HomeMy WebLinkAbout3086 YELLOWSTONE DR - Building Permits 2 CO Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. i
CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT 71-3 TRACT NO. LOT NO. UNIT NO. A P # Zone
- E LYJC `T 7 E Main Building: Accessory Building: Z
Project Address •S. - V. nand 1 �•� ] �-
4 TYPE OF CONSTRUCTION H NEW ❑ ADD ❑ ALTERATION U REPAIR
Applicant's Mailing Address i too tae Front 0
❑ CONVERSION ❑ DEMOLISH ❑ OTHER, 5 T
Owner's Name ! L. LI. Phone�6G•-/Z9b DESCR I PTI N WORK USE OF B 0G. [ a�Vn I B Rear N
Addtss '. a! .. •a. 9t/nts Dr e.M CA 92.0 r i N 1 •e.• A I
Arch/Eng. License No. TYPE OF ERMI GRADING( U FOUNDATION -.STRUCTURAL C Right N
G
AddressElTENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL S Left R
Contractor's Nam- 0 Phone ❑ OTHER 2 Ping. Ref.# Parking Req./Provided E
PROJECT DESCRIPTION SQ.`FT. OCCUPANCY Q
r� PlanningNotes:
Address(mailing/ CON STRUCTION TYPE r-7V VALUATION$J�Q`.� . M
City License No. T
- ZONE GRADING CU.YDS. ACRES S.
0 LICENSED CONTRACTOR DECLARATION
�1
I hereby a that i am licensedsion3 under provlslo (Commencing Remarks: fl c ��� n �� �./s� D ���� r rr
with section 7••. • Division 3 of e, nese and Professions Code, and l a res.)
` - ELECTRICAL FEES
\^ my license is in full force . ..- .. /Or� ' g �• . _ /' ./2-f
pc
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`U License Class • - No. (/B t/{'S C. (�'((�y�f s� �-' —
u Date Signature PLIiMBING FEES Automatic Washer Transformer 0 15-50 KW
WORKERS' COMPENSATION DECLARATION • Construction Pole Sub. • 0 50+KW
' treby affirm that I have a Certificate of consent to self-insure or a certificate Bar Sink Showers - -
Workers' Compensation Insurance, or a certified copy thereof (SectionCooking Unit Meter ❑up to 100 amps
JO, Lab. C.) Backflow Preventer Service Sink
Policy No. Company Backflow Irrigation Sewer Cap _
Dishwasher Meter Dover 100 amps
- Certified copy is hereby furnished. Dryers DGas DElectric Sub Panel
- Certified copy is filed with the city Building Division. Bathtubs Sewer Connection
Date Applicant Fan .
Motors❑0-1HP ❑1%-8
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors
(This section need not be completed if the permit is for one hundred($100)or Dishwasher - F.A.U. Inc.Solar 09-15 HP 016-15+
less). Solar Piping
I certify that in the performance of the work for which this permit is issued, I Fixtures
shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank icrowave
Workers' Compensation Laws of California. Device Boxes Pole Light Date Signature Floor Drains Swimming Pool w/Spa g
NOTICE: If,after making this declaration, you should become subject to the Outlets Range
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks �rinal
comply with such provisions or this permit shall be deemed revoked. -
CONSTRUCTION LENDING AGENCY Gas Service Outlets / Water Closet Switches Sign
I hereby affirm that there is a Construction lending agency for the performance
of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Garbage Disposal Standing Sections
Lender's Name
Lender's Address Kitchen Sink Water Service - Generator 00-5 KW 05-15 KW Trash Compactor
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash -
following reason (Section 7031.5 Business and Professional Code: Any city or -I .
county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays
any structure, prior to its issuance, also requires the applicant for such permit -
to file a signed Statement that he/she Is licensed pursuant to the provisions of Roof Drains
9
the Contractor's License Law (Chapter (commencing with Section 7000)of - . .
`ivision 3 of the Business and Professions Code) or that he/she is exempt - Reinspection Fee $15 Issue Fee $ 3
erefrom and the basis for the alleged exemption. Any violation of Section
531.5 by any applicant fer a permit subjects the applicant to a civil ,
eenalty of not more than five hundred dollars($500). DEVELOPMENT SERVICES REQUIREMENTS:
(LJ I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 Zoning Approved By Date
compensation, will do the work,and the structure Is not intended or offered -
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES - Building Approved By Date
License Law does not apply to an owner of a property who builds or improves /� :Itthereon, and who does such work himself/herself or through his or her own Boiler Hood or Type I 0 . Application Issued By Dat
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0 • SUMMARY OF F ES
oletion, the owner will have tho burden of proving he/she did not build or im- Duct- Under Ground
prove for the purpose of sale). - BUILDING PERMIT $ 2S • CO SMIP $ • 6z7
• ❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System PLAN CHECK $ PERMIT
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU PLUMBING $ ISSUANCE $
builds or improves thereon. and who contracts for such oroiects with a con- ENERGY P.C. $
tractor(s) license pursuant to tne Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 stem Repair/Alteration PLAN CHECK- 25% $
proof of their worker's Compensation insurance hould be provided to me. ELECTRICAL $ GRADING $
• ❑ I am exempt under Section B. • P.C.for this reason Firepl/Fact.Bit. ICBG# Fire Dampers
Date2 i- MICROFILM $
PLAN CHECK 50% $
Owner • -� � Heating System& Ducting Registers MECHANICAL $
TOTAL FEE $ 24•.SIU
I hereby certify that I have read this application and state that the above 00-100,000 BTU ❑100,0BTL PLAN CHECK 25% $
Information is correct. I agree to comply with all city and county ordinances -
and state laws relating to builds g co truction, and hereby authorize repre-
sentatives of this city to entu n the a ove-mentioned property for -
inspection purposes.Sre (�� Jo ry
Dirivers' Licensegt - -
Reinspection Fee $15 Issue Fee $ 3 i-- - - ._�, .,r-zi•_ J' -
0865-46,rev. 5/88 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor f .
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CONSTRUCTION AND PLANNING POO WPA
APPROVALS •'rfermit# Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit•Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcemeht 1 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. I 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test
9. Wafer Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11.Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer'Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing ' 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
18( Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign rl, 68. APPROVED FOR PLASTERING
18r Rough Electrical-T Bar Ceili`g 69. POOL/SPA SYSTEMS FINAL
19:Rough Heating & Air Conditi ni g FIRE DEPT. REQUIREMENT
20, Rough Factory Fireplace `'. -'1 APPROVALS Permit#
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21. Ducts, in:Structure 70. Underground Hydro
22. Ducts, Ventilating t_. _ 71...Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 1 it 72. Underground Flush
24. Roof Framing - 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing .i • 74. Overhead Hydro
26. T-Bar Ceiling (Structural) &Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing &'Siding 't. , 77. FIXED SYSTEM FINAL
•
29. Insulation ' 78. FIRE PREV. FINAL
30. Drywall Nailing • i' HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat -' ". 79. FINAL INSPECTION
32. Elgctrical Power Meter-Final;_ 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:on�. SMr o L C
34. Final Heating & Air Conditioning
..4/01- (WILD'D'\ - Celt, o Y/ F6) .�
35. Final Gas Pipe-Test es 219 NO AtLES.5
36. Hood or Canopy
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37. Final Factory Fireplace Aar IOOr .Q/Pa.. 0/L9��-.9
;"
38. Final Plumbing
39. Water Service-Final
..r•
40. Gas Service-Final
41. Solar Domestic-Final .
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42. Backflow Preventer
43. Backflow Irrigation /
t
44. Landscape Irrigation System •�
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING liyot C%i�le48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date '
r1
LIMITED STATEMENT of RESPONSIBILITY - Bldg. PermitQT7^ 3
TO WHOM IT MAY CONCERN: This Permit # /
( sZ) VAS-74 i)-) o e
Street Address AP Number
LE , 611 N . , as Owner in Title of the above referenced
property, do hereby auth rize:
7//9-v 1 /2 C 7��! G ����9
LA-r al id— C7 ) 966 — (caq6 ,
Name Telephone No.
.226s-D VIS 771- /7e/ og4)
3 vd'6 t //oma/ 540-�t_e /fir
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o r 7 &e cA StreetAddressd
h9.2C O
�.Cwl
Co ST MESA G1-1- qcoa6
City State Zip
to obtain permits in my behalf, as owner/builder, for
at the above referenced property.
Should any person become an employee engaged in the improvement of the property, I shall
immediately provide Worker's Compensation Insurance coverage and cause a certificate of that coverage
to be filed with the Building Division of the City of Costa Mesa, as required by State of California laws.
As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other per-
son, company or corporation.
I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any
claim resulting in damage or personal injury to myself or any other parties.
Printed Name Date
Signature
AuG 15 1989
0779-46,rev.8/87
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�3 � Q$0 r EE RECEIVE®
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2� 9 JAN 1 01361
COSTA MESA BUILDING-SAFETY DEPARTMENT F'r'I,A
P.O.BOX 317 COSTA MESA. CALIFORNIA IIP.CE DEPT.
CITY OF COSTA MESA
fOR APPLICANT TO TILL IN COMPLETELY APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
BUILDING 3086 Y
ADDRESS JELLOWSTONE DRIVE
�t
COSTA MESA, CALIFORNIA fOR ONCE USE ONLY
OWNER KWK CONSTRUCTION CO . , INC I RECEIPT NO. I .Ye 9J NO.
MAIL RECEI ED BY Df TE gECEIV D DATE ISSUED
ADDRESS 1555 PLA CENT IA AVENUE I 4' _ I / �Cr.-:- . / I - •.+ 11 1961
TEL. M BUILDING •
CITY NEWPORT BEACH CALIF ND. 0-3227 ADDRESS
ARr••'TECT LIC. COSTA MESA, CALIFORNIA
OF 1INEER NO. (�.
FIRE .
ADDRESS ZONE TYPE GROUP c-.1G
CONTRACTOR K. W. KOLL Lr261195 BYPROVED DATE
ADDRESS 1555 PLA CENT IA NEWPORT BEACH ZONING ragl•LEGAL LOT 4041 ZONE NO.OF USE OF NEW S1Sinai •
DESCRIPTION I NO. 24 I BLOCK I TRACT R-1 I PLANS 2 I BUILDING X/ att gar
APA.P.NO. fffP BY IV
W.L.D.��A/ DATE 1-6-61Y P
SIZE 60x 1 00 I NO.OF BLDGB. `(
OF LOT - 1' Now ory LOT 0 YARDS EVES
REQUIRED ALLOWED
USE OF (CENTER LINE ST.) rip
r
EXISTING BLDG. FRONT 1 [/ FT. IN.
SETBACK LINE FROM .[�
CENTER OF STREET 501
REAR YARD 28 8 1 R.SIDE •J FT. IN.
SIDE YARD I LEFT 51 I RIGHT 51 L.SIDE FT. IN.
DESCRIPTION OF WORK
REAR FT. IN.
NE I XII ALTERATION I II ADDITION I
. REPAIR I II MOVING I II DEMOLISH I
BUILDING 15O6SF NO.OF 7
SIZE ROOMS STORIES 1 nt
• EXTERIOR Wpp{L,L ROOF COMPOS LT ION
///i Y
COVERING JTUCC0 ICOVERING SHINGI ES Lfl
USE OF BUILDING AND WORK TO BE PERFORMED /
SINGLE FAMILY RESIDENCE AND
ATTACHED GARAGE PLAN No. 3-OR
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT A AGREE TO COM-
PLY WITH ALL CITY ORDINA ES AND STAT AWS RE LATINO PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
BUILDING CONSTRUCTI N. %. VALUATION
SIGNATURE OF PERMIT FEE $ I.5-----
• PERMITTEE c '%
$ ni e J S.", PLAN CHECK $ /
-�G
' AUTHORIZED AGENT .(� 3 V
TOTAL FEE $ (/