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HomeMy WebLinkAbout2238 STATE AVE - Building Permits a. • CITYtF OTA MESA )@ BUILDING DIVISION .•.fit,&tibial 17 Via. 8 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER t.' . -. PERMIT 111 B05-00734 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa. asisING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDJob Address: 2238 STATE AV Status: ISSUED • Suite: - Applied: 05/09/2005 Vicinity: GARAGE, KITCHEN AND DINING ROOM Issued: 05/09/2005 Primary Occ: R3 Type of Construction: V-N Parcel Number: 42207303 Zoning: Applicant: ' WALTER, JOHN MICHAEL- " `"" �` a ISSUED BY: Address: 2750 SIGNAL PARKWAY4,----” t- ,i t --.. ^:;`-4 ....--1.--t. '"rc r- ,1 1x.Phone J 562-528 8000 `— .t SIGNAL HILL,,YCAA`"�'r i l S J "I Zip: 90755-2207 ' ' Owner: RIEDLEY WILLIAM WALTER Address if. TR/ r'.A A \ r --•s-.- ;-. --- - 1 ' •‘ dQ' A 3tsr1 . Y sem` ��-+ t ,'COSTA MESA,_CA.„y;.y �� Phone: . - 9,�� �V - / , ' 7/.233.8 STATE-AVE 4A-48 - Zip. 92627-3928*'si -N i/ / i • a- t i 1 f/ �� \, K. j 2 T;r/3 `,:k.,‘„ Contractor: HAR`-BRO INC -��"��,,< �' t'Address: . 2750 SIGNAL PARKWAY v,"4:-.‘,'" E's - . / . - ss `r2 ' y .Phone: 562-528-8000 - \ \ ' ( a- / SIGNAL HILL,CA -I. _ U,. �.:.-, .Zip: 90755-2207._ r License-'258441 , fti TArdW-:. 'Eng: t ` --- , Address: (�/ , ' .Address: i N. ' A •1 �1� , - l)\ <, ;/ ) _ Phone: • '� Phone:, • - 1'�1- N . 1,1}.\ I \ '� 1, Zip:. i'-,- License -� _ License: -,l, .1 ,'h SCOPEOF PERMIT,:o •,r 'REPAIR DAMAGED AREA IN GARAGE KITCHEN AND'DINING ROOM(FRAMING:DRYWALL-'INSUL,LATH AND PLASTER) DUE,TO AUTO DAMAGE. t 1- ' ,r) L .1 01it, I . , 'lir i,l :2 cit b,., . • i C ‘1,k,1' f. —- FEE SUMMARY ' , -, --.-C-----) // ' Plan Check\A , ; $0.00 . - -r / _ _: Calc Valuation �JI� $s,000 00 t SMPermtt1',$111.25 �� Claim Valuation.,. 1 _ `$5,00000 IP Res: ' J';$0 50' .. / ci. 5'r, ,. - FGI/ C` / tt-,r` cSMIPs,Com:NV \ $0 00.:' / . Ct Other:) \`$0.00. f x.. ' — t.--?/.,// ( ti / /iii/ Inspection: $0 001. f -c ' , ` z..,.,,.,, I . . *'- ,, .✓ ,6 i ' 1 -Z.-0•:;.`, >n- i }Total ')$11175 :;1"r ,•.c!€c4, +. (O( -. f-(1) j,ft<<. . ,,.;r :;',/ 1_v A /; 6- ,, / A\ ? , ii Va , r ��l z'<' s.. ./u�F; ��".-C.-. ti .":„,„,-4:,.�„v%i u.: ?z� n ,s:--`✓f' / IFS I` I' , ---:<,-; \.;-\:-.72)“9. „ PL`ANNING &ZONING �� �� /� C��/,/ SETBACKS , p-�- ` t' ?." %%�(0 \{ / MAIN STRUCTURE`Front . 0'0),J Ai/Rear 0-0 -_- Left0--0-" Right--0-0 ,iiv ACCESSORY Front 0-.0 (Rea11 r �--0-0 ` _tLeft 'I--- 0-'0G- ��� Righty -0 PARKINGExisting: 0 <Required: 0 ' -,\ •• Proposed: 0,_- ,:;=;:=':- -r_- • 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 required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this per FOR INSPECTIONS CALL: (714)754-5626 2446-48(6/00) 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 w or which this permit is issued. '+rl'' and •will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this penit is issued. y workers'compensation Insurance carrier and policy number are: �/ Carrier _. =7¢hot/Cv_ iv frA2 ' L f-- PolWNOmbe!,— d, Ij /0 5 O G.a 2 ' • • : ecll&n need not be completed i1 the permit is valued at one hundred dollars(3100)or less.) • ❑ I certify that in the performance of the work for which'this perriiit is issbed,l shall not employ thy person in any manner so as to become subject to the workers' • compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith .s•' comply with these ro ns. G �� A12107 FAILURE TO CURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT ANM Date' PENAL PENALTIES AND CIVIL FlNES UP TO ONE HUNDRED THOUSAND CO LARE(S100,000),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: 1 hereby affirm that I am licensed under))rovi ions of Chapter 9(commencing with Section 7000)of Division 3 of the Business a • Professions Code,and my license is in full 1 •effict.' t - C essra CONSTRUCTION LENDING AGENCY: ' ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: 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,es 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 wilt have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,I.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes ❑No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application ap2ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes I]No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). e Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 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? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. .tura• _ . Owner s__ @And/or Aulhoisel BODE I INSPECTION TYPq ' ' ' " P1 'ILLS CODE• INSPECTION TYPE ' Qsg ' =Ala • 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 Signm 222 Final Site 204 Final Demolition 250 Final Building/Occupancy. . Mr PG CITY OF COSTA MESA orae BUILDING DIVISION F r i DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER t. -. PERMIT VA,dP E05-00432 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 2238 STATE AV Status: ISSUED Suite No Applied: 05/09/2005 Vicinity: GARAGE,KITCHEN AND DINING ROOM Issued: 05/09/2005 Parcel Nuhmber: 42207303 Applicant: WALTER, JOHN MICHAEL, necCitx > - ISSUED BY: 1-414-4) `.(----)(.•«,(!:„...4._(((;;---.„,, � Address: 2750 SIGNAL PARKWAY ,.,- ,,,.,.-.r Vii(-.,._;�3„) t'._-. t--:`=(`,'-,.,,` i'� y. - \ Phone:. 562-528-8000), i `r :,;� �„ SIGNAL?HILL At*) \"`, i Zi�190755-2207 ,� /i . ,' ', ;` Owner RIEDLEY WILLIAM WALTER \� Address "•TR., ; '�\\ `' / �\ • i 1 s COSTA MESA(ICA Phone: r.�/2 a �S )(ly /' 2238•STATE AVE#A Zip: 92627-3928 !_, i r Contractor HARBRO INC t - N . \--,,. - '• A ,t / - ,Address /,2750 SIGNAL PARKWAY t •l . t / , � + 1 r- - � I l i-h', ' / Q-*i 6�-- , •Phone: 562 528 8000%' - ) �� V.t\1 r )r-- j ipSIGNAL HILL,CA `,L. - Zip: 90755-2207 I {, 1 . • " nes/ License:258441 i -) 1 , ). Il, - 3 • Yi/ 1 "pi'',nli if I '! :_� i `� '' ' •$COPE OF PERMITLI ; ' 1t T\y .t A F I t 1 '!! ' / ELECTRICAL PERMIT FOR REPAIR OF'DAMAGED.AREA'IN GARAGE.KITCHEN AND DINING ROOM �_...) !t . p '� r 1I(FRAMING, NSU DRYWALL, IL,LATH AND PLASTER).DUE TO AUTOdDAMAGE. I . • I 1 i' 11- ;1 t)(�),r)WORK TO INCLUDE4 RECEPT OUTLETS �F{- .�yc ,t 1 J t I)�I , '�, -0 . \{REF#805-00734 M�.-n ,.._ (- -`_. / _ ._— fjr1l �`� ,1 ' �; ' ti�,.k FEE SUMMARY iill i0 ...,,&, - *''J., --'- L` Quantity ' Quan�y,j/V /-<, Jos`1 ISSUE FEE \ '�'ivh\v:$23.50 Temp Dist System/Lighting $0.00, -' / ,j / ./ Temp servicetest- ,:-.0 $0.00- , . Busway/100 ft $0.00 x ./.(40/ ( <—/ Res a/c package AA ' $0.00 i tr ' - Standing Section $0.00-177(,(0 '''''•4.,./ /)j/ New Res(1 2 units) '$0.00 I 0 Misc Electrical-Equipment $0 00/94 0 �'� Pool//New Spas 3 :� ) ..I7 \$0.00\ lea-.�-pc w T'k7) •, i 1 [-4-„ sformers up t 1 o kva/kv3Pv” '' $0 00/` 0 ` /f Lighting Fixis c� $0.000`0 /i(k t s -, ,�ry up to 50 kva/kw '$0.00(C,-;\1/4 ;'17 Recept Outlets(1.-(tit $4 40 �4 c ' ``,s p'�q�c.,(-1.- ' - up.t' 100.kva/kw/ /$0 00"�0; Switches $0.00 0� r=' 6 ' i- 7,tr -over 100;kva/kw/ ,,S0-.007\e,0 1;,1 Non Res Appl ,i�,� ^+.$0:00 ' 0 "- , -r1(..,_.'--�Low Voltage EquipmentY / ($0.00,-",,,, Oi �`� � Res Appl `,(4:.�>, $0.00 ,,, 0 `� `(`Low`,Volf Wiring System/CktK,\ $0'.00 0� Service.to.200a s A �$0 00(,,,s/.(1- 40, t Oyji5,- Misc.Conduit (� ��\r'$0f0071,. 0 ..- Service .. Service to 1000a ''$0'00 6-(0,.1! )(7C'1, Misc.Conductor\c3` \--' $0.00.r//0 Service over 1000a x'$0:00 0'---1/! - /;'7 ( I C:� Circus`(gen or'nde)' ,) -$0:00%/ 0 Motors to 1hp $0.00:.2< \0 i`-I,'I I' r Circus(niech'ride hi lights) .23$0.00 0 Motors to 10hp $0.00 "---.,0,-": _ - Christmas Tree Stand(;- - $0.00 0 Motors to 50hp $0.00 0� - - - Fireworks Stand%> :- -- $0.00 0 Motors to 100hp $0.00 0 ' -- _.c.:' Other Electrical-Fee $0.00 . Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 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)754-5826 2446-46(WO) • DECLARATIONS , - WORKERS'COMPENSATION DECLARATION: — .I hereby affirm under penalty of perjury one of the following declarations:; l - ❑ - 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 hav 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. ' V y workers'compensation Insurance carrier and policy number are: - : er: S a.i-r'r /,1-cu 497,71-6—6- Tcy'Nomba:_i64/0 5 0 6 0 - . cllolrneed 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 permitis issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California;and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith omp� i 7IIIFO ase. ow�/s/ion s. Apc yt"xwe%� //, le: ,�.- —9 -03 W ING:FAILURE TO ECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EERSOCRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(S1 W,WO),IN ADDITION 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 thatJjm licensed under provi ions of Chapter 9(commencing with Section 7000)of Division 3 of the usiness nd Professions Code,and my license Is in full ]and eff"` ..... , .- -e / •alfacto s me: _ 1- p na• 5 —9---O—y' 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 himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,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,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes 0N (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above.is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. /ilr �4ignature f Le a waer(SJ— 3- `Des t - (/->A cl//or.Authaized•-•.'cant Datea. 'CODE I INSPECTION TYPE - • • au •""" UmnALS CODE( 'INSPECTION TYPE MI INIIDSL$ 1616 Fixed System-Final Fire Prevention . ',.206 . Final Mechanical - ' . . 1266 Pool Spa Final 208Final Plumbing • 200 ' Final Re-Roof - • - 210 Final Electrical " 201 Final Block/Retaining Wall 212 Final Fire Prevention P 202 Final Factory Fire Place I. 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy• ' • LY r CITY OF COSTA MESA t BUILDINGIVITi •� m .'�1I DEVELOPMENT SERVICEDS DEPARTMENT PERMIT NUMBER 1. 1 l PERMIT M05-00255 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 2238 STATE AV Status: ISSUED Suite No Applied: 05/09/2005 Issued: 05/09/2005 Vicinity: KITCHEN -gri Parcel Number: 42207303 ,,,....-4-,-C49:, ,t F PAULO L r s 'u- f- ;y ISSUED BY: • Applicant: WALTER JOHN:MICHAEL A ' J ' j ' --c- yr"...../., t .tr e c i Address: 2750 SIGNAL PARKWAY!- V f i s° t: .-J ; _ - -I i U�1 -J> f, `,,, `" Phone-562-528-8000 ---.1/ 't: � / ''"--,S---,,----;\ Cr' �" � ' arSIGNA&HILL CA ' - ="t�Zlp--c907552207�"`x, - - 2 � ��\ Diner: RIEDLEY WILLIAM ALTER ��\�\ ',\,. Address TRS,1 y.,/ , \`•:,...\\-\\:\// ,c4, M vs,✓ `\.j� � COSTA'MESA,CA Phone: \ \`ct, .0 til 2238.STATE AVE#A Zip: .92627-3928 , �+ Contractor:• AR BRO INCa � t !1 �` A;‘ ; � / \y Address /2750 SIGNAL PARKWAY f. - I > i )J/+r" /;: .- ' --Phond. 562-528 8000 _1'- t I .-•, r' ;+: - • � SIGNAL HILL CA Zip: 90755-2207 -.-:,---` - �l',1k IBJ I.4. License:258441 - `\_'J\I It l., -� t ) '-+ .1.11- •".. 1,11 i I L , \ / 1(.' ' . '.,. , , „•i7 r SCOPE OF:PERMIT +.. 7 I )dill L i sl MECHANICAL PERMIT,FOR REPAIR OF+DAMAGED'AREA IN-GARAGE, KITCHEN AND DINING ROOM l - - _ ), . tH {{ (FRAMING, DRYWALL;-INSUL,LAIR-AND PLASTER).:DUE.TOAUTO-DAMAGE. ,', `--� '-' i �'I� WORK TO INCLUDE: 1APPLIANCE ' it _ , i • i � � / ', . i,, tt- , �kl -REF#B05-00734 - : ' - r r _ �':„ o �i - - ;i, •� f(i' -1 U - 1.Q, - ' "�.:- -_ ?' _.F , '-t t, , - T-1 1.4.1 i1 r ,-s l 1�; FEE SUMMARY< (lir; L - fl.'; t.V 'L✓ �l). i , - . {` i/i "..',. .7.....uaitil'! E.,.! > Quantity < y, ISSUE FEE . y� ,\ $23.50 Repair/Alt Absorbtion Unit -4/ / $0 00'x/071/1 Inst FAUr<100 k Bill ,} _ . $0.00 0 Repair/Alt Refrigeration Unit• l ('$0 00) 0li'; ��' Inst FAU>100•k BTU A \ x, _$0.00 0 t_ '2Venhllalicn System 1 .r l -_x$0.00 .6(41/ Repair/Alt'Coohng'/Heat -.`r,- $0.00 0 i�fl u-Evaporative Cooler y�,I'It $000 ; 0"! Inst/Rep.Recess Wall Htr -`•, -:,,--„,,,,,,,,$0.00 0 of r�'y c-Lc 001,L.;Commeiciahlncinerator_ -�i 4 $0.00`c0' Refrig Sys-5'160,k BTU>$ '\ N :$0 00 0 t.• N I "2Domestic Incinerator' ij/ `- ,2.$0.00,/,0 Refrig Sys>100 k•BTU \-,$0.90 0'x`+,1 "+ `- t c Compressors/Absorption Systems i,n' 1/ Gas Piping A 7 $0.00 0 '� ` , c",-a 'Up to:3 hp/1100 k BTU -- -% (:,,,x2;_, $0:007 0 Factory Fireplace ,,` `/// /'} so 00 OK:: tk ; 2. ` r a'3 To 15 hp/500,k BTUj� /� / 1$0.00 0 Hood w/Mech Exhaust'4,� ill$0 00 -":6;-, --:‘;:‘Si- p'1�, V' c _ ;�15 To-30-hp/ 000 k'BTU -� A✓%/�j'�$0 00 0 VAV Box y.,` ,'!/$0 00\•,,0 'ti. • ,-,., y--4,30 To 50 hp/4;750k BTU/ O \\,„/".,� ',I/ '$0.00$0.00 0 Vent Fan/Single Duct y .,\�N $0.00 )) 0'-,,.., - -r__ -Over 50 hp'/Over 1,750�BTU ")`- ,/t', $0.00 0 Appliance. `-� $10 •65 1„.y;r`I r Boilers • ,-' \ a C.21- 71✓ Fire Dampers '` $0.00-.(6,:=,,,--i7 '.- .) ,;"1 ' - Up to.3 hp ,�\ 1 , �,'Z $0.00 0 Smoke Dampers � $0.00, 0 `-=[', - ' ,: ' t 3 To.15 hp-'l / ..<Y j r $0.00 0 Inst or Relocate Appl Vent -$0.00x7'0-.-, \-`:) L,^,,`;� 15 to 30 hp--' =,“-� $0.00 0 Air Handlers< 10000cfm $0.00---...0"-- i --- __ 30 to 50 hp -�,'-=�',---- $0.00 0 Air Handlers> 10000cfm $0.00 0 "- - - _ _ - ='.Over.50'hp"4-- $0.00 0 Floor Furnace $0.00 0 -- _Other Mechanical Fee • Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 • 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 per ' FOR INSPECTIONS CALL: (714)754-5626 2446-46(6'00) 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. . "jS;f ave 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. y workers'compensation Insurance carrier and policy number are: // •>.•• s 42-(e�H% „,./5rC C.CT C o. Po • licy um ion-g4�a J5—C2 G O c� TO ; eed not be completed it the permit is valued at one hundred dollars($100)or less.) 7`-=�z:,- . - ❑ I certify that in the'performance of the work for wliich this pemlit is issued,I shall riot employ any person in any manner so as to became subject to the workers' ' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pr vI§'yns. / Apps SI ature: EUl l /n/ D W • RE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYERiOH• NAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS R100,003),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37050F THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereb affirm that I am licensed under rovy'sions of Chapter 9(commencing with Section 7000)of Division 3 of the Busines%and Professions Code,and my license Is In full farce and enect:isit x � J� - T-( e: . /.9. .�raure: ✓' `-1 Data�L. er —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). Lenders Name: Lender's Address: Signature: 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 sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivels license. ❑Yes ❑No Driver's License No. Expires: Verification of Ownership by(type of document,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,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: • Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application 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? 0 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? ❑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 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. /Aiorga+-ewner(s) Date 14Aifd/Q P i3 tat—RIVApplicant CODE a issPEFixed Tios TYPE . - IIIi11V1L' 206 INSPEFinal ec n •• 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 ,- ur4, CITY OF COSTA MESA rj �' BUILDING DIVISION ). . ., . DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER FI w..."- a ' .. ,, -`4>�bwril PERMIT P05-00347 • lE- (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 2238 STATE AV Status: ISSUED Suite No Applied: 05/09/2005 Issued: 05/09/2005 Vicinity: Parcel Nunmber: 42207303 ,,.yam;a,--tea'-%-" r "z""'`� 1 A. ISSUED BY: r""r Applicant: WALTER,-.JOHN MICHAEL 4l �1 n� . 1 �� 1 , �^"-+`A. y'fte e { �1 r -I ! V \---- Address: Address 2750 SIGNAL.PARKWAYz, y ,,s4 +�1 -) , ,,/ , // i I - r�e\ L /4 V.:\--rt_9 .Phone:::562=528 80001 r '� ' < SIGNAL HI L`CA (ry` r,. Zip 90755-2207 ,- ';':,-4-:,-::44-<44:"----, k �!/� • Owner. KIIEDLEY WI L AM WALTER ---,,,W,--:c"\ ' , ` AFddress, TR'----7,"7:4:-7 \ �,\ s 4 ! Al, COSTA:MESA,CA Phone:;.- /�- \ \t, ' . ,-) i a 2238 STATE AVE#AZip a-92627-3928 ; \1 ,yr;, • 41 al Y- .fit"--- \ \ \\ �.. _ t' ( ;1:.1 Contractor t//HAIL BRO INC Iy,.'- L. .:c._ k. ( , A '2 s r .. "- 1. '0l 1,I 1I" 7 Address it2750 SIGNAL PARKWAY - ,1-K '�:\ t 1 ) l\, 3 A yI,�, k r ` -- Phone: 562-528-8000 , \ /c\ r , ti , �� ` !A SIGNAL HILL;CAS �,' Zip: 90755-2207 \ 1' V L.- �'�' >,\ - -.: f r r.f .,,. License' -258441= -- -\ I 1' ,' � -' `�.,) I 1L/__ - L 'H if -. IL /3 . .1 I , t., . -_� `t, - 1 ,it t y 1 l,'J,p SCOPE OF PERMIT _._ _ %'t I ' t^ ' 1 _ _1 FI J,;PLUMBING PERMIT FOR REPAIR OF DAMAGEDAREA IN GARAGE KITCHEN AND DINING ROOM -1/ j�t� tVt,,(FRA-MING,DRYWALL�INSUL LATH AND PLASTER) DUE TO AUTO DAMAGE. - �- ,d , �'-% JO,, ( \tt.WORK TO INCLUDE 11'GASLINE,�1LAUNDRY TUB/WASHER (1/ ((4) �� l - - ,_-_ - ,' t.t-\ `y- Y�REF#B05-0073477 • _ f ' � ' ‘+'-‘, '_ FEE SUMMARY : '/7J/ A , 2 11/7 h 4 \\`\...:„.: ` QTY .....,7;A:Y '=' .- AMT QTY `:_'; ( 7 AMT., QTY ISSUE FEE ,t. $2350, LaundryTub'1 Washer ^ - $9.80 _ 1 Sump Pum, ~" $0.00 0 Backflow ungation - $000��$0 00\\ i0 0 1v Landape,lmgationct; $9.00 .r0 Swimmmg'Pool+-'L /$0.00 0 BackflFit-eaterven ow ter \ ^f:I.z.x lFt TrascP h - ,- rte `l a,0•.. '$0.002 '-0�e_.'S' Trap Printer L.�r /, $0.00 0 : Bathtub '4-1 $0:00 ",.."0'1,1,, ' z res •Psure egulator .� $0 00 0 -.. A')Urinal /$0.00 0 Clarifier System,• \ $0 00 0�''\ :Process Piping(per 1.0 ft)I.,$0,09,- , Oa Vacuum Brkr,Bkflow(114)) $0.00 0 Connect(Ice Soda etc), �`i.50.00:7,-,0r -��1Receptors xi+s" ' '4?. 50 00 .° 0f r Vacuum Brkr Bkflow(5+) $0.00 0 '� _. �u $0_00 Jc.�OJ.,/� Wash Basin (A $0.00 0 Dental Units �;;�'iti,, $0`.00 �/ 0> \-Seppc Tank. 1 - -�`J � Dishwasher `t,'Wt..,$0A0 J Ofd: Sewer Cap'.for-Demo mr'- _ . $0'00 ,;.-0r-` �•,(Wash Basin Set// $0.00 0 Drain, Floor ''"t'$0.00 0 F Sewer Cdnnect - = 5000 0 \� Waste and-Vent System $0.00 0 Drain, Rainwater $0.'00' 0--.",...tHyr , Sewer Private Line+ r$0 00 _,'0,`\ C Water Closet.jToilet) $0.00 0 DrSileMer 0 Drinking Fountain $0.00 'N,.O ''S Sink,bar L/ ` `'jt r- y$0'00 C-0`-' WaterPipingr(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0�^-'`>___Sink,commercial�.1...- $0.00_., 0 '.c-.)�,Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 `'`Sink'Floor- _ _ $0.00--:45:07,;(,----7::----, Water Service $0.00 0 Gas(1-4 outlets) $6.15 1 Sink,kitchen-''-c: ..?-q.,:_.7$010-0"--__-0---- 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 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, all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this p it. FOR INSPECTIONS CALL: (714)7545626 2446-46(6/00) . , 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 wfor which this permit is issued. cstr„sags 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: • •ardor:eie - ' i ter G,t.r / S u2rlrccr a ' olicy Number. JO J`— O 6 O g -- -section need not be completed if the permit is valued of one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and'agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith corn I w'h these••ro r "•ns. n. .n •" / Cha' t. — 9—0 5 the: ARNING:FAILURE TO.ECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereb affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business an.Professions Code,and my license is in full tarcebaeeeci`[1.1th S. _ CIasSN. is... •ontractors.Signature: ar Date�•"• —r/ �., - 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 himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2.Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 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 and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If 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 aapermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 8 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 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? 0 Yes 0 No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. rrtnT(:Ho78IfTFlHa7'7':T7Ri1/ '+� -� :Data „ / °.Ti,d/Or Authorized Ap.Ilcant - at )-- _^4 CODE S -1NSPECTIONTYPE pin- INTMAL$ • CODE It INSPECTION TYPE -I, • - ' PAIS- INImAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical / - o /t� - 1266 Pool Spa Final 208 Final Plumbing I�a�d/�O 77///Y/'f�fW. 200 Final Re-Roof ' , ' . , - • ' 210 Final Electrical - ' ' • P V ..201 Final Block/Retaining Wall 212 Final Fire Prevention• 202 Final FactoryyFire Place ' ' 220 Final Planning Approval - • ' '• . 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy ' ' .. , (<eu rr't5) 6 DING AND SAFETY DIVI Via© / �f . �„ FIRE DAMAGE INSPECTION REPORTor-5 N 3Z- Q ",v (Required Prior To Permit Issuance) Address: 1223 " 5-/ctle Unit: (4k1 /;71- 6 Yom Owner: ) lei frl ifitth>h Wl e pt• 1( pp1` t 2.' ePii ��O Owner's Address (if different from above): fiQ 2a-it Lr4��''d SA n z - cell/J. ?V'Y- 70'9=519# Street - City State EY Structural permit required. ' Repair or replace as necessary. i. ❑ Plans required. / L // Comments: ek-h't a 't a P rot -- G a.. v -e k 1 re. r t e-, Rif% _Fta u,, r tis OK/ k.4 /I, qhs 1. criav4 J.� dee 1.-- / L4 4 � o (gt v I • r 't Electrical permit required. a-. Repair or replace as necessary. n / / act,"- at ,_40 �o _ / lC 14,4 `�4 so Comments: �/��� �^" l �� � �' Plumbing permit required. . ©' Repair or replace as necessary. / Comments: QG� tq j 16' 6 45 (//ifir. •0 64< C.5i S4ef. eIR�j� (04s 4-.6,44 r� r • ❑ Mechanical permit required. ❑ Repair or replace as necessary. Comments: iti/74 . 611 Pr/ w . lio®t - r-3 0C" 7 /`-7- 75-1- 5-6 f -7 Inspector Date Phone 16/246 Triplicate:OriginaFUvner;Yellow-Contrator; Pink-Building Division ELF RECEIVED 12504 ifcJUL 111950 COSTA MESA BUILDING-SAFETY DEPARTMENTFINANCE DEPT. P. O. BOX 911 COSTA MESA. CALIFORNIA CITY OF COSTA MESA For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING BUILDIs 2238 State Avenue • /-ii:le COSTA MESA. CALIFORNIA For Office Use Only RECEIPT NO. I 1@V1M1T�N0,., OWNER. Columbia Homes, Inc. i) M1JJU�aV(/aC MAIL 1533 Baker Street • RECE D BY I DATE_ Erb I t1DA'TTE 118BUED ADDRESS ((��ff�� ((//((.. L 4 Ia✓J CITY Costa Mesa, Calif. TNo:K19115l BUILDING ADDRESS ARCHITECT GarlsOn & TEL- COSTA MESA. CALIFORNIA OR ENGINEER Mi rTdlebroojc NO: LE9774.7 ADDRESS Garden Grove, Calif. FIRE l:) ZONE TYPE GROUP of L CONTRACTOR Dike & Cole grove, Inc. APPROVED9_, ADAE�$�IL11 o/ ADDRESS 1533 Baker Street ZONING Tj^'777�`''' cL 4 ' O NO.OF USE OF / CITY fingt, MPSA CRl l I orni I PLANS `Y I BUILDING i Pj ' I STATE LIC. O 167293 I No.1{191151 LEGAL Lot 3, Tr. 3717 lir IVI DESCRIPTION (VELDT 60 x 100 No. OF BLTE,One -_ r.n ,. NOW ON LOT A.P.NO. lv_ ‘ .---51-----------— USE OFYARDS EVES EXISTING BLDG. none APPROVED ALLOWED SETBACK LINE FROM 43' 25t t (CENTER LINE ST.) CENTER of STREET REAR YARD l FRONT l.J.. -� FT. IN. 111 [r. SIDE YARD LEFT RIGHT R.SIDE .7 FT. IN. DESCRIPTION OF WORK L.SIDE S/ FT. IN. NEW I X II ALTERATION I II ADDITION I L,r REAR i FT. IN. REPAIR V MOVING III DEMOLISH I BYPROVED Lu \___.,\)) DATE —1 7, -GC \T to DING 1758 sq.ftOM ROS 1-0 STORIES 1 D EXTERIOR WALL ROOF COVERING StUCCO COVERING COMP.rOCk USE_OpF.BUILQJNG ANDORK TO PERFORMS Multiple family dwelling with attached garage (two living units) Gar 420 sq. ft. Plan CR I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS POR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION. a VALUATION SIGNATURE OF / v - £grove, • PERMIT FEE $ 37.00 PERMITTEF AA N $ 17,926.00 PLAN CHECK $ lo'50 w' AUTHORIZED AGENT Dike & Inc. 55.50 0 . TOTAL FEE $ 4