HomeMy WebLinkAbout3241 NEW YORK AVE - Building Permits�
'
�CITY O� COSTA MESA
`o ""'F9 BUILDING DIVISION
i�� 77 FAIR DRIVE, COSTA MESA. CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • Hv�nv.ci.costa-mesa.ca.us
° � FOR INSPECTIONS CALL: (714) 754-5626
�"°""`°� PERMIT NUMBER: M11-00039
PERMIT TYPE MECH STATUS: ISSUED
APN: 13910216 DATE ISSUED: 02/28I2011
ISSUED BY: KJB
JOB ADDRESS: 3241 NEW YORK AV CM .' ' Suite/Uni4: .
vicinity: - . - � �� . � � .
SQ. FT: 0
SCOPE OF WORK: FAU CHANGE OUT. 75K BTU. SAME LOCATION. �
OWNER: BRINK, CYNTHIA L . Address: 3241 NEW YORK AVE Unit:
PHONE: 714-553-0560 . - City/Stale/Zip: COSTA MESA, CA
APPLICANT: JUTARGATE, TUL � � Address: � 6250 PARAMOUNT BWD Unit:
PHONE: 562-984-551�1 � � ' City/State/zZip: � LONG BEACH, CA - �
CONTRACTOR: RELIABLE ENERGY MANAGEMENT License No. 704414
Address: 7201 ROSECRANS AVEUnit: ' PHONE: 562•9845511 .
City/State: PARAMOUNT, CA �.� � ZipCode: 90723 � - � • , CELL: � -
MECHANICAL PERMIT FEE SUMMARY
MECH ITEM FEE: � � ' $38.30
PLAN CHECK FEE: � . � , $0.00
INVESTIGATION FEE: . $0.00 ,
REINSPECTION FEE: $0.00 : '
TOTAL FEES: $38.30
,:•
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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
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 musl be obtained. Failure to obiain inspections and fnal approval will result in the expiration of this permit.
LODE M. INSPECTIONTYPE OpTE INTIlIA�S CODEN INSPELTIONflPE DATE INTTALS
1616 Fixed System Final Fire Prevention 206 Final MechaniCal e�
,1266 Pool Spa Final 208 Final Plumbing —(,+' � � ryi� i-�
200 Final Re-Roof 210 Final ElecMwl
201 Final Block/Re�aining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Finat Site
204 Final Demolition 250 Final Building/Occupancy
�
WORKERS' COMPENSATION DECLARATION:
I hereby affrm under penalry of perjury one of the following declaralions: .
❑ I have and will maintain a certificate of consent to self-Insure for workers'
compensation, as.providetl for by section 3700 of the Labor Cotle, for the
peAormance of the work for which this pertni[ is issued.
I have and will maintain v.orkers' compensation insurance, as required by
sectbn 3700 of lhe Labor Code, for the peAormance of the work for which this
pertnit is issued. My workers' compensation Insurance carrier antl policy
number are:
�rner—���[7)�11ER SE.�—�GT .
1hr5 sertion neeE nIN Ee mmpetetl A ihe peim4 is valueC at one huiMieE dollaislS100) w less.)
„ icyNumbe�.�3/00/7//.
� I certify that in the peAormance of the work for which lhis permit is
issued, I shall not employ any person in any manner so as lo become subjec�
lo the wnrkers' compensation laws o� Califomia, and agree that if I should
become subject lo the workers' compensa[ion provisions of S c[ion 3700 0(
t r Code, I shall fotlhwith comply with these provisions. % �/
VO I
s �L,D te�� —+
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
(`�100,000J, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affrm that I am licensed under provisions o� Chapler 9(commencing
with Section 7000) of Division 3 of the Business and Professions Code, and
my license is in full (orce and effect.
� - ass'#:�: C3 ' C
acas - ature� e'.��
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirtn tha[ there is a constmctbn lending agency for the
peAortnance of the work for which this permit is issued (Sec. 3097, Civil Code).
Lender's Name:
Lender's Adtlress:
Da�e
OWNER-BUILDER DECLARATIONS:
I herehy aKrm lhat untler penalty of perjury ihat I am EXEMP7 FROM 7HE
CONTRACTORS LICENSE LAW (or the lollowing reason (Sec. 7031.5.
Business and Professions Code: Any ciry or county which requires a permit to
consWct, alter, improve, demolish, or repair any strucwre, prior to its
issuance, also requires the applicant for such permit ro file a signed slatement
that he or she is licensed pursuant to the provisions of lhe 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 therefmm antl
Ihe basis for the alleged exemption. Any violation of Sec[ion 7031.5 by any
applicant for a permit subjects the applicant to a civil penalty of not more than
fve hundred dollars ($500).):
❑ I, as ovmer of the pmperty, or my employees with wages as meir sole
compensation, WILL DO THE WORK, and the structure is not intended or
oHered 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 vrork himself or herself or through his or her own
employees, provided that such improvements are not intended or offeretl for
sale. If, however, the building or improvemeM is sold within one year of
completion, the ovmer-builder will have the burden of provinq Ihat he or she
ditl not 6uild or improve for purpose of sale.).
❑ I, as ovmer of the property, am EXCLUSIVELY CON7RACTING WITH
LICENSED CONTRACTORS to conslruc[ lhe project (Sec. 7044, Business and
Professbns Code: The cont2ctas License Law dces not apply to an owner o(
property who builtls or improves thereon, and who contracts tor such project with
a cont2ctor(s) license pursuanl to the Contractors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
]051-06 (3I01)
�
Ovmer ID verifetl by tlriver's license. ❑ Yes ❑ No
Uriver's License No. Expires:
Verification of Ownership by (rype o! documenL i.e. - property tax bill or tlee0):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICA710N:
❑ I hereby cert'rfy that no excavation frve (5) or more feet in deplh into wfiich a
person is required to descend, vnll be made in connection with work authonzetl
by this pertnit, and that no building strucWre, scaHdding, falsework, a tlemolition
or dismanNinq thereof, will be more than lhirty-six (36) (eet high. (Chap. 32, Grp
2, AA 2, Sec. 341, Ttle 8, Califomia Atlministrative Code).
❑ As owner-builder, I will not employ anyone lo tlo work which would
require a permit from the Division ot Industrial Safety, as noted above, unless
such person ha5 a permit to do such work from the division.
ApplicanCs Signature
Division of IndusMal Satety Permit Number _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or Nture building occupant need lo file antl
certify a Business Plan for emergency response to release or threatenetl
release of a hazartlous material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Cotle requires, with some
ezceptions, that a Business Plan be filetl with the Costa Mesa Fire
Department by every business which has at any one time during a reported
year a quantiry of hazardous matedals equal to or greater than a weight of
500 pounas, or a volume of 55 gallons, or 200 cubic feet ot compressetl gas
at standartl remperature and pressure).
2. Does or will Ihe applicant or preseM or future building occupant need to fle
a registration fortn for acutely hazardous materials? ❑ Ves ❑ No
(Section 25533 of ihe Califomia Health and Safety Cotle, with some
exceptions. requires regis[ra[ion wilh [he Costa Mesa Fire Departmenl by
each business which a[ any one time has on hand a quanlity of acutely
hazardous matenals 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 antl pressure).
3. Does or will the applicant or present or future building occupant need to
prepare an RMPP (Risk Management and Prevention Program (or acutely
hazardous matenals)? ❑ Yes ❑ No
(Section 25534 of the Cali(omia Health and Sa(ety Cotle provides thal the
Costa Mesa Fire Department may require the preparation, certifiwtion antl
(ling wi[h [he Fire Department of an RMPP by businesses which are required
to register acutely hazardous matenals with the Fire Departmenl.
4. If an RMPP is presently require4 has Section 25534 of the Califomia
Health antl Safery Code been tully complied vrith? ❑ Yes ❑ No
5. Does or will ihe applicant or present or (uWre builtling occupant require for
ihe work which is Ihe subject of this application a permit for such construction
or motlification from the South Coast Air Qualiry Mana9emen[ Distnct or (rom
any other air polWtion con[rol disMct or agency? ❑ Yes ❑ No
(Sectbn 658502 of the Califomia GovemmeN Code requires that the requested
in(ortnalion be fumishetl on applications tor non-resitlential building pertnils).
6. Will any part of the facility ro be constructed under this pertnit be within
1000 feet from the outer bountlaries of a school? ❑ Yes ❑ No
Q! yes", lhe faciliry must meet Ihe requirement o( Sections 25534 antl 42303
of the Cali(omia Heal[h an0 Safery Code).
7. If a permit from lhe Soulh Coas[ Air Quality Management Dislnct or other
air polWtion control tlistrict or agency is required tor Ihe vrork which is the
subject o( this application, have all of the disclosures prescribetl by Califomia
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. �Qf yes", attach certificate of compliance from the appmpriate air pollution
control oRcer). �
CERTIFICATE OF COMPLIANCE: I certify that untler penalty of perjury the
information given above is wrrecL I agree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
oo�e
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify untler penalty of perjury Ihat I have read this application antl state Ihat
the information given is correcL I agree to comply with all state laws and city
ordinances relating to building construction, and authonze represenlatives of
the Ciry of Costa Mesa to enter upon [he above-describetl pmperty for
inspection purposes. I agree not ro occupy or allow occupancy of any building
authorized by this permil until fnal inspection.
're�cripLiveCerLi[icat� `umpli.�ucr.:ZllUfilZe,cideialiuJl�P�iCA1[e .a� CT'-1P.-AL`7'-F]\'AC
im�d3-7
—�— _.r ----
.Site4ddr'ess: 92q�,1 ln%iircerueuiflgertcR' �jnr ��� ����
Lquiumenl l y e� Lisi Miuimum EfTiciency` Flnnr Are.i � requiremep! - 'I�hemms[al
❑ PackngeA lini� o Over 40 f� f duc s
9jFurnucc - FUE��1l� ❑ GOY ,��rved bV systcm adtled rreol;t¢�Y in � Satback Low Yot(R3p�
❑lndoorCoil ❑SEER ❑HSYF i. (/lnnrnL'cadrpreseucnursiLc
)2JG sf mc nditio ie {5pece
❑ Condensing Unit ❑ EER � D 2csistonce p, 6(CZ ), 4-5) '°smllerq
❑ Uther
!. Lyuipmenl 7'ype: Choose the equipmenl being installed; l� mnro ILan oue syctem, use anofLer CP-llt-ALT-HVAC for eacli sVstem. �
2. Minimum iquipment Efficienciez: 13 SEER, 7X°iL AAUE, 7.7l�ISPF for typical residential sVstems.� �� - �� - � ��. �
Contractor (Ducumenx;ttion Antbor's /Responsiblc Desig��er's 7)eG:vatinn Sta�ement) . - _ ,
• I certify �hat this Certif�cate of Compliance documenta�ion rs accurate and complete. . �.
• I am eiigible underDivision 3 of Ihe Califomin Husines � and Professions Code ro accep� responsibility for the desi�i idontified on this
CeniScateofCompiiance, � � . ..
� 1 ceriity thai the ener�� features m�d perSomianee specincation:: For Ihe desi�i ideniiLed on ihis CcniSmate of�Compiiance confomi [0 0ie �
requirements of'I'iQe 24, Purts I and 6 of' [hc Calitomia Code of 2e�;ulatmns. � _ � � . .
• The design fcamres identified on tliis CediScate of Compiiance are cottsistent with Ihe infonnation ducumentecl on othe; zpplicaole
compliance tbrms, worlcsheets, calculations, plans and soecifmations submitted [o the enforcemem agency fo� approv2l witti_ ihe permit .
aonlication. ` � � - �
Name:-�UL �NTA t - � � . I�Signawr_ , . � � �
Companyr � . . . ` . . � ate: ; _ . .
Lacense:
20!!L' Re.rideiulal Cony�liai�ce Fa�nrs
March 3010
(ETdF'CIRCENIENT t1 GBNG]'
Cf1RT�G� �TOAIIZE :T�T�ITH L;ETTEIZHL�17�(SEFiL,)
20US Building Enere}�. �fficiency Standards Residential FI�'AC Alterations
Climxte Zunes 7 and 3 throueh 7 C' Z-6 ; �as�r�, r-rFs�
23USIN�SS ANI) PItOTGSS70NS CODl. S�CT70N 71] 0 � - .,
Vlillful or deliberate disregard and violation of the building laws, including the Calitomia Building Code, and �
lucal pertnit requirements constitutes a cause for discinlinary action t"rom Ihe Contractors State License Board
wor4ang in conjunetion with the local-build'vio department. This action may consisi of fines up to 3�5.00� per
violation or suspension/revocation oS a coneracto�'s license. �
WFI�N-IS A P�RM[T I�OUII' � D? � �
� A written construction permit shall be obtained hmn the eniorcement agency prior to die erection, consttuction,
� reconstruction, iiistallation, relocation, or alteration �of an}� mechanical system, ezcept aspernvtted:in Appendix
� Chapte� 1, Section ] 12? of the 2007 Califomia Mechanical Code. Prolects requiring permits ine]ude, out are not
limited ta:
� • New HVAC installation � � � � •
• HVAC ChangeAu� . . -
�� • I2eplacement of fumace, coil, FAU, or condenser .
� • Relocation of an existing HVAC uni� ' '
�• Adding or replacino more than�40fi ducting ui unconditioned snace - �
200F RUILDING EN�RG}� �rrICIENCl' STANDAP.IJS (TiUe 2S, Parr fil I2EC1IJIIt�TVI�NTS INCT iTDE•
1. Heating equipment must have a minimum 78% AFUE (Exceution: Wall 6`. floor fumaces; room�heaters): � ' � � '
: 2. Central air conditioners E. heat oumps ]ess than 6�,000 Btu/hr mus nave a minimum 13 SEER. � �� �
3. Newly installed or replaced ducts must hav� a minimum insulaiion value of R-41. � �
4. A setbacl: type thermostat (24 tu� clock wi[h iour se[ points) is required for all alterations. -� � � �'
. 5. New or replacemen, ducts must mee; the mandatory requirements oi Seccion 150(m): -' -
�• All joints and openings in ihe in the HVAC system must'oe sealed. '
-• Only UL 181, UL 1 S1A, or Ui, 181B approved tapes. or mastic shall oe used to seal duct openings.
• Connections of inetals ducts and the inner core of fler. ducts shall be mechanically iastened. Flex ducts �
must be connected using a mecal sleevefcoupling.
• Flex ducts that are suspended mus, be supponed every 4f!. ma>: for horizontal runs wiUi no more than 2"
of sag becween su000ns and 6 fi. mar. ior venical runs.
6. The CF-GR-MECH-04 must be completed and si�ned'oy the installvig contractor. The Insoecror will collec[ �
this form and verif�� that the model numbas are tne same as the inscalled equipment.
( - � ' ' `1 � ' � i
CITY OF COSTA MESA
��pMFq BUILDING DIVISION
r`�� 77 FAIR DRIVE. COSTA MESA. CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
� FOR INSPECTIONS CALL: (714) 754-5626
°Qq,�o fi
PERMIT NUMBER: B09-00080
PERMIT TYPE B ROOF2 STATUS: ISSUED
APN: 13910216 DATE ISSUED: 0 511 8/2 0 0 9
ISSUED BY: BJK
JOB ADDRESS: 3241 NEW YORK AV CM Suite/Unit:
Vicinity: RESIDENCE AND ATTACHED GARAGE � � � � � -
Squares: 2100 � . ' � Valuation:� , � � $5,300.00
SCOPE OF WORK: REROOF RESIDENCE AND ATTACHED GARAGE: T/O EXISTING COMP ROOF, REPAIR/REPLACE SHTG AS NEEDED,
2 LAYER 15# FELT, APPLY 40-YEAR COMP SHINGLES. PITCH 3:12 2100 SQ FT � ' �
OWNER: BRINK, CYNTHIA L Address: 3241 NEW YORK AVE �, Unit:
PHONE: . � , City/Slate/Zip: COSTA�MESA, CA �� -
APPLICANT: LANGDON, JOE .
PHONE: 714-536-18'16
CONTRACTOR: J N L ROOFINGAND REMODELING �-
Address: 16312 ARLINGTON LNUnit .
City/Stale/Zip: HUN7INGTON BEACH CA � � �
714-536-1816
ARCHITECT:
ENGINEER:
FEE SUMMARY
Reroof Plan Check:
Reroof Permit Fe�:
Reinspection Fee:
Bldg Std Admin Fund
TOTALFEES
Address: 16312ARUNGTONLN . �. Unit :
City/Slate/Zip: HUNTINGTON BEACH CA �
License No.
License No.
�o.00
� 125.25
$0.00
$1.00
$126.25
PHONE:
License No. 648337
714-608-8226 � � �
92649 CELL:
PHONE:
PHONE:
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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
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 fnspections and final approval must be obtained. Failure to obtain inspections and final approval wili result in the expiration of this permit.
LODE/. INSPECTIONTYPE DATE IN➢TIALS COOEII INSPELPONTYPE DATE INTITIRLS
7616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final I 208 Final Plumbing
200 Final Re-Roof ��7�[� 270 Final Elecirical
zoi Fina161ocWRetainingWdll 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Appmval
203 Flnal Slgn ?pp Final Site
204 Final �emolition 250 Final Builtling/Occupancy
� ,
WORKERS'COMPENSATION DECLARATIO :
I hereby aKrm under penalry of perjury one of the following Oeclarations:
❑ I have and will maintain a certifcate of consent to self-Insure for vrorkers'
compensation, as provided for by section�3700 of the Labor Code, for the
ormance of the vrork for which lhis permit is issued.
�❑ I have and will maintain v.orkers' compensation insurance, as requiretl by
an 3700 of the Labor Cotle, (a the performance of the work for which [his
permit is issued. My workers' compensation Insurance carrier and policy
number are: �1
,Carcier: �i�i'��l /
(Tnisseumneedro Demmpeleed�hppe.� i aloeea(onehuntlretlddlars(SfoOJoNess)
Policy Number:
/</(a'l ��r?
❑ I certify tha[ in the peAormance of Ihe work for which this permit is
issu shall not employ any person in any manner so as to become subject
to th ers�pensation laws o( California, and agree that if I should
beco e s je to e workers' compensation provisions of Section 3700 of
the La r C I s II torthwith comply with these provisr s� `��
WARNING: AILUR�"TO SECURE WORKERS' COMPENSATION COVERAGE
IS i�1N FUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
(§100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, If�fiEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affrm that I am licensed under provisions o( Chapter 9(commencing
with Seclion 7000) of Division 3 of lhe Business antl Professions Code, and
my I"�\R.�[\�se is��n II� 7(orce and ef1 ct.
Lic: #� \ /(/1'C 1� � � � Class�#� _ _�� ^�"�' _
�/ I:C.�
C NSTRU E INGAGENCV: �'
❑ by aftirtn that ihere is a consimction lending agency for the
performance of lhe work fa wfiich lhis pertnit is issued. (Sec. 3097, Civil Code�.
Lender's Name:
Lender's Address:
Date
OWNER-BUILDER DECLARATIONS:
I hereby aHirm Ihat under penalty o� pe�jury Ihat I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the following reason (Sec. 7037.5,
Business and Professions Code: Any city or county which requires a permit ro
construct, alter, improve, demolish, or repair any slrucNre, pnor to iis
issuance, also requires the applicant for such permil lo fle a signed stalement
[hat he or she is licensed pursuant to the provisions of the Contractors
License Law (Chapter 9(commencing with Seclion 7000) of Division 3 of the
Business and Pro(essions Code) or that he or she is exempt therefrOm and
the basis for the allegetl exemption. Any violation o( Seclion 7037.5 by any
applicant for a permit subjects the applicaN to a civil penalty of not more than
fve hundred dollars ($500).):
❑ I, as ovmer o( the property, or my employees with vrages as their sole
compensation, WILL DO THE WORK, antl the sVucture is not intended or
oKered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not apply to an ovmer of property who builds or improves
thereon, and who does such vrork himself or herself or lhrough his or her own
employees, provided that such impmvements are not intended or oRered for
sale. If, however, the building or improvement is sold within one year of
completioq the owner-builder will have the burden of proving Ihat he or she
did not build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS ro construc[ [he project (Sec. 7044. Business and
Professbns Code: The contractors License Law does not apply to an rnmer of
pmpeAy who builds or improves thereon, and who conlract5 for such project with
a contracta(s) license pursuant ro me Contractors ucense Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
, .
Owner ID verified by dri s license. ❑ Yes ❑ No
Driver's License No. Expires:
Verification of Ownership by (type of documenC i.e. - property tax bill or deetl):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
❑ I hereby certi(y that no excavation frve (5) a mwe teet in tlep[h inro which a
person is requiretl to descend, will be made in conneclion with wnrk authonzetl
by this pertnit, and ihat no building sWcture, scaHdtling, falsewnrk, or tlemolition
or dismantling Ihereof, will be more ihan thirty-sa (36) feet high. (Chap. 32, Grp
2, Art 2, Sec. 347, Title 8, Califomia Administ2tive Code).
❑ As ovmer-builder, I will not employ anyone to do work which vrould
require a permit fmm the Division of Industrial Salery, as noted above, unless
such person has a permit ro do such vrork from the tlivision.
Apphcanl's SignaWre Date
Division o( Intlustrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or fuWre building occupaM need to fle antl
certify a Business Plan for emergency response to release or threatened
release of a hazardous ma[erial? ❑ Yes ❑ No
(Section 25505 0( lhe Califomia Health and Safety Cotle requires, wilh some
exceptions, that a Business Plan be filed wi[h the Costa Mesa Fire
Departmen[ by every business which has at any one lime during a reportetl
year a quantity of hazardous materials equal lo 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 Ihe applicant or present or Future building occupant need lo file
a registration form (or aculely hazardous materials? ❑ Yes ❑ No
(Section 25533 0( the Califomia Health and Satety 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 vreight of 500 pounds, or a
volume ot 55 gallons, or 200 cubic feet o( compressed gas a1 standartl
temperaNre and pressure).
3. Does or will lhe applicant or present or future building occupant neetl to
prepare an RMPP (Risk Management and Prevention Program lor acutely
hazardous materials)? � Yes ❑ No
(Section 25534 of the Cali(omia Health antl Safery Code provitles that the
Costa Mesa Fire Department may require the preparalion, certi(cation antl
filing vnth the Fire Department o! an RMPP by businesses which are required
to register acutely hazardous materials wiN the Fire Department.
4. It an RMPP is presently required, has Section 25534 of Ihe Califomia
Health antl Safety Code been fully complied vnth? ❑ Yes ❑ No
5. Does or will the applicant or present or future building occupaN require for
lhe vrork which is the subject of [his appliwtion a permi[ for such construc�ion
or modification from [he Soulh Coast Air Qualiry Management Distncl or (mm
any other air pollution con[rol disMct or agency7 ❑ Yes ❑ No
(Sectbn 658502 0! Ihe Califomia Govemment Code requires that the requested
infortnation be tumished on applications for nomresidential building pertnits).
6. Will any part of the facility [o be constructetl under this permit be vrithin
1000 feet from [he outer boundaries o( a school? ❑ Yes ❑ No
Qf'yes", the facility must meet the requirement o( Sections 25534 and 42303
of the Calitomia Health and Safery Cotle).
7. If a permit fmm the South Coast Air Qualiry Management District or other
air polWtion control distric[ or agency is required (or the work which is the
subject ot this application, have all of the tlisclosures prescribed by California
Health and Safety Code Section 42303 been matle? ❑ Yes ❑ No
8. (If'yes", altach certifcate of compliance from the appropriate air polWtion
control offcer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury Ihe
information given above is correcL I agree to comply vnth all state laws antl
ciry ordinances regarding Hazardous Materials and Emissions.
Dale
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: 1
certify under penalty of perjury lhal I have read [his application and State Ihal
the infor on grve is correct. I agree to comply with all slate laws antl ciry
ordinanc lating building consWction, and authorize representatives ot
the Cirye�sta�sa to en[er upon Ihe above-tlescribed property for
inspection ose agree not ro occupy or allow occupancy of any building
authorize�,p t is p rt until final inspeytien:
Signawre Da�e \ ��% A_� S �/�i
]09-06�3I0]) ���T .
A 0�i r A Norrzea Appl¢an `Dat¢ �
- �2�a�
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX 9f7 C08TA MEBA. CALIFORNIA
For Applieant fo Fill In Complefely
TYPE OR PRINT
BUILDING
ADDRESS 32 Neti"+ �'ork Avenue
COSTA MESA CALIFORNIA
OWNER Vermont�A�enue Land Co. Inc.
MAIL �,19 E. 17th St.
nnnwra<
� SIZE � _ _ _ _ I No, OF
BHiBAC1( LINB PRON
�NTew o� srneer � REAR YARD
SIDE YARD ILEFT � IRIGHT �
DESCRIPTION OF WORK
NEW I X II ALYERATION I II ADDITION
BUILDING NO. OF
SRE ��ri C(}. it.600M5
EXTERIOR WALL ROOF
COVERING i COVERII
US8 OF BUILOING AND WORK TO 6E
FEE RECEIVED
,j�$ JUN 211960
f1NANCE DEPm SA
APPLICATIOtI'4� FI�(QFPErR�IT'
SUILDING
For Office Use Only
NECEIPT NO. PCHM^IT NO.
'� � <�Q
RECEIVEO BY � �ATE RECEIVEO I • E
APPROVED
BY
Z N �
•
(1 LEGAL
C05TA MESA. CALIFORNfA
ZONIIdG
NO. OF 1 / USE OF N
PIj�N$ v BUILDING
YAROS
APPROVED
(CHNTER LINE BTJ
APPROVEO
EVES
Ci
3 �v P � L
�i3a p � — � :
1 NEREBY ACKNOWLEDGB THAT I HAVE READ TH18 APPYWTION THE AMOUNT 6HOWN IINDER VqLIIATION �6 FOn TNE
AND 6TFTE TXAT THE ABtlVE IS GORRECT AND AGREE TO CON-
PURP08E OF EBTABLIBHING A eERMIT F6E ONLY.
PLY WIiM ALL ClTY OFDMANCE9 AND 6TATE LAWB RBGULATNG
euLLnlNa coNBTrtucil VALUATION
SIGNATURE OF � �'" � . PERMIT FEE .$ 34•
PERMITTE
s � 4,1']9 • PLAN CHECK $ �-� •
AUTHORIZED AGBNT D110E & ole�rove� Inc. . 51.
TOTAL FEE
OWNER � Ve*^nont Ave. Land Co., Inc. DATE 6/21/CO
JOB ADDRESS 3 eUr ork, Avenue sUiLDING PERMIT N0. 123 9
GENERAL CONTRACTOR Dik2 & Colegrove, InC. VALUE $ 1 17�
AP. No. LOT 12 T1tACT 3 FIRE ZONE DESCRIPTION OF WORK Res.w Htt.Gar.
INSPECTIONS �_�y..�,n I DA7E I GROUP I& J TYPE V ZONE R-1
SUBCONTRACTOR � PERMITSISSUED
t�
Test
OCCUPANCY � -
Form 210—SM-11-59 S-B P
DIKE � CbLEGROVE� �-..-,_' � FUG 1 0 1961 �'"�
OWNER
JOB ADDRESS 32Lt0 Vew Yox .ve. "''
GENERAL CONTRACTOR • • ���«ite --
AP. No. LOT
WSPECTIONS
OCCUPANCY
DATE
SUBCONTRACTOR
_r � .. .. �
DATE10-28-60. -
BUILDING PERMIT NO.-,13216�-
VALUE S 530.00 '._'
PERMITS ISSUED
Form 210—SM—I1-59 5-B P . 1321(�