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HomeMy WebLinkAbout2121 UNION ST - Building PermitsI t 111 M8 9 CITY OF COSTA MESA 111 ` 4 BUILDING DIVISIONF _ ,i DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER v siiij' j PERMIT B06-02054 BU(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.La.u., 1'CRMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 t;:ia , , ..: Job Address: 2121 UNION AV Status: ISSUF� Suite: APPI ed: 12/0t20000 , Vicinity: JJJ Issued: 12/1 Primary Occ: R-3 Dwellings/Gong Res<10 Type of Construction: V-N Parcel Number 42244210 Zoning: Applicant: COX, DAVID Address: 2121 UNION AV Phone: 949-646-6663 COSTA MESA,CA - - -Zip: 92627 ISSUED BY: Owner: COX, DAVID-, , '' EXTENSION Address 2121 UNION AV - Phone: 949-646-6663 ALLOWED COSTA MESA,CA - • Z' 92627 eli ALLOWED Contractor: ' .OWNER-BUILDER;-' EX1 * E� PER Address:- jj + DosjO f 0 ,. . EXPIRES . /D > Zip: - License: 100000 Arch :" GARY MAXWELL Eng: MORRISH, JEFFERY Address: 19722 WESTWINDS LN Address: 1495 RIVERSIDE DR Phone: 9491632-6018 Phone: 530-257-5173 HUNTINdTON BEACH,CA SUSANVILLE,CA . ' Zip:- ,92646 - Lidense: ' C13785 : • - 96130 License: 36929 ' ' SCOPE OF PERMIT ADD 376 S.F.TO EXISTING S.F.D.WORK TO INCLUDE:EXPAND EXISTING FAMILY ROOM,MASTER BEDROOM,MASTER BATHROOM AND LAUt ROOM STRUCTURES AT REAR OF PROPERTY MUST BE BROUGHT UP TO CODE PRIOR TO FINAL OF PROJECT.REDUCE HEIGHT OF STRUCTURES i ' 10-FOOT REAR,,S-FOOT SIDE SETBACK FOR STRUCTURES OVER 6'67.-PLNG,: - t . EXISTING BLDG: 1,466 SQ FT GARAGE:500 SO FT . ADDITION:376 SQ FT _ - DRIVEWAYS:684SQFT _ - - __ •.__ _ - , LOT-COVERAGE:44% - • . • FEE SUMMARY Plan Check: $320.29 - . Calc Valuation: $34,742.40 Permit: $492.75Claim Valuation: $0.00 SMIP Res: $3.47 SMIP,Com: , $0:00, '. :Other: , $0.00 Inspection: $0.00 ' Total: ,� i$816.61. - . PLANNING &ZONING SETBACKS MAIN STRUCTURE Front - 20-0',, ' -,Rear 0-0 Left 5-0 Right 5-0 ACCESSORY Front 0-0 '- : Rear 0-0 . ' Left 0-0 . Right 0-0 • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No.92-28,§1, 12-21-92) EXPIRATION: This permit shaft 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 pe FOR INSPECTIONS CALL: (714)754-5626 244646(6/00) fir WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This action need not be completed if the permit is valued at one hundred dollars($100)or less.) !I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws 01 California,and a. ::I at' I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,1 shall forthwith comply with these provisions. y Applican45ignelure r LDateii. /,rd r< WARNING:FAILURE TO SECURE WORKE- •�• PENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADP • TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3106 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 Professions Code,and my license is in full force and effect.Lic.# - Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY:, ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: . Lender's Address: Signature: •. I Date: OWNER-BUILDER DECLARATIONS: . _ _ . I hereby affirm that under penalty of perjury that 1 am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is Id within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). r `/f,as owner of tra tors License m awEXCLUSIVELYsf CONTRACTING WITH LICENSEDwhCONTRACTORS to and the nt (Sec.7044,Business and Professions Iy.� Code:The suatt to the Law icen not apply to an owner of properly who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: ig0aWr F,DQ,w:- (2 ^Ir`d$ Owner ID verified by dri r' e. s 0 No priveraLicanse:fyg. _ (aclExt'res:_ l f^Z4—/4 Verification of Ownersh' y(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or presgnt or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes U 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 (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and tiling with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of thisapplication apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes 0 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? 0 Yes ❑No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with - :at.. :ws and cit ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described propert c'.n pur..:. . agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. 12-1n .6 . ure.Of.Legal.Owner(s) D ate And/Or Authorized Applicant Date CODE s INSPECTION TYPE PATE INTRIALS CODE/ INSPECTION TYPS PAM INTMALs 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall _ 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy • ti May 18 07 09:13at David r in-64-6-6663 p.1 si FAX Co VEIL SHEET David Cox 2121 Union Avenue Costa Mesa,CA 92627 Phone- 949-331-6663 Fax—949-646-6663 Date: 05/18/07 FAX: 714-754-4856 To: Mr. Ed Petros From: David Cox Re: Permit Extention Mr. Petros, Please read the attached letter and let me know your thoughts. Thanky= D avid Cox May 18 07 09:13a David 'A ` ‘ ` 949-646-6663 p.2 05-18-07 TO: Ed Petros • Chief of Inspection City of Costa Mesa,CA FROM: David Cox 2121 Union Avenue Costa Mesa, CA 92627 949-331-6663 Permit Numbers: B06-02054 E06-01492 M06-00847 P06-01055 Mr. Petros, I am requesting an extension on the building permits I received on 12-15-06. I am aware of the 6 month time limit to begin the project and I am requesting an extension until December 1g of 2007. I was planning on starting the remodel in March of this year and ran into problems with the financing for the project. I have straightened out the problem and I will have financing available by the end of July of this year. The reason I need the extension until December 151 is that I am getting married in October of this year and we do not want construction going on when we have guests from out of town for the wedding. I do plan on doing this remodel and the project will start before Dec 15`of this year. Thank you for you time and consideration in this matter. Feel free to contact me with any questions or concerns. Sincerely • (A. 949-331-6663 On t, CITY OF COSTA MESA - BUILDING DIVIS 3• ; ANSI®N 1 F • r,„'I 1" DEVELOPMENT SERVICES DE•= _ PERMIT NUMBER ek 1.04 PERMIT 1].jA ® D E06-01492 te%catalsa it (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesaELEsCTRICAL PERMIT PER"" FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 2121 UNION AV EXPIRES Status: ISSUED Suite No `-.- -Th' (� Issued: 12/15/2006 Vicinity: ADDITION AND REMODEL )� � lrL.,VJI LS � Issued: 1 2/1 52 006 Parcel Nunmber: 42244210 Applicant: COX, DAVID Address: 2121 UNION AV XJ t )'\� Phone: 949-646-6663 ISSUED BY: ��- COSTA MESA,CA - Zip 92627 Owner: COX, DAVID , Address 2121 UNION AV - FTt�1 1,- , Phone: 949-646-6663 - EXP r,R,1Jy COSTA MESA,CA Zip: 92627 DATE 1014filiffti Contractor OWNER-BUILDER Address: Phone: Zip: License:000000 • SCOPE OF PERMIT ELECTRICAL PERMIT TO ADD 376 S.F.TO EXISTING S.F.D. REF#:806-02054 WORK TO INCLUDE:20 LIGHT FIXTS,26 OUTLETS, 1 CEILING FAN,12 SWITCHES, 1 SERVICE TO 200A. FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 • Busway/100 ft $0.00 0 Res.a/c package $0.00 • Standing Section $0.00 0 New.Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0 Lighting Fixts $22.00 20 up to 50 kva/kw $0.00 0 Recept Outlets $26.38 26 - up to 100 kva/kw $0.00 0 Switches $13.20 12 over 100 kva/kw $0.00 0 Non Res Appl N\ $0.00 0 Low Voltage Equipment $0.00 0 Res Appi \ $0.00 0 . Low Volt Wiring System/Ckt $0.00 0 Service to 200a. $30.50 ' 1 Misc.Conduit ' $0.00 0 Service to 10008 $0.00' ' _ 0 Misc.Conductor $0.00 0 Service over 1000a; N $0.00'. 0 Circus(gen or ride) - $0.00 . 0 Motors to 1hp \ '7.\ -'7 10.00, -0 ,� - - - Circus(mech ride or lights) , $0.00 0 Motors to 10hp10:00 0 - - ' ' Christmas Tree Stand $0.00 0 ' Motors to 50hp $0.00 " 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 , 0'- Other Electrical Fee $1.10 , Motors over 100hp $0.00 0 , Communication drops $0.00 - 0. Investigation Fee $0.00 Sub panel to 200a $0.00- 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 - ' Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $116.68 Intermed Pole $0.00 0 NOTICE: The Work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92.28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or 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 end final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 - 2446-46(WOO) • DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have end will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This s ion need not be completed it the permit is valued at one hundred dollars WOO)00)or less.) .yr e I certify that In the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, ould become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. A plica LSignature: tam,__ "TO4 WAR4Ir :FAILURE TO SECURE WORKER ' NSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL— PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN AD TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lie.Of Class If Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the 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 hi elf 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 Id 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. 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.). ❑ I am exempt under - Business and Professions Code for this reason: Signator — ate: Owner ID verified by driv tt�- ❑No IZase: _ EEx��`/-Z-y_/D Verification of Owner y(type of duo mE ent,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: 0• I hereby certify that no excavation live(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: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health end Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons. or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the Califomia 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 ar present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the Califomia Health and Safety Cale been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? PI Yes LJ No (Section 65850.2 of the Califomia Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will anyfacilitypermit __........._...__...._ part of the to be constructed under this be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this application,have all of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? ❑Yes 0 No B (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all st' •�- .1-uuu---- . •• . .• anc• elating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for ins •• ,-10 -,;I:, . to occupy or allow occupancy of any building authorized by this permit u t al impaction. > _ 2 !6"' X51.. : :get Owner(s) (2Qdie > r Authorized Applicant Date CODE L INSPECTION TYPE 2611 INTRIALS CODE II INSPECTION TYPE QM UMW 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy _ Ss. CITY OF COSTA MESA BUILDING DIVISION >:j•,' rues i DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4I PERMIT EXTENSION M06-00847 Jam_' ALLOWED (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us PER AIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT �+ EXPIRES loh7 Job Address: 2121 UNION AV Status: ISSUED Suite ia , IUD) 2ssued: 12/1520 21 06 Vicinity: ty. _ Parcel Number: 42244210 ISSUED BY: giLilD Applicant COX, DAVID Address: 2121 UNION AV Phone: 949-646-6663 COSTA MESA,CA Zip: 92627 Owner: COX,-DAVID - - Address: 2121 UNION AV. - Phone: 949-646-6663 �1 °K1 F E " COSTA MESA,CA F Zip: 92627 iP 1 / Contractor: OWNER-BUILDER DATE Q Address: . Phone: Zip: • License:000000' SCOPE OF PERMIT MECHANICAL PERMIT TO ADD 376 S.F.TO EXISTING S.F.D. • REF#:'B06-02054 WORK TO INCLUDE: 1 VENT FAN/SINGLE DUCT. FEE SUMMARY . . , Quantity Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $0.00 0 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 \ Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 - Evaporative Cooler $0.00 0 Inst/Rep.Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 .0 Refrig Sys<100 k BTU $0.00 0 Domestic lncinerator $0.00 0 Ref rig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct , v`\ $7.25 1 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance. $0.00 -_.0, Boilers Fire Dampers.v ' ;"$0.00 0 ' Upto3hp $0.00 0 'Smoke Dampers- //'- $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent;V j $0.00_- 0 - 15 to 30 hp Air Handlers< 10000efm -- ', $0.00' b. v , " , 30 to 50 hp - . / , '$0.00 0 Air Handlers> 10000cfmv ' $0.00_ 0 -- ' Over 50 hp - $0.00 0 Floor Furnace $0.00 . 0 Other Mechanical Fee ' Floor or Suspend Heater $0.00 0 , , Investigation Fee . ' $0.00 Plan Check Fee $0.00 Reinspection Fee - $0.00 ' TOTAL CALCULATED FEES $30.75 COMMENTS I SPECIAL CONDITIONS • 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 II 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 9 required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permits FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affiml 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. ❑ I 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 se on need not be completed if the permit is valued at one hundred dollars($700)or less.) r",s I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree . • uld become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. -/ Applfcam:Signatnra'—'1 �/ pta: 2 - ^o to WARNING:FAILURE TO SECURE W•" 'S'COM SPACE IS UNLAWFUL AND SHALL SUSIECT AN EM [OYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLIARE(S100,000),IN ADDITION ••P' E COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.a Class a Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097.Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business end Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himelf 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 within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). / I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt undo - Business and Professions Code for this reason: Sip[ietur� - i •••• Owner ID ve fi: r: - s license. Yes ❑No Dri a'Clcnse CExpires: ) " 1 Verification ofd-rship by(type of document,i.e.-property tax bill or deed): i/-z y-d O DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding.faisework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2.Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater then 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 0 N (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LI Yes D No (Section 65850.2 01 the Califomia Government Code requires that the requested information be fumished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South f st Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property f• aial'. ur'•••:= to• •••. or allow occupancy of any building authorized by this permit until final inspection. •G"O� 12- i j'-u r, ao. .kOwnor(s)-- Date dfit'Or Authorized Applicant Date CODE d. INSPECTION TYPE MI Emma CODE! INSPECTION TYPE 2AIE t[ar08L24 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202' Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy _ 2 MFA CITY OF COSTA MESA 4 BUILDING DIVISION F • r,; l DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4 PERMIT P06-01055 'Not se XTENSION (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa. . Pt Fl�llj T ®ZQJ�ic,IR DRIVE,COSTA MESA,CA 92626 Job Address: 2121 UNION AV t11�1��.L WJJ�J Status: ISSUED Suite No PER Applied: 12/15/2006 EXPIRES Issued: 12/15/2006 Vicinity: Parcel Nunmber: 42244210 , f 1 I Applicant: COX, DAVID u Address: 2121 UNION AV u ISSUE BY . • Phone: 949-646-6663 COSTA MESA,CA Zip: 92627 Owner: COX, DAV,IO y v - Address, 2121 UNION AV ` - - � Phone: 949-646-6663 COSTA MESACAEXPIRED , , - Zip: 92627 Contractor: OWNER-BUILDER DATE �� Address: - ' Phone: Zip: ' License: 000000 2 . - SCOPE OF PERMIT - PLUMBING PERMIT TO ADD 376 S.F.TO EXISTING S.F.D. . ' REF#:606-02054 WORK TO INCLUDE: 1 BATHTUB, 1 DISHWASHER_;1GAS(1-4 OUTLETS), 1 KITCHEN SINK,2 WASH BASINS,1 WATER,CLOSET. , ' .. FEE SUMMARY - AMT On AMT . QTY AMT QTY ISSUE FEE $23.50 • Laundry Tub/Washer '$0.00 ' , 0 - - Sump Pump $0.00 0 Backflow irrigation $0.00 0 ' Landscape Irrigation ,$0.00 0' Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub ` $9.80 1 , Pressure Regulator '$0.00' 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 fl) - $0.00 '0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank._ . i $0.00 0 Wash Basin $19.60 2 Dishwasher \$9.80 1 Sewer Captor Demo $0,00 0 Wash Basin Set $0.00 0 Drain,Floor,, $0:00 0Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain,Rainwater - $0.00' , 0 Sewer Private Line $0.00' ' 0 Water Closet (Toilet) $9.80 1 Drain,Roof $0.00\: X01.- Shower $0.00 '0- •-• Water Heater/vent $0.00 0 Drinking Fountainv -$0.00 \<0 - Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank _ , „ „,$0.00„ 0:, , Sink,commercial $0.00 0 -Water Re-pipe $0.00 0 Gas Earthquake Valve ",$0.00, 0-"•,C -Sink,Floor $0.00 ' '0 , Water Service- $0.00 0 Gas(1-4 outlets) \ '' . $6.15' - 1 - -Sink,kitchen $9.80 1 Water Softener $0.00 0 Gas(Over 4 outlets)'. $0.00 ' 0 -- Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe . ,$0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00.\ '0 - Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 - , - 0 _. ' ' - REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 -0 _. . - C , , - TOTAL CALCULATED FEES: $88A5 COMMENTS I SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned , for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. ` `\ FOR INSPECTIONS CALL: (714)754-5626 1 \ 244646(6/001 DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to sell-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section n ed not be completed/f the permit is valued at one hundred dollars(3100)or less.) certify that in the performance of the work for which this permit Is Issued,I shall not employ any porson in any manner so as to become subject to the workers' compensation laws of California,and a. that it I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Appli,n�,6 = WARNING:FAILURE TO SECUR ••" PENSAT1ON COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TO ONE HUNDRED THOUSAND DOLLARE(S100.000),� . • TOTHE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full force and effect.IJc.p Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: 0 I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500).): ❑ I.as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant_i/to C.•tractors License Laws.). ❑ 1 am exjv- . Business and Professions Code for this reason: Ownet ID..'w i� Ez ires'�/h2 )/�•1 a' V n akf ion of Ownership by(type of d men*,i.e.-properly tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,Califomia 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: I Will the applicant or present or future building occupant need to filo and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section'25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,ore volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature end pressure). 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 end 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 en RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application akermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes j i No (Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If'yes',the facility must meet the requirement of Sections 25534 and 42303 of the Califomia 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 prescnbed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If ycertificate attach 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: CERTFICATE 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 ity • sin:. -s relating to building construction.and authorize representatives of the City of Costa Mesa to enter upon the above-described property for'•-•action•- •^•r oto occupy or allow occupancy of any building authorized by this permit until final inspection. • egat'Owner(s)t ( Date----- / 'P.ttr Authorized Applicant Date CODE A INSPECTION TYPE PAg 1I4f9Lfl CORE INSPECTION TYPE BEE IIQMTBALS 1616 Fixed System Final Fire Prevention 206 Final Mochanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Root 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy _ a • • • r 824 . _ DEC _�3958 COSTA MESA BUILDING DEPARTMENT FINANCE DEFT COSTA MESA. CALIFORNIA {EP P.O. BOX CITY OF MIA MIR FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT ADDRESS .�, ��i GTh'IicN 4v2 . BUILDING COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY 1 1/ 1 1 -I �( RECEIPT NO. PERMIT(N/O../ OWNER c 4. ✓ W . i7 k r r�-Q I G T T NN ��// RECEIVED BY DATE RECEIVED DATE ISSUED MAIL A /h / Chi loN ----rt.-7-.1_ ,/ AiY-e /?- -S d' /.2-/...2 Ja ADDRESS A CITY ` O$„rr 6. )i72v .„._ NO. 4/ cp.` 42.1 ADDREISS ARCHITECT LIC. OR ENGINEER NO. COSTA MESA. CALIFORNIA FIRE ADDRESS y/l,/lI �j] ,r ZONE CONTAAI`VO 4 3/9/µ1,/T-R/ CITY NICC_ ZONE /� ' PLANS /pTYPE DROOP /�/�/y`//�/L _ADDRESS �/ A TEL O. APPR9(O'IV(`E E^,/ DATE �/ 2``fi/(/ �4 NO. BY 1/ LEGAL LOrCORRECTIONS DESCRIPTION NO. / 7 / BLOCK TRACT a 7 L A.P.NO. 1 / S- 4/1- /o �R' A� SIZEro No. OF BLOCS, iy r� LOT y/.rrz71'�////y77)z(ssr/col'�t. Now ON LOT / USE OF 'J( f �- `STP. MESA EXISTING BLDG. 'Q SI O PTIN . CITY O. _ SETBACK LINE FROM / / ~LI,IY` I „ C! CENTER OF STREET J o REAR YARD �J/. J SUBJECT TO DG. DEPT. REG. ...- , SIDE YARD RIGHT j , LEFT J / [/ / jr„ St DESCRIPTION OF WORK BY I � ' �t” LAN 1 y/ / NEW y ALTERATION ADDITION V REPAIR MOVING DEMOLISH BUILDING; x�// NO.OF SIZE �A Z L 3ROOMS STORIES EXTERIOR WALL 54ROOF r _COVERING �CCOCOVERING J 4/ N7/ } USE OF NEW /"? `BUILDING /n7/y7 / 6 OnI, 44tt. Ii , /_ aJ9 ay art (ZelV , L .iTe �teV e el Y It shown under valuation is fnr the I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND of establishing STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL purpose a parnit foe only. CITY ORDINANCES ♦ D STATE LAWS REGULATING BU DING CONSTRUC- TION. �/i VALUATION /S- PERMITTEE ' SIGNATURE OF / • � AE..i PERMIT FEE S /[.�- — PERMITTEE -v / f S �'Ji) — PLAN CHECK 5 7 - V AUTHORIZED AGENT TOTAL FEES a / 9xi OWNER HARTEL, WAITER DATE 12-12-58 _ JOB ADDRESS 23 21 Union Avenue BUILDING PERMIT.NO.8p)1), ffitiARAL i8NTRACTOR Owner-Builder VALUE $ b,255•w AP. No. LOT 177 TRACT 1872 FIRE ZONE• DESCRIPTION OF WORK Add & Enclose To Res GROUP 1 & J TYPE V ZONE Rl PLAN NO. 82b4 • INSPECTIONS DATE SUBCONTRACTOR " - PERMITS ISSUED • � �.�} DATE NUMBER Trenches Forms Steel 64'a /�1-3r0�V . Floor System gr4. e -✓i -5 Steel Reinforce Chimney Re-Rod • Bond Beam y;, Frame and Flashing '17c--- r J Lathing, In Out c2 i4. I•G� Ai/M-9 .��44-ra'y SIC'4 /-[r'!�h Plaster, brown coat •J Q, c1 f 4'-, ma Underground soil hV WIG Pipe Test/y15(-Z4 Ser Top Out /9-.241-4-9- Furnace -z9-4v _ Furnace /�}{-S '- z4 -1•09 1,t,rylj 4 i /e-'/7— �‘Thi C. Gas Vents Rough Plumbing 44/C '-'+-(r-s 9 aim,-, c/t-.} - I.2-(7-51( / G f'/ 9 4-- Cesspool Septic Tank Prop. Swr. Line Hy'CCon. St. Swr. //yyIcy 0-74.--i...-4.---L, /i Y-(Q/S'e/ / S-% t'( Sprinkling System Heating Final - . _ Plumbing Fixtures, Final .f!/-it , Final Gas Test //j A-01 , 72/-37 Construction Pole Underground Power Rough Wiring 2-/%J! a cc rvt.t_A j (')--17-St 7 '7 K,5- Z/ , Fixtures, Fixtures, Final t-ii./-41 \1 -OCCUPANCY_ -3adY' Form 210-5M-1-57 32414 Costa Mesa Building Department APPLICATION FOR PERMIT 111 EAST 20STREET y58B " ILDlNG • ' r, COSTA MESA, :FORNIA - FOR Oi TICE USE ONLY FOR APPLICANT TO FILL IN • ecei t No. + Permit No. Building Address 2 i 2 / 1/I A//'O Ai.: • 4trQ. JJJ DDt.7 , Costa Mesa, California Received y DateRee' . Z + ed Nearest /� Cross St V/ €1641 O4t 4t �// Building Address i // N r✓ Owner kN,y.LTCC kJ, /J4 gT E L ; Costa Mesa, California \ Mail X vi I' - Address /Z1 $Ji pw - Nearest. et` /� /,� Tel./; Cross Se...Nearest/et , 6 '• T City\-frett. /�/h-sa No. /-4142/4 Zone�a�•/1 Nd.ns I Tf°- Groupe• Architect or Lic. /� ✓ Engineer No. Approved \ -- -- - by , !1 _ ) Date \ Address t fl Vali +t City Lie. `moi,Contractor No. 41 I ' . l, Address ' +• Legal Lot Description I No. / 77 I Block I Tract/f72.' VEC 6 1954 1 1 (Attach Metes and Bounds) �g/ / /OC•tib„ GSX No.of BCITY OF CQS'(,�E 700 Size of Lot.C"(�,I,�X/C P''L3 I Now on Lot `v Use of n (( No.of No.of Existing Bldg.�..triae ac .e I Families I Rooms - --- -- - G1 Setback Line from rO 7 Rear Yard SI'•J ' D-"� N°t� IA Z Center of Street ”- Side Yard J.) > DESCRIPTIONyOF WORK New -/I Alteration I I Addition IIV Repair I I Moving I I Demolish I Building No.of Size Rooms Stories • Exterior Wall Roof Covering Covering APPROVALS Use of New Building Foundation Location Inspector Date J ..y +'4/I p Forms,Materials, (9 %At/eeF 04,-,11 Ce„!rtie `Diet.( Under-Pinning �N,I' 01Vv Cw•d 84 A ci yardS%4/ .R • Frame: Fire Stops, Bracing,Bolts I hereby acknowledge that I have read this Application Lath. Int. and state that the above is correct and agree to comply Lath. Ext. with all City Ordinances and State Laws regulating building constructio Signature of /I� Plaster,Int. Permittee -Q/ .9/21,44 Plaster,Ext. Authorized Agt. Masonry Reinforced Valuation Permit Fee $ $ .4>" FucalCheck $$ ( -i FINALeam V-731- 6.1t,.• . . i f. . zr rt . ' t .._ _ / it .:. . i f. 4.', II 4;1: Ali. . • . S - .. r . 1. 1 ::)-1 ,'r: . . � N . S eet - - _ - .... . . .. - • PLOT PLAN . . - . Show location and distances from j .• - . property line and between buildings. ,-A,icr ^.,,.c., OWNER HARTEL, WALTER W. VDATE 12-6-54 U JOB ADDRESS 2121 Union Ave. BUILDING PERMIT NO. 748 GENERAL CONTRACTOR Owner-BuilderVALUE $ 800.00 LOT 177 BLOCK TRACT 1872 6' Concrete Block Wall r. GROUP J TYPE III ZONE RL FIRE DISTRICT 758 PERMITS ISSUED INSPECTIONS ,� , DATE SUBCONTRACTOR DATE NUMBER Footing Trench a--et.--i .3 -7-`S'i 1 Foundation Forms and Grade to Garage Rough Framing e 7--/)_ i , . I Plumbing,Rough to Slab Plumbing,Rough Complete Temporary Pole ..,c Wiring, Rough er .� �/E,.(. �/ --{ rt.G.� �-a-. ''%". d' vj, Heating,Rough C../tcevl-f".,'` Heating,Final „ - (,t —yy .,/--c(/ �.'— Sewer Septic Tank or Cesspool �".�'�"..c��T�i , Lathing / � ����A ^,%� Plastering _ /—';✓ Plumbing,Final,Fixtures Complete a Plumbing,Final Gas Test Wiring,Final „ y� ce] Occupancy L.-4-, Is-f�..eG�- Form 210 GH 1M 12-58 / i n_!/1.4 �-F -, ,- w S LC,.,ts-y �-a' %Cc..