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HomeMy WebLinkAbout934 CONGRESS ST - Building Permits0 � r . � � ~ a • , I CITY OF COSTA MESA B!/ILDING DIYISION 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 �• www.ci.costa-mesa.ca. fOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBE . BC08-00100 PERMIT TYPE: B COMBO Sub Type: ACCSTR �os nooRess: 934 CONGRESS ST CM APN: a22a22'I'i ' Zaning: , , Vicinily: Const Type: V-A SQ. FT: 252 STATUS: ISSUED DATE ISSUED: 03117I2008 ISSUED BY: Suite/Unit: Primary Occ: R-3 � Valuation: $4,062.24 SCOPE OF WORK: REPLACE 252SF SOLID ROOF OPEN PATIO, SERVICE UPGRADE TO t00AMP, WASHER AND DRU=YER HOOK=UP, NEW 5 FLUORESCENT FICTURES, 1SHOWER VALVE, 1 KITCHEB SINK AND FAUCET. OWNER: ARTIGLIO, KATHLEEN Phone: APPLICANT: JERRY MCKINISH . Phone: 714-404-9846 � CON7RaCTOR: J K CONSTRUCTION Phone: 714-404-9846 CELL Cell: 714-960,7052 � , ARCHITECT: . � , ENGINEER: - . Address: 934 CONGRESS ST City/SWte/Zip: COSTA MESA, CA Address: City/State/zZip: Unit: Unit: : License No. � 450297 � Address: 915 LAKE STUnit: � � CitylState: HUNTINGTON BEACH, CA . TipCode 92648 License No. - �,� PHONE::. . License No. � ' � ' ;- PHONE: � � COMBINTATION PERMIT FEE SUMMARY Building Plan Check: ' � $72.31 � - - Building Fees: � , $111.25 Electrical Fees: $39.30 Mechanical Fees: $0.00 Plumbing Fees: � � $35.55 � � SMIP Residential: $0.50 SMIP Commercial: ' $0.00 � TOTAL FEES: $258.97 "Reter to fee receipts for all fees paid for project NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Cali(ornia statutes and related regulations. (Ortl. No. 92-28, § 1, 72-21-92) 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 must be obtained. Failure to obtain inspections and final approval vrill result in the expiration of this permit. COpEt. INSPEL710NTYPE D�T INTRIRLS COOER INSPECTIONiYGE ORTF NITRIALS 7676 Fixed System Final Fire Prevention 206 Final Merhanical 1268 Pool Spa Final 208 Final Plumbing 200 Final Re-Roo( 210 Final Electrical 201 Final Block/Retaininq Wall 212 Final Fire Prevention 202 Final Factory Fire p�ace 220 Finai Planning Approval 203 Final Sign 222 Final Site �,L�� 204 Final Demolition ' � 250 Final BuildinyOccupancy �/a 6, o g /7 • � . �.,. � : �. , WORKERS' COMPENSATION DEClARA710N: Owner ID verifietl by dnver'� ❑ Yes ❑ No I hereby aKrm under penalry of perjury one of the following tleclarations: Driver's License No. Expires: ❑ I have and will mainlain a certificale of consenl to self-Insure (or workers' Venfication of Ownership by (lype o( document, i.e. - property tax bill or deed): compensation, as provided for by section 3700 of the Labor Code, tor Ihe peAormance of the vrork for which this permit is issued. ❑ I have and will maintain wnrkers' wmpensation insu2nce, as required by sectbn 3700 of ihe Labor Code, for the pertortnance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: pertnit is issued. My vrorkers' compensation Insurance carrier and policy � I hereby certify that no excavation frve (5) or more feet in depth into which a number are: � -_ person is required to descend, v.ill be made in connection with v.vrk authorized �� � � �by this pertnit, and that no building stmcNre, scal(dding, falsevmrk, or demolition Carriec J/•- �� i' (/ i✓ ( or dismantling thereof, will be more than lhirty-su (36) feet high. (Chap. 32, Grp �j (Thksectmnee0rolbecandetedY�hepemiaisvaWetlatmehwMretl4uars(EtoO)orless) 2 lut2 Se� 34� TitIeB,CalifomiaAdministraliveCotle). / Y �% S��l% � �� Polic Number: 9 /.i ❑ As owner-builder, I will not employ anyone to do work which would ❑ I certify that in the peAormance of the wark for which lhis permit is i55uetl, I shall noI employ any person in any manner so as lo become subject to the workers' compensation laws ot Califomia, antl agree ihat if I should become subject (o the workers'cp mpensation provisions of Seclion 3700 0( the Labor Code,�� shall foqhwith�-iSompty with these provisions.� / .,/n ,/ r/ VSARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALT7ES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLL4RS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE IABOR CODE, INTEREST, AND ATTORNEV'S FEES. require a permit from the Division of Intlustrial Sa(ely, as no[etl above, unless such person has a pertnil to tlo such work from the division. j Applicfnl's5igiawre Dale Division of Intlustrial Safely Permil Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 7. Will I�e applicant or present or fuWre builtling occupant need to fle antl certity a 8usiness Plan tor emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 0( the Cali(omia Heallh and Safery Code requires, with some exceptions, Ihat a Business Plan be filed with the Cosla Mesa Fire Department by every business which has at any one time during a reported year a quantity ot hazardous materials equal ro or greater ihan a vreight of LICENSED CONTRACTORS DECLARATION: 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas I hereby aKrm that I am licensed under provisions o( Chapter 9(commencinq al stantlard temperature and pressure). with Section 7000) o( Division 3 of lhe Business and Professions Code, and Z, Does or will the appliwnt or preseni or future building occupant need to file my license is in full force and eRect. � a registration tortn for aculely hazartlous materials? ❑ Yes ❑ No Lic. # � r'� o' 7, Class # � �ection 25533 of the Califomia Health and Satery Code, wim some � �� � ,�� j �— �li 1 i�a � exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity ot acutely /� Cont2cmYs5ignaWre �aie � hazardous matenals equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed qas at standard ONSTRUCTION LENDING AGENCY: temperature and pressure�. ❑ I hereby aKrm that there is a construction lending agency tor the 3. Does or will ihe applicant or present or Wture building occupant need to pertortnance of the work fa which this permit is issued. (Sec. 309�, Civil Code). prepare an RMPP (Risk Management antl Prevention Program for acutely Lender's Name: hazardous materials)? ❑ Yes ❑ No (Section 25534 of the California Health and Satety Cotle provides that Ihe Lender's Address: Costa Mesa Fire Departmenl may require the preparation, certifcation and filing with the Fire Department of an RMPP by businesses which are requiretl to regisler acutely hazardous matenals with Ihe Fire Department. Signature Date 4. I( an RMPP is presently require0, has Section 25534 of the Califomia OW NER-BUILDER DECLARATIONS: I herehy affirm [hat under penalty of perjury thal I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business antl Professions Cotle: Any city or counry which requires a permi[ to construct, alter, impmve, demolish, or repair any structure, prior to its issuance, also requires Ihe applicant for such permit b Poe a signetl stalemenl Ihal he or she is licensetl pursuant to lhe provisions of lhe Contractors License Law (Chap[er 9(commencing with Section 7000) of Division 3 of the Business and Professions Cotle) or that he or she is exemp[ there(rom 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 ihan frve hundred dollars (5500).): ❑ I, as owner of the property, or my employees with waqes as their sole compensation. WILL DO THE WORK, and the strucWre is not intentletl or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an amer ot property who builds or improves ihereon, and who does such work himsel( or herself or ihrough his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the buildinq or improvement is sold within one year of completion, the owner-builder will have the burden of pmving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of ihe property, am EXCLUSIVELY CONTRAC7ING WI7H LICENSED CONTRACTORS to construct the project (Sec. 7044, 8usiness antl Professbns Code: The conl2ctws License Law dces nol apply lo an owner of property who builds or improves thereon, and who contracts fw such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempl under sec. Business antl Protessions Code for this reason: Health an0 Safety Code been fully complied with7 ❑ Yes ❑ No 5. Does or will the applicant or present or fuWre building occupant require for the work which is the subject of this aOPliwlion a permit for such conslruction or modification (rom the South Coast Air Quality Management DisUict or from any other air pollution control disMct or agency? ❑ Ves ❑ No (Sec[ion 658502 0( Ihe Califomia Govemmem Code requires that the requestetl inlormation be fumishe0 on applications for rron-residential building permits). 6. Will any part o( the facilily lo be cons�ructed under lhis permit be within 1000 feet from the outer boundaries o� a school? ❑ Yes ❑ No Qf "yes", the facility must meet the requiremenl of Sections 25534 and 42303 o( Ihe CalifOmia Health and Safety Code). 7. If a permil from the South Coast Air Qualiry Management District or olher air pollution control disMcl or agency is required for lhe vrork which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. Qf �yes", altach certificate of compliance from the appropnale air pollution conirol oKcer). CERTIFICATE OF COMPLIANCE: I certify that untler penalry of perjury the information given above is cortecl. I agree to comply with all state laws and city ordinances regarding Hazardous Matenals and Emissions. Signalure �aie CERTIFICATE OF COMPLIANCE AND AUTMORIZATION OF ENTRY: I certify under penally of perjury that I have read this application and state ihat the information given is cortecL I agree to wmply with all state laws antl ciry ordinances relating l0 6uilding construction, and authorize represenlatives of the City of Costa Mesa to enter upon the above-descnbetl property for inspection purposes. I agree not to occupy or allow occupancy of any builtlinq authonzed by this permit until fnal inspection. , Signa�yre ol Legai Owner�e) Date $ign3ture Da�e y� ^^ � � G� 305]<813ro1) _.� - *7� �` >� `' ' 1� �/ An0/or PUNonieC POPlitanl D e r 2133-46 C� o� C?adta BUILDING ��%a,a S'uiE'd.� Div�¢iaa PLAN REQUIREMENTS FOR ATTACHED PATIO COVERS (Note: Detached patio covers require an engineered design.) �2 P.L. � v Feet � fi � ❑6 ❑6 Post � � � � (�YPJ Edge of � PROPOSED STRUCTURE patio cover � ��� � House � S J7 0 Garage � ❑z Owner �� ✓ �� �r � I [J Address�7�`+ I'oNG-�Z� S� _C'v s �- /ti� s .a- ❑�' DF B LDING SAFETY OF STA MESA PIB�� VED Thie Ee1 d pens end MUST be ept m Ihis job at aV iinies ard i� is u mek6e�A'dispesoretteretiaBon ,�n penn6simhomlhBDivisionf �d Sh�/, G1Y ol Costa Mesa LJ t3o g— c o� TIIE 6 $ apNOT bE hEld f0 pE�mi1 W �0 b8 3f d• vblation af mry pmmions ol arry Ciry of-Costa Mesa Ordinance anNw ; D�S e�d Pemml ahall expre bN W�W1 � became null and void B Ne b dbndaam�ercedaMm�tainedaqHe CBCSec.tOS.SrAui180daysd i c T m I _ � 2❑ P.L. % J Street �j �❑ Scale: —" _ — INSTRUGTIONS - 3 COPIES MUST BE SUBMITTED Using this as an example drew your own plot plan on a separate drawing. ALLOW TO PRC HnrH ww crr�ac nus a coNsmure � pu��p upMP.�ry/q �tJqFpIbIR Q Show owner's name, project address, north arrow and scale. 4� De,�g,y ❑2 Show and dimension all propeRy lines, easements and driveways. ,f�on1Gra..�,�,,, a� � ,.r ..��, ��_� ❑3 Show locations of existing and proposed structures, including all setback dimensions 4❑ Show dimensions of proposed structure. � i3 �� Pa ❑5 Show setbacks from property lines to proposed structure. (3'-0" min.; verify if Planning Dept. requires greater setbacks) 6❑ Dimension overhangs � Lattice Cover Rafter Solid Floor Cover I�— Roof Covering 26 Ga. L Roof Sheathing Lattice FRAMING PLAN Flashin\ Roofing � �; � 12" Sheathing � 0 � Lattice � p ��� --- - - �� i�t Fiafi�� Ledger � e'srl � OtGltwr,inut�;,brthzsm .&;sd�,z:i'nc;�`�+.c �1-7 Header — %•. �` — Post -----------`- - .^.o�)ra�Lr.qz Or5 m5:�� ! ra2nrleis�'r:ietsp�it� n Fz.a�� t,!¢oJ ;� Nia y r Slope �—>__ .y �Y Ir.ws�et0 Drain �",� �� � brr ��,�q � n. ic on,,,: .wt� ntF;d �. t.�v. ,.,.. , �;, , _,.�. �. - �� o' � •� •,;.:� .,,.�.,,YFo'ofng ".__.... . ; npn�h:iud,,;� u.,,:ui.,,.� 4Lattice.s a�e�miWm:a�a�°r���xi�ansqinsznH�9gzaAT .;;n5uz��oz:�haC�,r,�;:�i'�^C.9Y?f.?: �wle�:r.nM�nrdnS�"'I,TIVNJ �nz�irr� Rafter— Joist Hanger Ledger — Slab� Solid Roof COV2f DETAIL OPTIONS Check the ones ihat apply: Lattice Cover ❑A ❑B ❑C ❑D ❑E �F Solid Cover. ❑A ❑0 ❑E ❑F Post Anchor Post 6' min • Footing �epth PAD FOOTING A 750# max per post post 6" min . ,�si.as SLAB FOOTING B _� Z% 2x6 Min Zx Joist Slope Fascia J to Drain ExiSling Anchors wall8 2'.0" 8'-0" I roof ax Span AVE CONNECTION _ � _ ' . ' CONSTRUCTION'MATERIALS •: � ` SPECIFY LUMBER: q DF ❑ Redwood ❑ Hemfr SPECIFY GRADE: ❑ No. 1 ❑ No. 2 CONCRETE: 2500 psi min. @ 28 days CONNECTIONS: ICBO approved or equal I/L 1. Roofcovering: i02�l� JO«�'� Slope: �:12 2. Roof sheathing: Maximum spans: lattice: x____ @_" o.c.: 2x2 - 6'; 2x3 - 8'; 2x4 - 10' solid: ° CCX plywood or _" lumber: 1" - 2' - 8'; 2" - 8' - 0" 3. Rafters: �x G@�" o.c. ❑ Single ❑ Double �Veaderr��x"'�"""1 ❑ Single ❑ Double ..a «r em �;;� �� 2 b X �—�'C R �r1a5.,,Ledger.v6�, �__ (2x'min)� �. �'I �Y��74�fist�"""ti=� "� z� �l ��(4x4 min), Raise 1" min above slab surface �yp+,qc� F�tioiih�:a Y�i�c r�12"x12" min for up to 66 sf tributary area; 18"x18" min for 67-150 sf tributary area " depth (Expansive Soil Zone _� ='��ti`�_`thiCk`(Ex`pansive Soil Zone � 10. Connections: a. Joist to Ledger - Metal joist hanger b. Joist to Header - Solid blocking with framing anchor c. poubled joist or header to post -(2) 1/2" dia. thru bolts w/ washers d. Joist to Fascia - Metal framing anchors each side (min. capacity = 0.5" joist span 'joist spacing' 15) e. Fieader to Post - Column Cap f. Post to Slab or Footing - Metal Anchor/Post Base - � g.� � Roof Sheathing ' �- 8 d@ 6" o.a Edges and 12" o.c. Field 1/2" x 5' Joist Lag Screws OO ts" o.c. Existing Joist wall Hanger Ledger YO(ALL CONNECTION Dummy Post Support Posl Beyond RAFTER/HEADER � E Roof Sheathing or Lattice Rafler Framing AnChor Each 6bck Header z X Blocking Post � _ Column Cap JOISTIHEADER � F 2]33i6 back 19W UBC SPAN TABLES LATTICE PATIO COVER SOLID PATIO COVER 1997UBC 2713-46Tables CITY OF COSTA MESA . E '' �"'� BUILDING DIVISION i 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754�856 • www.ci.cosT -rfies'a.c F � ` FOR INSPECTIONS CALL: (714) 754-5626 �'°'��� PERMIT NUMBER. P08-00119 PERMIT TYpE PLUM STATUS: ISSUED APN: 41218334 DATE ISSUED: 0510512008 ISSUED BY: KJ6 JOB ADDRESS: 924 DAHLIA'AV CM Suite/Unit: ` vicinity: �. , , .. . . � � . � . - . SCOPE OF WORK: WATER HEATER CHANGE OUT. STORAGE TANK WATER HEATER. '; OWNER: STERLING, HAROLD AND LESLIE Address: 924 DAHLIA AVE � PHONE: -�_ City/State/Zip: COSTA MESA, CA APPLICANT: STERLING, HAROLD AIVD LESLIE Address: 924 DAHLIA AVE : PHONE: 949•290-2565 ' . , Cily/State/zZip: COSTA MESA, CA ,. CONTRACTOR: ' � License No. � � Address: � - • ' � �- PHONE: � ' � City/State: . � ZipCode: � CELL: ARCHITECT: � � - License No. � � � PNONE: ENGINEER: License No. - � PHONE: PLUMBING PERMIT FEE SUMMARY PLAN CHECK FEE: $0.00 PERMIT FEE: $35.80 TOTAL FEES: $35.80 'S�i? � NOTICE: The work authorized by lhis permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1. 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspeclions and final approval will result in the expiraGon of this permit. co�: ixsa�cnoxrme o�re ixmu�s cooet ixsr�cnoxTrae o� umn�i 1816 Fixed SyBtem Final Fire Prevention 206 Final Mechaniwl 1266 Pool SOa Final . 208 Final Plumbinq 5_�A_O$ _� 200 Final Re-Root 210 Final Elecincal 201 Final BIo�WReWining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Fina15ign 222 FinalSite '� �� 204 FinalOernolition 250 Final BuildinglOccupancy WORKERS' COMPENSATION DECLARATIOh' I hereby affirm untler penalty of perjury one of th, ,owing declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers' wmpensation, as provitled for, by section 3700 of the Labor Code, for tha , peAormance o( the work�lo�wMcnihis permit is issued. ❑ I have and will maintain �wrkers' compensation insurance, as required by section 3700 of the Labor Code, for the pedortnance of the vrork for which this permit is issued. My workers' compensation Insurance carrier and policy number are: Cartier: (Thu secfion nee0 irol0e cvmplefetl4lne pemut 6 raluetl at one hurMretl0.Hlars (St00J a IessJ P�olicy Number. .,�(i(certify that in the peAortnance o� the vrork for which lhis permit is �"i45ued, I shall not employ any person in any manner so as to become subject [o�lhe workers' compensation laws o( Califomia, and agree that if I should: become subject to the workers' compensation provisions o( Section 3700 f th o ode, I shall ort ' h comply with these provisions. ..J �Appli�nfs SlBnalu � ` le_ . 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 DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aKrm Ihat I am licensed under provisions o/ Chapter 9(wmmencing wi�h Seclion 7000) of Division 3 of the Business an0 Professions Code. and my license is in full force and eRect. Lic. # Class # CanVaclor's Signalure Dale CONSTRUCTION LENDING AGENCY: ❑ I hereby aKrtn that Ihere is a consiruction lending agency (or the pertortnance ot the v.ork for wfiich this pertnit is issued (Sec. 3097, Civil Code). Lentler's Name: Lender's Address: � OW NER-BUILDER DECLARATIONS: I hereby aKrtn that under penalry of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for �he following reason (Sec. 7031.5, Business and Professions CoCe: Any ciry or counry which requires a permit to construct, aller, impmve, demolish, or repair any strucwre, prior to its issuance, also requires ihe applicant for such pertnit to file a signed slatemen� that he or she is licensed pursuaM to the provisions o( the Contractors License Law (Chapter 9(commencing with Section 7000) of Division 3 ot Ihe Busine5s antl Pfofe55ion5 COde) Or lhat he or She i5 exempl tllereffom and lhe basis (or the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the appliwnt to a civil penalry o� not more than frve hundred dollars ($500).): ❑ I, as owner o( the property, or my employees with vrages as Iheir sole comoensation, WILL DO 7HE WORK, and the strucNre is not intended or offered for sale (Sec. 7044, Business and Protessions Code: The Contractors License Law does not apply to an owner of property who builds or improves therron, and who does such vrork himself or herself or through his or her ovm employees, provided that such impmvements are not intended or oRered for sale. If, however, the building or improvement is sold within one year of completion, the ovmervbuilder will have the burden of proving that he or she �ditl t build or improve tor purpose of sale.). , as ovmer of Ihe property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to constmct ihe prqecl (Sec. 7044, Business and Professions Code: The contractors License Law dces not apply lo an ovmer of propeAy who builds or improves thereon, and who contracis for such project with a contractor(s) license pursuant b the Contractors License Laws.). ❑� I am exempt under sec. Business and Professions Coae for this reason: Owner ID verified by dri� ice �] Yes ❑ No Driver's License No. y� Expires: Verificatiomof Ownership by (rype o! document, i.e. - property tax bill or tleed�: DIVISION OF INUUSiRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby cert'rfy that no ezwvalion frve (5) or more (eet in depth into wfiich a person is required to descend, will be made in connectbn with work author¢ed by this permil, antl that no building slmcture, scaf(dding, false.wrk, a demolition or tlismantling Ihereof, will be more than thiAy-six (36) feet high. (Chap. 32, Grp 2. Art 2, Sec. 341, Ttle 8, Calitwnia P,tlministrative Code). ❑ As owner-builder, I will not employ anyone to do vrork which woultl require a permit (rom the Division of Intlustrial Safely, as noted above, unless 5uch person has a permit to do such vrork from the tlivision. Applit�anCs SBnalure Division of Industnal Safety Permil Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will Ihe applican[ or present or future builtling occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous matenall ❑ Yes ❑ No (Section 25505 of the Califomia Healih and Safely Code requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Depariment by every business which has al any one lime during a reportetl year a quantity ot hazardous matenals equal ro or greater than a weight of 500 pountls, or a volume of 55 gallons, or 200 cubic feet of compressetl gas at slantlard temperature and pressure). 2. Does or will ihe applicant or present or fuWre buil0ing occupant need to file a registration fortn for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of [he Califomia Health and Safery Cotle, with some exceptions, requires registration vrith the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazartlous materials equal to or greater than a vreight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet ot compressed gas at standard temperaWre and pressure). 3. Does or will ihe applicant or presenl or tuture building occupanl need ro prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 of the Califomia Health and Satery Cotle provides that lhe Costa Mesa Fire Department may require ihe preparation, certification and (ling with Ihe Fire Department o( an RMPP by businesses which are required to register acutety hazartlous materials with the Fire DepartmeN. 4. If an RMPP is presen[ly requiretl, has Section 25534 of the Califomia Health and Safety Code been fully complied with? ❑ Ves ❑ No 5. Does or will the applicant or present or tuture building occupant require for the work which is the subject of Ihis application a permil for such construction or motlifiCation (rOm the South Coasl Air Quality Management Dislrict or from any other air polWtion control tlistrict or agency? ❑ Ves ❑ No (Section 65850.2 of lhe Cali(omia Govemment Cade requires lhat Ihe requestetl infortnation be fumished on applications (a rarrresidential building permi�s). 6. Will any part o( the (acility lo be consWctetl untler this pertnit De within 1000 (eel from the outer boundanes of a school? ❑ Yes ❑ No (If'yes", Ihe facility must meel ihe requiremenl of Sections 25534 and 42303 ot the Califomia Health and Safety Code). 7. If a pertnit fmm the South Coasl Air �uality Management District or ol�er air pollution control disMct or agency is requiretl for the work which is the subject of this application, have all ot the disclosures prescribed by Calitornia Health and Satery Code Section 42303 been made? ❑ Yes ❑ No 8. Qf 'yes", attach certificate of compliance from the appropriate air pollution coNrol oKcer). _ CERTIFICATE OF COMPLIANCE: I certify that under penalty of peryury the information given above is conect. I agree to comply with all state laws and ci[y ordinances regarding Hazartlous Materials and Emissions. � Sig�alure Dale CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this appliwtion and state that ihe information given is cortecL I agree to comply vnth all �state laws and ciry ordinances rela6ng to building wnstruction, and authorize representa[ives o( Ihe Cily of Costa Mesa lo enter upon [he above-described propeAy for inspection purposes. I a ree nol to occupy or allow occu ancy f any bui ng by lhis p i n' final inSpeUion. ,\ l.l [SiqnaW eof ep310 er(s) - le-- - . 305'!>61�/0]) �� L� -- - • Antllor Aulhonie0 Appl¢anl Costa IVIesa Building Department APPLIpCATION FOR PERMIT ' "" � 111 EAST 20th STREE7 306 _.p U. I L_ D�� N_ G_ COS7A MESA, CALIFORNIA � - �---� ' � -�. ' F'OR OFk'ICE USE ONLY FOR APPLICANT TO FII.I. IN ; : Receipt No. Permit No. , Building � 3 / �� Address - osta Dfesa,` ' aliftrrnia Received'by Date Rec'd. Date Issued � �� rv Nearest Cross 8t. wr � Building , . -.� -•� �+•.u� n � Address ' Owner r�,,,,,�� n__ COSte� M0S8�� California � Mail • Address n�L � t.r+ �..._a Nearest � - � 7� , • Cross St. � ' City ., No. „ , Zone ( No. of I Type i Group -• Architectb " ` Lic.'�1� 7�}i0 Plans Engineer _ rr .r _ No. Approved � � — ---- .. �- - •+ � + b Date : Address ,���� T:. .. , ,PAaedena � � CORRECTIONS ' - City Lie. Contrector n., � • .. „ No. �L �� ' � � � .�...� .... .,�. ..v • —r�- - � Addreas ���ovur: . .,_.. ' Legal �L t -� - ` "'� �`�' '� ! . Descriptlon � No. •�� Block � Trect U [ (Attach Metes and Bounds) No. of Bidga � Size of Lot q � �r I Now on Lot ' _ - -- � p Use of re� jII�- I No. of I No. of � 9 Existing Bldg. Families Rooma Lf Setback Line from Rear Vard ��� � ' - - �- ' - ' - " ' - -' � � Z Center oi Street K�+ f Side Vard � i. %7 �,. r . t � D DESCR ON OF WORIi"` "� "' � - � - � _--- � a,. New I Alteratiqn I Addition � J e. Repair I Moving � I Demolish I ` .�� Building No. of , Size Rooms Stories Exterior • • I Roof ' Covering „ Covering C� o APPROVAI� Use of New Foundation Location Inspector Date Building � Forms, Materials, --ztY.3�t2�6I1L'B� L�— Under-Pinning Frame: Fire Stops, Brating, Bolts Lath.lnt. i hereby acknowledge that I have read this Application Tnd state that lhe above is eprrect and agree to comp]y Lath. Ext. with al] City Orclinances and State I�ws regulating building construc�ion. Signature oi Plaster, Int. Permittee — � Plaster, Ext. Autharized Agt. Masonry Reinforced Valuation U Q 00 F'ermit Fee $ � 3• Plan Check $ Bond Beam 8 Total FeG $ FINAL Gorm 'LO< G- 11f I2-63 e . 'i : PLOT PLAN � Show Iocation and distances trom . property Iine and between huildtngs. � . .