other: $0.00 - , - Inspection: $0.00 ." - . N '-Notal: , $84:57 . •- _ - �� H-. �� • PLANNING &ZONING :''' ' / /� SETBACKS'V '/ MAIN STRUCTUREFront__/'0f 0 ' Rear� x;16-0_ Left / 6-0 Right',,10;0 , - " '' _ .� ACCESSORY Front 0-0 , , Rear 0-0 Left 0-0 Right .0-0.,"y ' ' PARKING Existino: �0- -- Required: " 0 . Proposed: 0 NOTES: " - 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(ero0) 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 ills 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: - Camier: • . 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 should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. 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 DOLJARE($100,000),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: 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# 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: 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 subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the properly,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: 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 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 appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? PI Yes ❑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 (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 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. ;ire Of Legal Owner(s) Date „.7.7 L An Authorized Applicant Date CODE t RISPECRON TYPE PAM MALS CODES INSPECT10N TYPE PATE. RIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site • 204 Final Demolition - - 250 Final Building/Occupancy .- Li—/O`d,2 I - • t` 9 ' ` CITY OF COSTA MESA • BUILDING DIVISION }y ,�, DEVELOPMENTTSERVICES DEPARTMENT PERMIT NUMBER F t � eg t PERMIT / t)• IPINI J B00-01775 YY (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.casisING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDJob Address: 2367 ELDEN AV Status: ISSUED Suite: Applied: 11/02/2000 Vicinity: Issued: 11/13/2000 Parcel Number: 43927212 Zoning: Applicant: SULLANO, BINI ISSUED BY: Address: 10 SAN ANDRES RANCHO SANTA MARGARITA Phone: 949-589-3660 Zip: 92688 , Owner: KLASSERT, JOEL& MARY Address 2367 ELDEN AV ` Phone: - COSTA MESA,CA - Zip: 92627 • Contractor: • - " Address: . . " Phone: , Zip: "License: Arch : Eng: Address: Address:, , Phone: Phone: Zip: " License: License: SCOPE OF PERMIT . CONSTRUCT 220 SO. FT.COVERED PATIO 6 FEET FROM POST TO'SIDE P.L.AND WITH A 2 FOOT OVERHANG. r •CONSTRUCT PER CITY STANDARD. - - - - - - - ' " ' FEE SUMMARY - Plan Check: $63.21 . _ _ _ - Calc Valuation: _ $3,546.40 "Permit: $97.25 - Claim Valuation: . Woo SMIP Res: $0.50 , ' . SMIP Com: $0.00 • - , Other $0.00 'Inspection: $0.00 �` - Total: $160.96 PLANNING & ZONING SETBACKS, . ' ' MAIN STRUCTURE Front 0-0 Rear 0-0 _ Left 0-0 - Right - 0-0' ' ACCESSORY Front 0-0 Rear 0-0 ,- --• ;- Left 6-0 - Right 0;0 PARKING Existing: 0 Required: 0 Proposed: 0;" NOTES: .0-- • - NOTICE — 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 2448-46(6/00) • DECLARATIONS WORKERS'COMPENSATION DECLARA I hereby affirm under penalty of perjury one of the following declarations: a ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed 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 become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML 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,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.M 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). 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 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 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,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 ❑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 appermit 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? ❑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 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 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. L Signature Legis) / /)//�/fie, �{• AnWOr u prized Applicant O / �Da`te CODE E INSPECTIONTYPE DATE REIMS CODE! INSPECTION TYPE PATE MOMS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203: Final Sign 222 Final Site 5---a-417( � 204 Final Demolition 250 Final Building/Occupancy 7 --lg 417( ct- -- , 8721 ,i E R CEiVED FEB 27 1959 C/% COSTA MESA BUILDING DEPARTMENT FINANCE DEPT. P.O. BOX 317 COSTA MESA. CALIFORNIA CITY OF COSTA MESA FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT ARESS`36 7 „EA- e A/ an. BUILDING DD COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY G RECEIPT NO. PEE IT NO. �A OWNER - nes S I .S/ IA/ (/ 0e/ MAIL T j._ ( / fl/E/CElyy�y BY DATE RECEIVV 'jOATS ISSUED �//� ADDRESS /3 o fJjy�.//C.' A 4.1.;5 O A jC/I .(7C,a!7-S 9 J - //, / CITY `OS/R /%C .S. TNO. ADDRESS tEL. BUILDING ' ARCHITECT DC_ COSTA MESA. CALIFORNIA OR ENGINEER NO. . ADDRESS ` OFIRE FORE CITY LIC ., ZONE /(�, PL �' 1• .TYPE GRO P J CONTRACTOR, ()/C'J /�f 1 AS (((0 NO. 9�9 / ` I 04 / ${// i ADDRE55/•.�.j,JO.//ASN (}I✓13 NO. APPRTEL. V, Il�� DATE / LEGAL LOT` r. IJ (CORRECTIONS DESCRIPTION Noi jyt St BLOCK TRACTS A.P.NO. // /1 " (/ 12- I ) ' ^� SIZE /i j� No.OF SLOGS. 1 S r}( OF LOT `j4 /\ /R3 y NOW ON LO/T l,. . � �`.f USE OF �_ / 4. C/�!1'-� /� I EXISTING BLDG. rQe,LpLLw�� Ci(�[.LNr i , CITY r '�� P,.-�A ) IiCi ✓a^'v t''r. SETBACK LINE T SUBJECT 'In DI n CENTER OF STREETM Si REAR YARD ` I n -•. I. hGV. SIDE YARD RIGHT 6 LEFT /0 f-== �� " DESCRIPTION OF WORK BY-PI ,n' `r r DATL444 l NEW ALTERATION' ADDITION 1 REPAIR MOVING DEMOLISH S ZIE DING /082 /s NO. MO .3 / • (� ROOF (/fro ROOMS STORIES EXTERI COVERIONG R WALL.J(accc COVERING 1700 (C USE OF NEW !�J / /�///.�// BUILDING 1� L(Ai(L• �i� I HEREBY ACK NOW • E THAT I HAVE READ THIS APPLICATION AND r STATE THAT THE •E IS CORRECT - D A TO COMP V WITH CITY ORDINANCES STAT w y�L�[� Tlorv. elf .01v ,_ --' / LU ATION / b� SIGNATURE PERMIT FEE $ Y PERMITTEE / { / / $ 9 4/ B� 1 ' PLAN CHECK $ /&• / 0 AUTHORIZED AGENT TOTAL FEE $(..49(0. • Veer