HomeMy WebLinkAbout3112 YELLOWSTONE DR - Building Permits L' V
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•`e P CITY OF COSTA MESA
4 BUILDING DIVISION
>D-' A DEVELOPMENT SERVICES DEPARTMENT PER IT NUMBER
1 r�.� w ! PERMIT
�. 04-01986
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(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.caBIJILDING PERMIT 77 FAIR DRIVE,COSTA MESA, CA 92626
Job Address: 3112 YELLOWSTONE DR Status: FINALED
Suite: Applied: 11/22/2004
Vicinity: Issued: 11/22/2004
Primary Occ: • Type of Construction:
Parcel Number: 14107224 Zoning: R1
Applicant: LEHMAN, JEFFREY
Address:
Phone: ISSUED BY:
Zip:
Owner: WONG, EMILY F TR f
Address 3112 YELLOWSTONE DR
Phone:
COSTA MESA,CA Zip: 92626
c;yr.'.
Contractor: J S L ROOFING INC �/ r
Address: 2415 MARGARET DR `
Phone: (949)646-3571
NEWPORT BEACH,CA ./ .
Zip: 92663 License: 747706 t- -,:,.,
Arch
Address: Address:'(, ��, ; - .
Phone: - Y ( Phone ''-
\ X :+
Zip: License: tt^+r+ - r. 7 License::
ar . .. I
tWI' SCOPE OO S) ; - i ,t..,,_' j I,
REROOF:GO OVER EXISTING COMP.ROOF WITH•30 YR'COMP.'(25 SOR S) • n ` I/
/ A - A kr '
�.FEESUMMARY ',
Plan Check: $0.00 Pa +r }fry I,..i„-. /, r ` , ,
Calc Valuation $44,000.00
Permit $97.25 &Y , °'rClaim Valuation: 54,000.00
•SMIPRes:,,rr£.$r;$0.50 3.,:.1.:,',,'"' ✓'
SMTP Com F''$0.00 rS' '•
'aOtlier�`. .$0-00 & : 1
nspection g =r$O 00 4,t7,-1.,4,,i;:%1
.erd`A J S e
�v.4 iir fl rj ' r
b ,5x " .PLANNING &ZONING
SETBACKS t ,,r,+ s
";MAINASTRUCTURE Front 0-0 4", Rear t '0 -0 Left 0-0 Right 0-0
7-34.'.x �xj C� Xopiw : t+fsiw�, .-.
'ACCESSORY Frorit 0 0 Rear { � Left 0-0 Right 0-0
'.`PARKING Existmq: 0 Required. 0 Proposed: 0
F t
4' ,..:, S,
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 pe+mit 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
2446-46(6/00)
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of penury 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 perlormance of the
work for which this permit is issued.
❑ I nave and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the penormance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: .. Policy Number:
(This section need not be completed if the permit is valued al one hundred dollars($100)or less.)
❑ I certify that In the penormance 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
comply with those provisions.
Applicant Signelute: Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE is UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP 1O ONE HUNDRED
THOUSAND DOLIARE(S100.030).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3705 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION: !
„z Yid{
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Profession;Code,'and my license is in lull
force and effect.Liar Class I_ .."-e"1 /-Tag-.4/
Contractor's Signature: Date: -4''I - 3 / - /
,. , ox. , r
CONSTRUCTION LENDING AGENCY: ..44-,-A.,...
r-',-', `s-')
❑ 1 hereby anion that there is a consttuc%on lending agency for the penormance tit the work for which 1Nq permit is issued.(Secs3097,CSt Code).
Lender's Name: Lender's Address: ,14,•,+z'--2&,'` \.: 'J. x-1a' .M
Signature: -1 :-'i"iy''4 Dal,:y'-n:
/.).t.•k-
•
OWNER-BUILDER DECLARATIONS: .:}. - " . 1 r'
I herooy affirm that under penally of perjury that I am EXEMPT FROM THE CONTRACTORS UCENSE LAW kith's following reason Pk:2031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,.domolish,or ripiiieany structur lJiprior,to its issuance;etso requires the applicant for such permit
to tile a signed statement trial he or she is licensed pursuant to the provisions of the Contractor,License Lain.(Chepler 9(commendrg i IIh'Seclion 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom-and the basis for t`-'a)Ieged exemptiert-My violation of Sectlon 7031.5 by any applicant for a permit
suotects the applicant to a civil penalty of not more than five hundred dollars($500).): �, I I _ I
❑ I.as owner of the propeny.or my employees with wages as Amir lots compensation,WILLDOITIiE 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 property1who builds or improves thereon,and who does such work
himself or herself or through his or her own employees/provided that such Improvements wino;intended or offered tor sale.11;however,the building or improvement is
sold within one year of completion,the owner-budder wlll have the.burden of proving teat he or the did not build or improve for:purpose of sale).
❑ I,as owner of the property.am EXCLUSIVELY CONTRACTING WITH L CENSED CONTRACTORSirto construct the project(Sce .7344,Business and Professions
Code:The contractors License Law.does not apply to an Owner of property who builds oeirnOcoves thereon,and who contracts for_rich project with a contractors)
license pursuant to the Contractors License Laws.); " JIP ' -- I I „ _% - "F- )
❑ I am exempt under sec. - - I Business and Professions Code toe Nis reason: j'
/�
Signature: f * "...1 i' -.. ( I' .1 C:` : .I Date: I"
Owner ID verified oy driver's`iicanse.,`•_rc 0 Yes 0 No i 1 Drivers LiceAseiNo.i I Expires:
Verification of Ownership py(type of document,La, property tax bill or deed):,_-; .• -� �I ',•-
7' t'.... 1 i , a.- ,..r
DIVISION OF INDUSTRIAL'SAFETY PERMIT CERT iFICATION: i,
l I I' ; I
❑ I hereby certify that no excavation five(5)or more feet'N depth into which a person is-requited to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding lalsewoik,or demo1Non Or dismantjnp therein,will be more than thirty-six(36)feel high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 6,California Administrative Code). / 7te
❑ As owner-builder I wlk.not employ anyone to do workviniet would require a permit from the Division of Industrial Safety, as noted above, unless such person hes a
permit to do sufch work from the division. {
Signature: { •r....' �. Il ..
Date:
i Lr 1 \.-
Division of IndustrialSafetyPermit Number:-
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
tore_„
1 Will the app0 eor:pre or,tutur0,buUding occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? Yes if Oati 1ti/t,a/
!Section 25505 of the California Haelnd Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which mast any one tithe during a reponed year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cuoic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant a-present'or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of Ifie'Cdlifornie.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 nanda'qua'ntlly 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 ❑Nu
(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
Depanment of an HMPP by businesses which ate required to register acutely hazardous materials with the Fire Department.
4 It an HMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Dues or will the applicant Or present or future building occupant require for the work which is the subject of this application a$$ermtl for such construction or modification
from the South Coast Air Quality Management District or nom any other alt pollution control district or agency? LJ Yes LJ No
(Section 65850.2 of the Calltornia 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
Of'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 11 a permit horn the South Coast Air Quality Management District or other alt 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 0 No
a Oi'yes",attach certificate et compliance!morn 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.
Signature Of Legal Owner(s) Date
AncUOr Authorized Applicant Date
CODE P. INSPECTION?yn DATE INTI_ TTS CODE r IfSPEC1iON TYPE La L INTngI S
1616 Fixed Syatrun Final Fire Prevention .-..-ii-t7'�"'--ei---.. 20(5-C.FInat{YteGlardgat - r /- .. '—? 7
1266% Pod Spe Final 1:..-- . r 208 Fkml Phenbh1p' n r , r /r -°./
Ir ` �\� y
200 in Final Re Rool Amax--'` if - -..N.:4,tri;:. ).. 210 FIr1aLEleolrlcal } Ii",�' t . . -\\ C7R.,,,/'
201 M,Flrml Block/Helaining Wall .Gtri }'I - . r 212 Flnal.'e Pre titbit•t: -r i r i t
20
1&,,-..,-,.,:-.y",.
^vz F((ta Factory Fire PI '•":µ '1r-;i r 1tl frty id•, b 1'-. F ` 1K 4 -5 ",1 '.„
{3rP - 220 FInalelenning Approval'
203 F SI n, `pr A ' ' I 1
pi t ..)t.-x- ! 222 Ftrtal Site ['
204 Final Demolition It•T , �'�•. ..,tlic.t` ,,- `- 9 F. t.,.. '
250.-Frrml 9uildlnyOccupency apt
CITY L COSTA MESA, BUILDING SAFETY LT.VISION
POST IN CONSPICUOUS PLACE ON THE JOB
4
NOTICE kJ
Schedule inspection one workday in advance. To schedule inspections, call (714 5 5626. Provide the ollowing information:
1) Permit number, 2)Job address, 3) Inspection item number.
Building Address: 3 / /Z d a�sDX Owner: Z. 4,9rycp T.�
p r// �/
Building Permit/ry//./ '79/q �j Electrical Permit#: Contractor: ? S ,. At/.
Mechanical Permit#—: Plumbing Permit#: Job Descripti✓ (/` C/r� ^
NEW ADD ALTER SUES T
REPAIR MOVING DEMOLISH ISE —�,/y�U�j/
Dv�
r.-k- /171
PERMITS EXPIRE 180 DAYS (6 MONTHS) FROM ISSUANCE OR LAST INSPECTIO
CONSTRUCTION APPROVALS
Item# STRUCTURAL Date Inspector Item# POOL&SPA Date Inspector
3 Job Site Consult 94 Pool&Equipment Location
4 Footings/Ufer Ground 96 Steel Reinforcement
6 Slab 100 Electrical Bonding
8 Structural Floor 102 Rough Plumb&Pressure Test
11 Pre-Inspect Roof J/jz/cf I!L/ 104 Approval to Cover-Gunite
12 Roof Sheathing / . 106 Elec Conduit-Underground
14 T-Bar Ceiling-Structural 108 Gas Pipe/Underground Test
16 Shear Panel 110 Backwash Lines, P-Trap,
18 Frame& Flashing Underground
20 Lathing&Siding 112 Approval to Deck
22 Insulation 116 Pool Plumbing System-Final
24 Drywall Nailing 118 Pool Electrical-Final
26 Plaster Brown Coat 122 Fencing/Access/Alarms Approval
30 Pre-Grout 124 Approval for Plastering
33 Disabled Access 126 Pool/Spa Systems- Final
FIRE DEPARTMENT APPROVAL
1610 Overhd Hydro/Overhd Rough
1612 Dry Chemical
ELECTRICAL 1614 Dry Standpipe
36 Ufer Ground 1616 Final-Fixed System
38 Elec Conduit-Underground
44 Rough Elec-Wiring FINAL INSPECTIONS
46 Rough Elec. Conduit (Most be completed prior to requesting occupancy.)
48 Elec T-Bar Ceiling Call(714)754-5626 for the following: Date Inspector
50 Elec Power Final 200 Final Re-Roof /ZOO Z
51 Temp Power Final 201 Final Block/Retaining Wall
203 Final Sign
204 Final Demolition
206 Final Mechanical
PLUMBING&MECHANICAL 208 Final Plumbing
52 Soil Pipe-Underground 210 Final Electrical
53 Shower Pan Call(714)327-7400 for the following: Date Inspector
54 Water Pipe-Underground 212 I Final Fire Prevention
55 Underground Gas Call(714)754-5671 two(2)working days Date Engineer
62 Rough Plumbing prior to final.
63 Prewrap 216 I Final Public Svs. Dept.Approval
64 Rough Mechanical Call(714)754-5245 for the following: Date Inspector
66 Rough -Factory Fireplace 2201 Final Planning Approval
68 Sewer System Call(714)754-5626 for the following: Date Inspector
72 Gas Pipe-Rough _ 222 Final Site
90 Gas Pipe Test-Final 250 Final Building/Occupancy
92 Water Service-Final
NOTES: SEE REVERSE
0559.46 (rev.10/05)
1
O f CITY OF COSTA MESA•
4 D@ BUILDING DIVISION I rr-
f
I 8
DEVELOPMENT SERVICES DEPARTMENT
PERMIT NUMBER
{P PERMIT
J1.111141 •
' ,e�,,a�' B04-01986
•
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT .
•
Job Address: 3112 YELLOWSTONE DR Status: ISSUED
Suite: Applied: 11/22/2004
Vicinity: Issued: 11/22/2004
Parcel Number: 14107224 Zoning: R1 R1 •
Applicant: LEHMAN, JEFFREY ISSUED BY:
(ff_\L14___'
Address:
Phone:
Zip:
Owner: WONG, EMILY F TR
Address 3112 YELLOWSTONE DR
Phone:
COSTA MESA,CA Zip: 92626
Contractor: J S L ROOFING INC
Address: 2415 MARGARET DR
Phone: (949)646-3571
NEWPORT BEACH,CA .
Zip: 92663 License: 747706
Arch : - Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
REROOF: GO OVER EXISTING COMP. ROOF WITH 30 YR.COMP.(25 SOR'S) •
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $4,000.00
Permit: $97.25 Claim Valuation: $4,000.00
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $97.75 •
PLANNING & ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTES:
•
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required 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
2446-46(6/00)
1 a
WORKERS'CQMPENSATION 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 section need not be omelet,d i/the permi valued of one hundred dollars($100)or less.)
❑ rtify that In the pe • i., ce of the rk for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
ompensatlon laws. / •rnla,an ree that if uld become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
e‘o
cornet;with these• •ns.
erg f It /2 p a:� /1 2`7—e cf
WARNING:FAILURE TO•J/ -WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED
THOUSAND DOLLARE($1 r r,r r r),IN ADDITION TO THE MaT OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby,affirm that I am livens:. d: •L°f J of Chapter• commencing with Section 7000)of Division 3 of the Business and Profsfs • ns Code,and my license is in full
�foc nd-effect.Lic.# •/SAW.,
/��i C s.#r+^--"""C/ / �s�o
6�Jniractor's Signature: ��/i/A , �D ,fes`//— 2— 0 Cr
V jl
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 tile 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. 0 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:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑Yes ❑No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 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 et 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 ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 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 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? ❑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 A IZAT1ON 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 th all state s and city ordinances relating to building construction,and authorize representatives of the City of Costa Masa to enter upon the
above-described prop' r,/or inspecti urposes.I agree not to occupy or allow occupancy of any building authorized By this permit until final inspection.
Pt
It
/ i Si tura Of L er s)
Ile
'/��1. -A nd/Or Authorized Applicant '�ete
CODE IL 1, PE+10N TYPE PATE INTRIAL POE INSPECTIONTYPE \11 PAM itilmau
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 PoolSpa Final m/� 208 Final Plumbing
200 Final Re-Roof Z 47A 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
tU E- I CITY OF COSTA MESA
fa)
BUILDING DIVISION
1. • r .� DEVELOPMENT SERVICES DEPARTMENT / PERMIT NUMBER
le t I PERMIT
'Pita
Sbkaternso'erP01-00644
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 3112 YELLOWSTONE DR Status: ISSUED
Suite No Applied: 11/01/2001
Issued: 11/01/2001
Vicinity:
Parcel Nunmber: 14107224 ISSUED BY:
Applicant: STARK, CHRIS
Address: 7229 VARNA AVE
Phone: (800)444-8865
NORTH HOLLYWOOD,CA Zip: 91605
•
Owner: WONG, EMILY F TR ,
Address 3112 YELLOWSTONE DR
Phone:
COSTA MESA,CA Zip: 92626
Contractor: ALAP ASSOCIATES GP
Address: 7229 VARNA AVE
Phone: (800)444-8865
NORTH HOLLYWOOD,CA Zip: 91605
License: 771905
Arch / Eng:
Address:
•
• Phone:
Zip:
License:
SCOPE OF PERMIT
PLUMBING PERMIT TO REPLACE AN EXISTING WATER HEATER.
FEE SUMMARY
AMT QTY AMT QTY AMT QTY
ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 • Sump Pump WOO 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 $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0
Clarifier System $0.00 0 Process Piping(per 10 ft) $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 $0.00 0 Wash Basin $0.00 0
Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0
Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0
Drain, Rainwater 50.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0
Drain, Roof $0.00 0 Shower $0.00 0 Water Heater/vent $12.30 1
Drinking Fountain 50.00 0 Sink, bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0
Expansion Tank 50.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0
Gas Earthquake Valve $0.00 0 Sink, Floor . $0.00 0 Water Service $0.00 0
Gas(1-4 outlets) $0.00 0 Sink,kitchen $0.00 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
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
TOTAL CALCULATED FEES: $35.80
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
2448-46(6100)
DECLARATIONS a
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
wo hich this pe t Is issued.
I have and III m nC ••rkers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for
[whihi'chh this permitpemiis Issued.
My wo� .n Insurancacarri: d..licy number are: S G 2 /// 962-7
Carrion / I . Li
"•'.../ Policy Number:
(This section need ilf:completed if the perm' valued= one hundred dollars($700)or less.)
O I certify that In he performance of the ellMcthis permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of Calif. �,r_ i t If should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisi• �,all//'
Applicant Signature: +'I``i/.E� / Date: //'"/_p
WARNING:FAILURE TO SECURE W0 t21 irMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND OVIL FINES UP TOONE HUNDRED
THOUSAND DOLLARE(5103,030).1N ADDTTI• TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am license. n•e •;L Al.. hapter 9(commencing with Section 7000)of Division 3 of the Businep$nd F oesions Code,and my license is in full
force and effect.Llc.If ./a _I c1 Class A Lam'
Contractor's Signature: Magi,rilre Date: //—/—p /
'
F
CONSTRUCTION LENDING AGENC':
❑ 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 peen.i
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
O 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. 0 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).
O 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:
I
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? ❑Yes 0 No
(Section 25533 of the California Health and Safety Code.with some exceptions,requires registration with the Costa Mesa Flre 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 ❑No
_..h construction
5 Does or willothe applicant orpresent a or future building occupant at yo then for the work which is the or this application a0e NOit for such or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ
(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 0 No
(It'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by 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 NTRY: 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 or.. ces relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purpo •t to occupy or allow occupancy of any building authorized by this permit until final inspection.
Sign. ure E�-may. Y, q
And/Or A thori.:• •• • +.nt+.nt Date
CODE 1. INSPECTION TYPE lag INRDAL$ CODEX INSPECTION TYPE PAIL 1111-.
1616 Fixed System Final Fire Prevention 206 Final Mechanical A
1266 Pool Spa Final 208 Final Plumbing leg_ Fr
200 Final Re-Roof 210 Final Electrical I
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
•
.4CITY OF COSTA MESA
O4 6�, P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628-1200
'Y0 .; e,
;i;
$;' DEVELOPMENT SERVICES DEPARTMENT
• G{IE -..:
December 12, 2001
Ms. Emily Wong
3112 Yellowstone Drive
Costa Mesa, CA 92626
Re: Permit P01-00644—Permit to replace an existing Water Heater
Dear Ms. Wong:
With reference to the above, we received the enclosed finaled inspection card and permit
in the mail from you today.
However, these important documents should be kept in your homeowner's file for future
reference. The City already has a copy that is kept in the address file. I am returning
these documents to you for your safekeeping.
Please let me know if you have any questions. I can be reached at 714.754.5273 Monday
through Friday Sam to 5pm.
Sincerely yours, )
��ILV
•
Sylvia Chalmers
Office Coordinator
SC/so
cc: Address file
Building Division(714)754-5273 • Code Enforcement(714)754-5623 • Planning Division(714)754-5245
FAX(714)754-4856 • TDD(714)754-5244 • w.w.d.costa-mosa.ca.us
INSPECTION CARD DESCRIPTION OF WORK" ti A44-64-44.4.44-ii
P RMIT NO. This job''is ' released until final inspection is called fr id
�, i r����
DAT I S ED approved. It .ne duty of the owner or permittee to ca,. ,lis PERMIT NUMBER
// %/ �D / office upon completion of work covered by the permit.
BUILDING DIVISION 7--
COSTAP01-00644
COSTA MESA 754-5627 OWNER:
4{$.,IP ? ! _, ,re t
ADDRESS: ) ��� p RDRIVE,COSTA MESA,CA 92626
y=•?l PLUMBIN - I IT DATE HEATING INIT. DATE '
❑U/G bg. I ICI Rough
ugh act Final
ELECTRICAL INIT. DATE anal ..ark NS • Status: ISSUED
U/G Elec. ❑U/GWater_
•
Rou h STRUCTURAL INSP. DATE
9 Applied: 11/01/2001
13 Final 9 Trenches-Steel
Issued: 11/01/2001
Framing
❑Final
CMF 0751-46 (BU-22) Rev, 6/80
. --. - - --EDGY:
Parcel Nunmber: 14107224
Applicant: STARK, CHRIS
Address: 7229 VARNA AVE
Phone: (800)444-8865
NORTH HOLLYWOOD, CA Zip: 91605
Owner: WONG, EMILY F TR
Address 3112 YELLOWSTONE DR •
•
Phone:
' COSTA MESA,CA Zip: 92626 -
•
Contractor: ALAP ASSOCIATES GP
Address: 7229 VARNA AVE • ' •
• Phone: (800)444-8865
NORTH HOLLYWOOD,CA Zip: 91605
• License: 771905
•
•
Arch / Eng:
Address:
Phone: I .
Zip:
• - License:
SCOPE OF PERMIT
PLUMBING PERMIT TO REPLACE AN EXISTING WATER HEATER,
FEE SUMMARY
AMT QTY 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 $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0
Clarifier System $0.00 0 Process Piping(per 10 ft) $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 $0.00 0 Wash Basin $0.00 0
Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0
Drain,Floor $0.00 0 Sewer 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) $0.00 0
Drain,Roof $0.00 0 Shower $0.00 0 Water Heater/vent $12.30 1
Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping (Ins(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 Sink, Floor $0.00 0 Water Service $0.00 0
Gas(1-4 outlets) $0.00 0 Sink,kitchen $0.00 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
Gas Service $0.00 0 Spa(pudic) $0.00 0 PLAN CHECK $0.00
Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0
Interceptors(Sand Auto) $0.00 0
TOTAL CALCULATED FEES: $35.80
•
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
2446-46(8/00)
13592 FEE RCN
COSTA MESA BUILDING-SAFETY DEPARTMENT JAN 10DE
.9.0.BOX 317 COSTA MESA. CALIFORNIA FINANCE DEPT.
CITY OF COSTA MESA
FOR APPLICANT TO FILL IN COMPLETELY APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
BUILDING
ADDRESS 3112 YELLOWSTONE DRIVE
COSTA MESA. CALIFORNIA EOR OFFICE USE ONLY
RECEIPT NO. I 135902
OWNER KWK CONSTRUCTION CO., INC.
MALL REC�'EO BY 7TE REr VEq DATE ISSUED
ADDRESS 1555 PLA CENT IA AVENUE M (�C.� / '� /G'67/ UFO j j 1961
TEL I BUILDING
CITY NEWPORT BEACH, CALI F NO.6-?227 ADDRESS )
ARCHITECT LIC.
OR ENGINEER NO. COSTA MESA. CALIFORNIA
FIRE n
ADDRESS ZONE TYPE GROUP Y
CONTRACTOR K.. W. KOLL LIC.NO.STATE 61 1955APPROVED DATE
ADDRESS 1555 PLA CENT IA NEWPORT
1 BEACH ZONING re
LEGAL LOT 9 1}01}1 ZONE NO.OF USE OF NEW s111K1 rw..
DESCRIPTION I NO. 1 ] I BLOCK I TRACT R-1 PLANS 2 I BUILDING_/ att gar.
APPROVED, M YY
Tnne _ BY W.L.D. OWALLS
DATE 3. 63.
SIZE 60x100 I NO.OF BLOBS. YARDS
OF LOT 1 NOW ON LOT
O REQUIRED ALLOWED
USE OF (CENTER LINE ST.) r
EXISTING BLDG. FRONT 5 FT. IN.
CENTER OFI STREET REAR 521 REAR YARD 261 R.SIDE ,NFT. IN.
5 SIDE YARD LEFT S 1 IRIGHT 51 L.SIDE FT. IN.
DESCRIPTION OF WORKa
REAR FT. IN.
NEW I X II ALTERATION I II ADDITION
REPAIR I II MOVING I II DEMOLISH I
BUILDING 1506sF NO.OF ROOMS 7 STORIES 1
EXTERIOR WALL, ROOF COM o$ IT ION
COVERING STUCCO COVERING SHINGLE S
w
USE OF BUILDING AND WORK TO BE PERFORMED //�����.I
SINGLE FAMILY_RESIDENCE AND 9f°
ATTACHED GARAGE PLAN No . 3-D
I HEREBY ACKNOWLEPGE THAT I HAVE REA• THIS APPLICATION
AND STATE THAT MK ABOVE IS CORRECT D AGREE TO COM- THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
PLY WITH ALL CITY ORDINANCES AND ST B LAWS ' GULATIN PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
BUILDING CONSTRUCYI-N. / VALUATION
•
SIGNATURE OF i.4.ii PERMIT FEE $ j,5 .—
PERMITTEE 7z7,, ` /}ry1 JJJ
$ / 65 —/ PLAN CHECK $ /7,3-13
AUTHORIZED AGENT 0
TOTAL FEE S rS' , •�„ S