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Home My WebLink About360 15TH ST - Building Permitso'er CITY OF COSTA MESA BUILDING DIVISION pER NUMBER DEVELOPMENT SERVICES DEPARTMENT PERMIT 99-00644 (714) 754-5273 Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT Job Address: 360 E 15TH ST Suite No Vicinity: THROUGHOUT HOUSE Parcel Nunmber: 42531103 Applicant: MELROSE, JOHN Address: 1525 MACARTHUR BL. Phone: (714) 641-1545 COSTA MESA, CA Zip: 92626 Owner: NEWLAND, ANNABEL M Address 1635 HILLCREST PL Phone: (805)543-1751 SAN LUIS OBISPO, CA Zip: 93401 Contractor: C AND R DRAINS INCORPORAT Address: 1525 MACARTHUR BL. Arch I Eng: Address: COSTA MESA, CA Phone: (714) 641-1545 Zip: 92626 License: 531746 Phone: Zip: License: SCOPE OF PERMIT GAS REPIPE FOR EXISTING SINGLE FAMILY RESIDENCE. OTY Status: ISSUED Applied: 11/8/1999 Issued: 11/8/1999 ISSUED BY: Ry -f\ ` FEE SUMMARY AMT ISSUE FEE $23.50 Backflow irrigation $0.00 Backflow Preventer $0.00 Bathtub $0.00 Clarifier System $0.00 Connect (Ice,Soda,etc) $0.00 Dental Units $0.00 Dishwasher $0.00 Drain, Floor $0.00 Drain, Rainwater $0.00 Drain, Roof $0.00 Drinking Fountain $0.00 Expansion Tank $0.00 Gas Earthquake Valve $0.00 Gas (14 outlets) 50.00 Gas (Over 4 outlets) $0.00 Gas Repipe $9.80 Gas Service $0.00 Interceptors (Grease, Oil) $0.00 Interceptors (Sand Auto ) $0.00 OTY Status: ISSUED Applied: 11/8/1999 Issued: 11/8/1999 ISSUED BY: Ry -f\ ` FEE SUMMARY AMT QTY AMT QTY Laundry Tub /Washer $0.00 0 Sump Pump $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 P -Trap $0.00 0 Trap Primer $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Process Piping (per 10 ft) $0.00 0 Vacuum Brkr Bkflow(14) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Sewer Private Line $0.00 0 Water Closet (Toilet) $0.00 0 Shower $0.00 0 Water Heater / vent $0.00 0 Sink, bar $0.00 0 Water Piping (Inst or Rep.) $0.00 0 Sink, commercial $0.00 0 Water Re -pipe $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 Sink, kitchen $0.00 0 Water Softener $0.00 0 Sink, service/mop $0.00 0 OTHER $0.00 Spa (private) $0.00 0 VIOLATION $0.00 Spa (public) $0.00 0 PLAN CHECK $0.00 REINSPECTION $0.00 0 COMMENTS / SPECIAL CONDITIONS TOTAL CALCULATED FEES: $33.30 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: 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 aulhodzed 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) 7545626 DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 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 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 carder and policy number are: Carder: Policy Number: (This section need not be completed if the permit is valued atone hundred dollars ($100) or tests.) ❑ 1 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 Cade, I shall forthwith comply with these pr'slops. Applicant Signature: Data: _q WARNING: FAILURE TO URE WORKERTCOMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLAR 00,000), 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 affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Prolesgjons Code, and my license is in full force and effect. Uc. If d Class If fi — 3 Contractor's Signature; — Date: CONSTRUCTION LENDING AGENCY: ❑ 1 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 PTOteSaiOnS Code) or that he Or she Is exempt therefrom and the basis tot 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 Properly who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑ Yes ❑ 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: ❑ 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 (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 WIII 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? ❑ Yes ❑ 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? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costs 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 Califomia 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 ❑ No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit 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 65050.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 WIII any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ 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 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 Califomia Health and Safety Code Section 42303 been made? ❑Yes ❑ No 8 (If yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I cerbly that under penalty of perjury the information given above is correct. 1 agree to comply with all state laws and city Ott ineffCSS 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. Sign to Of Le Owner(s) at And/Or Authorized Applicant Date CODE -0. INSPECTION TYPE gOjE ILLS J9M INSPECTION TYPE 2AM gam$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 206 Final Plumbing (� 0 200 Final Re -Roof 210 Final Electrical 201 Final BlocklRetalning 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 244646 (714) 754-5273 • Fax (714) 754-4856 ,lob Address: 360 15TH ST Suite: Vicinity: Parcel Nunmber: 42531103 Applicant: CRANK, JIM. Address: CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT BUILDING PERMIT Zoning: 898-00822 PERMIT NUMBER 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED .Kyr Applied: 05/12/1998 Issued: 05/12/1998 Phone: -Zip: Owner: NEWLAND, ANNABEL M Address 1635 HILLCREST PL, Phone: SAN,LUIS OBISPO,cA- Zip: 93401 — - Contractor: CRANK BROTHERS ROOFING CO Address:: 00126 COMMERCIAL WY' r ' Phone: COSTA MESA CA Zip: 92627 - License: 408677�� Arch / Eng Address: _ :phone: .. zip:- License: ip:-License, SCOPE OF PERMIT T/OOF 1500S17 FLAT ROOF OF REAR RESIDENCE 8 REROOF WITH BUILT-UP FEE SUMMARY Plan Check: $0.00 — Calc Valuation: $0.00 Permit: $87.25 _ — j ' : Claimed Valuation: $3,185.00 Other: $0.00 Inspection: $0.00 / Total: $87.75 PLANNING &'ZONING SETBACKS MAIN STRUCTURE Front- 0-0 �_ Rear - 0- 0 Left 0-0 - -Right 0- 0 - ACCESSORY Front 0-0 " Rear X0`0 - - Left - 0_'0_ - Right 0- 0' PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: 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 0 OWCLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 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 Cade, for the pedomtence of the work for which this permit is issued. My workers' compensatlon Insurance carrier and policy number are: Cartier: Policy Number. (Ras section need not be completed if the permit IS valued at one hundred dollars ($100) or less.) ❑ 1 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 is of California, and agrpp that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shell forthwith comply with these ovisions. r�(J— Applicant Signature: Date: WARNING: FAILUR CURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND $100,000), 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 affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Divislon 3 of the Business and Professions Code, and my license is in full force and effect. Uc. P Class P C 3 9 Cr Contractors Signature: /2--2Date: .�-9' � 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). Lander's Name: Lendefs Address: Signature: Date: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sac. 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 dull 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 o1 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 contractors) 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. ❑ Yes ❑ 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 certity 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? ❑ Yes ❑ 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? []Yes ❑ 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 r(Section 25534 of the California Health and Safety Code provides that the Costa Mese Fire Department may require the preparation, certification and filing with the Fire partment of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. .... ..................................................................................................................................................................................................................................................... 4 If en RMPP Is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ 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 emit for such construction or modification District the South Coast Air Quality Management Disct or from any other air pollution control district or agency? U 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 ❑ 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 [3 as ❑ No .................................................................................................................................................................................................................................................................................... 8 (If yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I mill ly that under penalty of perjury the information given above is cored. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emiss ons. 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 corect. 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. * ign Of Legal Owners) Date M _t) - /dz -9� And/Or AlMorized Applicant Date C22LL INSPECTION TYPE BATE gf®ALS CODE INSPECTION TYPE HATE INTMA65 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 206 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final BlocktRataining 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 Bullding/Occupancy 2"8.16 q� i (714) 754.5273 • Fax (714) 754-4856 Job Address: 360 E 15TH ST Suite: Vicinity: HOUSE ONLY Parcel Nunmber: 42531103 CITY OF COSTA MESA BUILDING DIVISION DEVELOPMENT SERVICES DEPARTMENT PERMIT BUILDING PERMIT Zoning: Applicant: CRANK BROTHERS ROOFING CO Address: 00126 COMMERCIAL WY, " ��-• Phone: 949-548-5569 COSTA MESA CA Zip: 92627 Owner: NIEWLAND, ANNABEL M Address/ '1635 HILLCREST PL - - 77 FAIR DRIVE, ISSUED BY: PERMIT MESA, CA 92626 Status: ISSUED Applied: 07/13/1999 Issued: 07/13/1999 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 Inspectlons 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) 7545626 Phone: SAN LUIS OBISPO, CA Zip: 93401 Contractor CRANK BROTHERS ROOFING CO _ Address:, 001 26'COMMERCIAL WY - - Phone: 949-548-5569 _ COSTA MESA CA ' Zip: "92627 - License: 408677 r, - Arch Eng: -t Address: i "Address: Phone: �",'Phone: - Zip License: Zip: License: " SCOPE OF PERMIT . REROOF - TIO, INSTALL NEW BUILT UP ROOF OVER FLAT AREAS & NEW 30 YEAR SHINGLES ON PITCHED PORTIONS. USING EXISTING SHEATING. _ FEE SUMMARY Plan Check: $0.00 Calc Valuation: $6,771.00 Permit: $124.75 Claim Valuation: $6,771100 SMIP Res: $0.68 SMIP Com: „ $0.00 'Other`,'11$0.00 \Inspection:' "S0.00 Total:'. $125.43 PLANNING & ZONING SETBACKS MAIN STRUCTURE'Frdnt,. 0-0 �, Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 . -Rear 0-0 Left 0-0 Right 0-0, PARKING Existing: 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 Inspectlons 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) 7545626 DECLARATIONS WpRKERS' COMPENSATION DECLARATION: mby affirmm 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 this permit is issued. ❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Cade, 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 it the permit is valued at one hundred dollars ($100) or less.) ❑ I certify that in the pe formance of the work for whit his permit is issued, I shall not employ any person In any manner so as to become subject to the workers' compensation laws f alif mala, and agre t it I s uld become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these pr ions. Applicant Signature: Date: WARNING: FAILURE CURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SMALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND 100,000),INADDITIONTOTHECATS OF WMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37060E THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am Iansa 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. x K, Class e (' `7 Contractor's Signature: Date: A — 9 E, CONSTRUCTIONNDING AGENCY: ❑ I hereby affiml 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: 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 Cade) 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).): ❑ 1, 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. It. 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 Lew does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractors) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑ Yes ❑ 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 (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Pile 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? ❑ Yes ❑ 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 torte for acutely hazardous materials? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Masa 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 Ii an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication a�PJermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 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 WIII any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ 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 ❑ No 8 (It 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 stale 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. Of ge wner(s) / Data P / And/Or Authorized Applicant Date 999EL INSPECTION TYPE GATE INTrMLS CODEC INSPECTION TYPE 2F INITTAL 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Ro0t I 210 Final Electrical 201 Final BlocklRetaining 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 BuildingrOccupancy 244646 OWNER YOUNG, 14INSTON L. / DATE 10-17-55 JOBADDRESS 360 E. 15th St. BUILDING PERMIT NO. 1981 NERAL CONTRACTOR Owner -builder VALUE $ 1,700.00 LOT AP 117-261-3 BLOCK TRACT Convert garare to den GROUP I TYPE V I ZONE R4 FIRE DISTRICT 200 INSPECTIONS D/Aly SUBCONTRACTOR PERMITS ISSUED DATE NUMBER Footing Trench /7 � Foundation Forms and Grade to Garage ' Rough Framing Plumbing, Rough to Slab Plumbing, Rough Complete Temporary Pole .Wiring, Rough Heating, Rough Heating, Final °-wer, House Sewer, St. /V tic Tank or Cesspool Lathing, In Out Plastering Plumbing, Final, Fixtures Complete Plumbing, Final Gas Test _Wiring, Final Occunancv _ `-Cipsta Mesa Building Department APPLICATION FOR PERMIT 111 EAST 28th STREET 03 BUILDING COSTA MESA, CALIFORNIA FOR APPLICANT TO ML IN FOR OFFICE USE ONLY Receipt No. I Permit No. reas Costa Mesa, California�Celve !� Date Recd. Date Issued I Ir �/,7 S Nearest Cross St. fb Building Address Owner / Costa Mesa, California Mail Address _ Nearest Cross St. - Tel. City No. (l Zon ' T I plaof ns T I Tyy/ Grou Architect or Lia Engineer No. Approved by Date Iress CORRECTIONS City Llo. Contractor No. ' Address LegalI Description Lot I No. I Block. I Tract (Attach Metesand Bounds) O No. of Bldgs. Size of Lot / g I Now on Lot Use of , No. of No.of Existing Bldg W -(,(.(:i. I Families (I Rooms - 1 Setback Line from Rear Vard Center of Street' �- Slde Yard �( '� 7 '" DESCRIPTION F WORKS GW New I I Alteration I X1 Addition I n't Ono Repair I I Moving I Demolish I B��Ilding r No. of ` Rooms Stories / , covering , ` Roof Covering APPROVALS Use of New Building�. Foundation Location Forms, Materials, Under -Pinning Inspector Date ,i �� - Frame: Fire Stops, Bracing, Bolts I hereby acknowledge that I have read 's Applical6on and state that the above is correct and agree to comply with all City Ordinances and State Laws regulating building constructi _ Signatureof / Permittee U - Authorized Alit. - Lath. Int. A (�f Lath. Ext. Plaster, Int Plaster, Ext Valuation 8 / Permit Fee $ & — Plan Check $ $ ( Total s J Fee ! Masonry Reinforced Bond Beam FINAL PLOT PLAN Show location and distances from property line and between buildings. a c J u c J G a d L • ,. - - a o 0 - i s/de A Ge ser �,,hzyel korise � /QlCyo' ,Z.SX3c Provo, s ed� I& W14 �l Street —I— i5 PLOT PLAN Show location and distances from property line and between buildings. WNER io JOBADDRESS 36Q $ 15th St BUILDING PERMIT NO. 2342 9 -NERAL CONTRACTOR Owner—builder ' ' VALUE $ 10.160:00 LOT AP 117-261-3 BLOCK TRACT Rental apts. (2) & 3 carports n Rnllo T R. .T TVRF b fnNP R)i FIRF nISTRICT iiiA ' INSPECTIONS �j.-gij DATE ,j!„•�!� s'S SUBCONTRACTOR C!w�t,%y.ri`� PERMITS ISSUED DATE NUMBER Footing Trench Foundation Forms and Gr de to Garage Rough Framing Plumbing, Rough c S —@ Plumbing, Rough Complete Temporary Pole Wiring, Rough S/%'s'C 5 '/U-SY .9-3 -� Heating, Rough %{�I t— ^ _ . Heating, Final 6 Sewer, House "A*f /Sewer, St. P�JL/, e- F : Tank or Cesspool Le_.,ing, Ind/ f Out Plastering" —'y74 —� Plumbing, Final, Fixtures Complete ^ Plumbing, Final Gas Test /S,.. /,S' lU.p.6 /-sa-Sr '• %-- Wiring, Final AN 2 9 1957 M3 FORM210 3M 10-05 -Costs Mesa Building Department PLICATION FOR PERMIT III EAST 20th STREET BUILDING COSTA MESA, CALIFORNIA �. !�� FORM 204 S -BP 2M 6-55 FOR OFFICE USE ONLY FOR APPLICANT TO FILL IN Receipt No. Permit No. BilldAddress;, Q ' Costa Mesa, California Received by Date Recd. Date Issued Nearest Cross St., Building Address ' Owner Costa Mesa, California Ma" Addre` Nearest Tel. Cross St. City No. Zone No. of Type Group. I Architect or Lie. PPans f d Engineer No. Approved by Date 'dress CORRECTIONS . City Lie. contractor 'YI/it/ No. Address --� -^-+ — ip Description I Not I Block I Tract (Attach Metesand Bounds) .'r Size of Lot / ,K fl NoN i -won Lots I .;,4N 3J 1950 Useof r No.of No. of tJ� O-Za I I O Existing BI Families % Roo -/ /J� C "-" O Setback Linefrom Rear Yard' �j :IIT!/ nr AnA'Pl1 nnrn„ Z Center of Street - Side Yard "^ 0 1 G V 1 VVJ I ill GVG6.� y DESCRIPTION OF WORN yer , New I Alteration I I Addition I s 12 , hr�--f :2a�rrto .� '�t' J O-' Repair I I Moving I Demolish I ' Building/ rNo. of `—(o c`^ 'L b Rooms Stories riot Wal Roof 't,_,ering I Covering APPROVALS Use of New Building Foundation Location Inspector Date Forms, Materials, _ Under -Pinning - Frame: Fire Stops, Bracing, Bolts I hereby acknowledge that I have read this Application and state that the above is correct and agree to comply Lath. Int. with all CIty Ordinances and State Laws regulating building construction. Lath. Ext Signature of Permittee Plaster, Int. Authorized Alit. Piaster, Ext Valuation Permit Fee $ 6. Masonry Reinforced /rf / G 0 Plan Check $ / Bond Beam $ / v10 Total 2 Fee $ .J FINAL FORM 204 S -BP 2M 6-55 K a.vi KJ uI Show location and distances from property line and between buildings. ' - it OWNER W. L. YOUNG DATE 7-24-58 _ JOB ADDRESS 360 E. 15th Street BUILDING PERMIT NO. 7194 GENEF.AL CONTRACTOR_ Owner _ VALUE 5_.4,234.00 FIRE ZONE ZONE INSPECTIONSI DATE I SUBCONTRACTOR I DATE NUMBER coat Final Gas Test 7XVII REOUIREMENTS / -34 719'4 -] PCOSTA MESA BUILDING DEPARTMENT P.O. BOX 317 COSTA MESA. CALIFORNIA FOR APPLICANT TO FILL IN BUILDING ��- ADORESS 1% COST4 45201 4A4.A2-00 ' AIC 22-58MIJE5A APPLICATION FOR PERMIT BUILDING VW! COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY 'RECEIPT NO. PEN%IT O. OWNER MAIL /� RREE,C"EIVED BV DATE RECEIVED 195UE0 ADDRESS ' -F _stA r �L, iM �jD>TE TEL. BUILDING / G � 5 CITYca NO. ADDRESS3 ARCI :T OR a IEE LIC. NO. COSTA COSTA MESA. CALIFORNIA FIRE 3 ADDRESS ZONE CITY LIC. ZOME NO. NF PLACONTRACTOR TYPE GROUP NO. TEL. APP O D (� e NO. BY �A Z J S P, '� _ADDRESS LEGAL LEGAL LOT Ory NO. BLOCK TRACT F aNTIM Z A.P. NO. CITY OF rnr:rovx SIZE rvD.OP BILL .. 3 PLANNING DEPT. OF LOT Now ON LOT _ USE OF EXISTING BLDG. SETBACK LINE FROM / Q p CENTER OF STREET REAR YARD 9Y t H. SIDE YARD 3 RIGHT LEFT T DESCRIPTION OF WORK ( NEW ALTERATION ADDITION _ ly I� II REPAIR MOVING DEMOLISH BUILDING '/NOOF •� SIZE ROOMS+.� STORIES / EXTERIOR WALL ROOF _ )FST COVERING -- rr D _COVERING USE OF NE BUILDING d So I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUC- VALUATION ?;D N. SIGNATURE O -.. ^ PERMIT FEE S �S PER A TTE 4 Q� 41 2 3 / PLAN CHECK $ 7• {,• O s -;1-3Y- • AUTHORIZED AGE � TOTAL FEE 5 a/. 0 0 VW!