HomeMy WebLinkAbout1912 KAUAI DR - Building Permits CITY OF COSTA MESA
►9 BUILDING DIVISION
,,, �; DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
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PERMIT E04-00225
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(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 1912 KAUAI DR Status: ISSUED
Suite No Applied: 03/09/2004
Vicinity: Issued: 03/09/2004
Parcel Nunmber: 13951102 . 410.
Applicant: HEINSOHN, BRIAN ISSUED BY:
Address: 23025 EL CABALLO
Phone: (949)462-0090
LAKE FOREST CA Zip: 92630
Owner: KHAIAT, AKEMI N
Address 1912 KAUAI AVE
Phone:
COSTA MESA,CA Zip: 92626-3542
Contractor: BRYMEL HOME IMPROVEMENT SPECIALISTS
Address: 23025 EL CABALLO
Phone: (949)462-0090
LAKE FOREST CA Zip: 92630
License: 725371
SCOPE OF PERMIT
1634 SF SFD ADDITION(750 SF ON 1ST FLR AND 884 SF ON 2ND FLR).ALSO,EXTEND GARAGE
BY 42 SF.
20 LIGHT FIXTURES,52 OUTLETS,32 SWITCHES
REF: B04-00180
FEE SUMMARY
Quantity Quantity
ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0
Temp service test $0.00 Busway/100 ft $0.00 0
Res.a/c package $0.00 Standing Section $0.00 0
New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0
New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0
Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0
Lighting Fixts $22.00 20 up to 50 kva/kw $0.00 0
Recept Outlets $45.36 52 up to 100 kva/kw $0.00 0
Switches $30.76 32 over 100 kva/kw $0.00 0
Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0
Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0
Service to 200a $0.00 0 Misc.Conduit 50.00 0
Service to 1000a $0.00 0 Misc.Conductor $0.00 0
Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0
Motors to 1hp $0.00 0 Circus(mech ride or lights) $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 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)754-5626
244646(WOO)
DECLARATIONS e
WORKERS'COMPENSATION DECLARATION: . •
I hereby affirm under penalty of perjury one of the following declarations:
O 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.
iitt I have and will maiin workers'c e lion insu ante,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued.
My w rs'comp
r5� satlon Insue rrier and olicy number are: " /
Carrier: ( JAP1 Pa) z "' ^y'9 Policy Number: /\4 0O2_30 1
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
O I certify that in the performan of the work r is this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of Califo and agr t if hould become subject to the workers'compensation provisions of Section 3 1.of the Labor Code,I shall forthwith
comply with these provisi _ _ O1
Applicant Signature:
2.----- <
ture: � Date: -r�-lAv/L/(
�
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMI NALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(Mom,),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licens }jnd,, r s' ns of hapt 9(commencing with Section 7000)of Division 3 of the Business d P fessions Code,and my license is in full
force andtrsefLic.# x(j5 � Classat : # —
Contractors Signature: ‘filE i Date: •
( p �7j
CONSTRUCTION LENDING AGENCY:
O 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. ❑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,teamwork,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,Califomia Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
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 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
0
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 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? ❑Yes El 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.
i t
Signet a r gel•• ner(s) 3/_ /4ate -.
And/Or Authorized App can Date
CODE I INSPECTION TYPE 2MIE INTRIAI.4 BODE( INSPECTION TYPE MIK INTIRALq
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing ._ W�7�u"1 C }'
200 Final Re-Roof 210 Final Electrical cc,- l/
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
6 CITY OF COSTA MESA
• --C'
4 .� , BUILDING DIVISION
F ''� DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
PERMIT
, e • f/04-00225
mo
6.
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 1912 KAUAI DR Status: ISSUED
Suite No Applied: 03/09/2004
Vicinity: Issued: 03/09/2004
Parcel Nunmber: 13951102
Applicant: HEINSOHN, BRIAN ISSUED B air
Address: 23025 EL CABALLO
Phone: (949)462-0090
LAKE FOREST CA Zip: 92630 .
Owner: �KHAIAT, AKEMI N
Address /1912 KAUAI AVE .
Phone:
COSTA MESA,CA Zip: 92626-3542
Contractor: BRYMEL HOME IMPROVEMENT SPECIALISTS
Address: 23025 EL CABALLO
Phone: (949)462-0090
. LAKE FOREST CA Zip: 92630
License: 725371
SCOPE OF PERMIT
1634 SF SFD ADDITION(750 SF ON 1ST FLR AND 884 SF ON 2ND FLR).ALSO,EXTEND GARAGE •
BY 42 SF.
20 LIGHT FIXTURES, 52 OUTLETS,32 SWITCHES
REF: B04-00160
8/9/04-PERMIT SUPPLEMENT TO INCLUDE 400 AMP SERVICE UPGRADE&SUBPANEL.
FEE SUMMARY '
Quantity Quantity
ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 . 0"
Temp service test $0.00 Busway/100 ft $0.00 "0
Res.a/c package $0.00 Standing Section - $0.00 0 '
New Res(1-2 units) $0.00 0 - Misc Electrical Equipment $0.00 0
New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 . 0 " '
Pool/Spa . $0.00 0 up to 10 kva/kw $0.00 / 0
Lighting Fixts $22.00 20 up to 50 kva/kw $0.00 . 0 '
Recept Outlets $45.36 -52 up to 100 kva/k 'w " $0.00. ' ` 0 '
Switches $30.76 32 - over 100 kva/kw. $0.00 0
Non Res Appl $0.00 0 Low Voltage Equipment $0.00 . 01/
Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 -'0'
Service to 200a $0.00 0 Misc.Conduit $0.00 " 0
Service to 1000a $62.15 1 Misc.Conductor $0.00' 0
Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0
Motors to 1hp $0.00 0 Circus(mech ride or lights),.- $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 Other Electrical 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)754-5626
2448-46(6/00)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of Consent to 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 completed if the permit is valued at one hundred dollars($100)or less.)
❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws 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 provisions.
Applicant Signature: Date:
WARNING:FAILURE TO SECURE 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(fST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES.
•
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.if Class#
Contractors Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
•
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK.and the structure Is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
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.). •
O 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 w 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 Contr s Li nse Laws.).
O I am exam der sec. Business and Professions Code for this reason:
Signature: � •/
Expires:_d 197
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,Gm 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions.that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater then a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑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 end Safety Code been fully complied with? ❑Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 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? 0 Yes ❑No
(If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 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 OMPLIANCE AN, OR • ON OF ENTRY:I certify under penalty of perjury that 1 have read this application and state that the information given is
correct. I agr t comply with all :at: I: s (city ordinances relating to building construction,and authorize representative of the ity of Costa Mesa to enter upon the
above-des property for in .• sur...es.I agree not to occupy or allow occupancy of any building authorized by th/is} rmit u II final inspection.
A y 6 y
Signa ure Of Legal Owner(s) Date
And/Or Authortzed Applicant Date
CODE t INSPECTION TYPE GALE jNTITIALS CODE INSPECTIONTYPE PSIS INTmAIa
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing p
200 Final Re-Roof 210 Final Electrical �l,�A "J,(��
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
' CITY OF COSTA MESA
o` BUILDING DIVISION
F�'„ - DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
PERMIT
Rano
MOd_pp117
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
MECHANICAL PERMIT
Job Address: 1912 KAUAI DR Status: ISSUED
Suite No Applied: 03/09/2004
Issued: 03/09/2004
Vicinity:
Parcel Number: 13951102 ISSUED BY:
Applicant: HEINSOHN, BRIAN
Address: 23025 EL CABALLO
Phone: (949)462-0090
LAKE FOREST CA Zip: 92630
Owner: KHAIAT, AKEMI N
Address: 1912 KAUAI AVE
Phone:
COSTA MESA,CA Zip: 92626-3542
Contractor: BRYMEL HOME IMPROVEMENT SPECIALISTS
Address: 23025 EL CABALLO
Phone: (949)462-0090
LAKE FOREST CA Zip: 92630
License:725371
SCOPE OF PERMIT
1634 SF SFD ADDITION(750 SF ON 1ST FLR AND 884 SF ON 2ND FLR).ALSO, EXTEND
GARAGE BY 42 SF. -
1 INST FAU< 100K BTU,3 VENT FANS/SINGLE DUCT
REF:604-00180
FEE SUMMARY
Quantity _ Quantity
ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0
Inst FAU<100 k BTU $14.80 1 Repair/Alt Refrigeration Unit $0.00 0
Inst FAU>100 k BTU $0.00 0 • Ventillation System $0.00 0
Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0
Inst/Rep.Recess Wall Htr $0.00 0 - •Commercial Incinerator $0.00 0
Refrig Sys<100 k BTU $0.00 0 • Domestic Incinerator $0.00 0
Refrig Sys>100 k BTU $0.00 0 - Compressors/Absorption Systems
Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0
Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 0
Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0
VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0
Vent Fan/Single Duct $21.75 3 Over 50 hp/Over 1,750 BTU $0.00 0
Appliance $0.00 0 • Boilers
Fire Dampers $0.00 0 Up to 3 hp • $0.00 0
Smoke Dampers $0.00 0 3 To 15 hp $0.00 0
Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0
Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0
Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0
Floor Furnace $0.00 0 Other Mechanical Fee
Floor or Suspend Heater $0.00 0 Investigation Fee $0.00
Plan Check Fee $0.00
Reinspection Fee $0.00
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)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
O 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.
gI have and will maintainers'compen ti I surance,asirequired by section 3700 of the Labor Code,for the performance of the work for which this permit Ls Issued.
My works pompensati Inspranca r a d policy nur//Der are: D /C p fl d2 q(
Carrier: C MPG Nl 4 A- I an) Policy Number: /C3 0
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
O I certify that in the parlor• nce of the work r ich is permit is Issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of Ionia,and agr If I ould become subject to the workers'compensation provisions of Sectioppp 3704 of the Labor Code,I shall forthwith
comply with these p :• nnAs.,w
Applicant Signature: Date:� `d'��(///v 64'
/�Ll�
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMIN P- ALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($I00,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licens-. .er• • "si.• •f Chapter 9(commencing with Section 7000)of Division 3 of the Business Pr essions Code,and my license is in full
force and effect.Lic.# Class#
Contractor's Signature: 40.11111177
Date: ' 9 AV
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,eller,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 DMSIon 3 of the
Business and Professions Code)or that he or she is exempt therefrom end the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant fore permit
subjects the applicant to a civil penalty of not more then 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? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,ore volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature 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 aggermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0111 Yes u No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 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 prescnbed 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 purpose .I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signatu 0 al wner(s) Date
And/Or Authorized Applicant Date
cgpgs INSPECTION TYPE PATE UfID194$ CODE( INSPECTIONTYPE
1616 Fixed System Final Fire Prevention 206 Final Mechanical zrecu i
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
CITY Qc�F. COSTA MESA
4 . BUILDING DIVISION
>r ,, � �. DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
;t w'"%� I PERMIT
J't+romco'. PO4-00169
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 1912 KAUAI DR Status: ISSUED
Suite No Applied: 03/09/2004
Issued: 03/09/2004
•
Vicinity: 4010.
ISSUED BY: rad/ -
Parcel Nunmber: 13951102
Applicant: HEINSOHN, BRIAN
Address: 23025 EL CABALLO
Phone: (949)462-0090
LAKE FOREST CA Zip: 92630
Owner: KHAIAT, AKEMI N
Address 1912 KAUAI AVE
Phone:
COSTA MESA,CA Zip: 92626-3542
Contractor: BRYMEL HOME IMPROVEMENT SPECIALISTS
Address: 23025 EL CABALLO
Phone: (949)462-0090
LAKE FOREST CA Zip: 92630
License: 725371
Arch / Eng:
Address:
•
Phone:
Zip:
License:
SCOPE OF PERMIT
1634 SF SFD ADDITION(750 SF ON 1ST FLR AND 884 SF ON 2ND FLR).ALSO, EXTEND GARAGE
BY 42 SF.
3 BATHTUBS, 1 GAS OUTLETS(1-4), 1 LAUNDRY TUBNJASHER,3 SHOWERS, 1 WASH BASIN,3
WATER CLOSETS
( REF: B04-00180 •
FEE SUMMARY
AMT QTY AMT QTY AMT QTY
ISSUE FEE $23.50 Laundry Tub/Washer $9.80 1 Sump Pump 50.00 0
Backflow irrigation $0.00 0 Landscape Imgation $0.00 0 Swimming Pool $0.00 0
Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0
Bathtub $29.40 3 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 $9.80 1
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) $29.40 3
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
2446-48 WOO)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to 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 I ued.
C. I have and will maintain wo rs'compen ns ranee,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued.
My worke�! c/1mpeensatio sur nce car n�((olicy num r are: /)// ��� ?,r /
Cartier: ���},et.ry gal /t n"4 I Policy Number: ✓7 t >f1 '( (
(This section need not be completed if the permit Is valued at one hundred dollars($100)or less.)
❑ I certify that in the perfor• 'nce of the work ,r .hic' this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of 0QPomia,and agr=- - If should become subject to the workers'compensation provisions of Sectio 37 of the Labor Code,I shall forthwith
comply with these p •F''• / r'{/
Applicant Signature: �iv '��
V,' Date: O /
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUaJECT AN EMPLOYER TO CRIMI PE TIES 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 hereby affirm that I am licensed er aui I Chapt r 9(commencing with Section 7000)of Division 3 of the Business zPPrr/geesssiioonnns-e�C/ode,and my license is in full
force andeffect. DlClass#------ •
Contractor's Signature:
ree: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec.
7044,Business 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 Ucense 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 Ucense 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,Gm 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? ❑Yes ❑No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and 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 a plication apermit for such construction or modification
from the South Coast Air(Duality Management District or from any other air pollution control district or agency? Yes LI 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 purpos'..I a not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signet illeg wner(s) ////`,ate
And thorized Applicant
��/ /Date Date
CODE I INSPECTION TYPE PATE BOAS CODE( INSPECTION TYPE PATE ICAL$
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing _ ^ZO� (,
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
•
i DEPUTY 1 INSPECTION SERVICE 1>NC. DEPT. OF BLDG. & SAFETY
25121 DE SALLE ST, LAGUNA HILLS, CA 92653 CITY OF wjna Lt i t
1 - 800 - DEPUTY 1 = 1 - 800 - 337 - 8891 COUNTY OF
I SPECIAL INSPECTION REPORT
Building Permit No. '70�"l - t SO Job. No. Date
Job Indentification/Address I><-4MitA [3 y Zfr S, CI L L_ Gh-i Pt—.➢ GL:,
General Contractor/Address 6R-teivt-t_
Sub - Contractor/Address -'!—
Structural Engineer/Address f'&-2s1-64__ Arch.
REINFORCED CONCRETE MASONRY HI-TENSILE BOLTING CHEMICAL ANCHORS
PRESTRESSED CONCRETE WELDING GYPSUM CONCRETE OTHER
WELDER RECEIPT NUMBER WELDER RECEIPT NUMBER
DATE OF INSPECTION DESCRIPTION OF WORK INSPECTED
-2Z- 013b6-42-4€1> INSf .L.iATOM OF- tTfe-Oftr A 30-1 Tl}120, R D5
W( S14tfSoM S'£a -uT° 'y *l 571 G 'Put_• D ID / 54-7-. 3
yfriritst utF S Ptd. -r 3 y9&l5M1c0 pe_c 4auso
/ T t sr 2- i3D K-is‘ PatwitThc ; -
4 St 06-- v-1A-t-t tt) Co 1Nr S/ " 2e- cmIta " £cnCirca f .frc ' 4- 734s
1,77 " Eal-Orco (? /s3 " c7-c.
RzE Ala v.I/N.L : (a) CT ZS i u-''/15 4'2 " tE n5£n 7 .575) " s'
C /8 ' d, c ,
6 : - Sat w4t-L : ( /9 C.T. Zi$ n W/r5/j' f6wt6
6 '5 2-s" rtc,9�C 4Y',,;,: ft d�7. �� t It
Co) L. „ v -f; sh911-- 4tc (I) 7'g r (/) cr. s' "-c t,�,n� /2_ '
A-r /g" o -c •
HOURS SAMPLES
DATE Reg. OT Time In Time Out Grout Mortar Concrete Block Density
Prisms
All inspections based on a minimum of 4 hours&over 4 hours-8 hours
minimum.Any inspection extending past the noon hour will be billed as 8
hour minimum. In addition,any inspection extending past an 8 hour pe-
riod,or Saturday inspection will be billed at time and a half.
ATTORNEY'S FEES - If any action at law or in equity is brought to enforce or interupt the terms of this Contract, the prevailing party
shall be entitled to reasonable attorney's fees,costs and necessary disbursements in addition to any other relief to which such party maybe
entitled.
SPECIAL INSPECTION REPORT ,�1�
Inspector's Name: I („ 2712- Inspector's Signature: ('r-v'
I.D. No. tut S Sc1- `t7 has been filed and it states that the above work to the best er kn ledge complies with the
provisions of the Uniform Building Code d ets approved plans and specificatio .
Respectfully S itte
Approved by: 'Ala~ • By:
Project Superintendent Larry Carter
.„--•
CITY 4F COS*A MESA
o ► pC BUILDING DIVISION
F• ; . DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
!t PERMIT
"avamms do B04-00180
(714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 1912 KAUAI DR Status: ISSUED
Suite: Applied: 01/16/2004
Vicinity: Issued: 03/09/2004
Parcel Number: 13951102 Zoning: -or
Applicant: HEINSOHN,BRIAN ISSUED BY: %/LA _
Address: 23025 EL CABALLO
Phone: (949)462-0090
LAKE FOREST CA Zip: 92630
Owner: KHAIAT, AKEMI N
Address 1912 KAUAI AVE
Phone:
COSTA MESA,CA Zip: 92626-3542
Contractor BRYMEL HOME IMPROVEMENT SPECIALISTS
Address: 23025 EL CABALLO
Phone: (949)462-0090
LAKE FOREST CA
Zip: 92630 License: 725371
Arch : Eng: FOERSTEL ENGINEERING
Address: Address: 2377 S EL CAMINO REAL
Phone: Phone:
SAN CLEMENTE,CA
Zip: License: 92672 License: S957
SCOPE OF PERMIT
1634 SF SFD ADDITION(750 SF ON 1ST FLR AND 884 SF ON 2ND FLR).ALSO, EXTEND GARAGE BY 42 SF. 1ST FLR ADDITION INCLUDES
NEW BDRM AND ENTRY WAY.2ND FLR ADDITION INCLUDES NEW BDRM, BATH, M BDRM CLOSET AND A HOME OFFICE.ALSO INCLUDES
REMODEL OF AN EXISTING
2ND FLR BATHROOM.MINOR ALTERATIONS BY RELOCATING KITCHEN SLIDING DOOR TO THE KITCHEN AND REMOVING UPSTAIRS WALL
TO INCREASE THE SIZE OF EXISTING BDRM.
ZA-03-103: MINOR MODIFICATION AND MINOR DESIGN REVIEW FOR 1,810SF ADDITION(768SF AT 1ST FLR; 1,000SF AT 2ND FLR;42SF AT
GARAGE).APPEAL PERIOD ENDS 1/29/04.
FEE SUMMARY
Plan Check: $871.62 Calc Valuation: $161,458.20
Permit: $1,340.95 Claim Valuation: 50.00
SMIP Res: $16.15
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $2,228.72
PLANNING & ZONING
SETBACKS
MAIN STRUCTURE Front 21-0 Rear 26-0 Left 5-0 Right 5-0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1,12-21.92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections 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(woo) `f
DECLARATIONS -1 L, -
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.
ift I have and will maintain w ers'comps ion nsurance,a required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued.
My work s' mpensati Insyrance erjnd policy nyinber are: /- �7 //
Carder. �/ N 0^z A J/Oft'.-t I Policy Number: 0/ /COO 2 lee d
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
❑ 1 certify that in the perform:• e of the work for w ' h this permit. issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of Cal ia,and agree t' I should bec a subject to the workers'compensation provisions of Section 7.3 • .1 the Labor Code,I shall forthwith
comply with these provi-; . Q V
Applicant Signature: /Mr:= Date:
WARNING:FAILURE TO SECURE WORKER$',COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL E TIES 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 hereby affirm that I am licens d un o ' ' s of Chter 9(co encing with Section 7000)of Division 3 of the Business Pjofessions Code,and my license Is in full
force and effect.Lic.# /'''2 /f// Class 4
Contractor's Signature: �r2/L3.. _ 'YY•��•,vl Date: 3/9/61
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. 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? 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? ❑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 greeter 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 end Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application akermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 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? 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.
dtare Of Le Owner(s) '3 9//p� y
And/Or Authorized Applicant ( Date
CODE I INSPECTION TYPE 26.TE INTrTML$ CODE( INSPECTION TYPE PAIL IIMIIAL$
•
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 e/ ____/ .
204 Final Demolition 250 Final Builtling/Occupanry 7/11 O 5 N /--
ppJ r
•
•
NEWPORT-MESA UNIFIED SCHOOL DISTRICT N° - 4964
CERTIFICATE OF COMPLIANCE OF DEVELOPMENT FEES
PURSUANT TO AB 1600 AND AB 181
To: 0(3 City of Costa Mesa District Receipt No.
( ) City of Newport Beach
( ) County of Orange / / Plan Check Ng��
Applicant: ,e/A41-1://L/i5e/t�"
Address: / ',I/ 2 f5 /R/lJf��// iei!/G
Telephone Number: 7/7 /4/4/q J 7y6
Tract/Parcel and Lot Number(s): /✓ l —-,7/ —0 2--
Location of Project:
Number of Square Feet of: / z S6
Residential Space /4 J g x $1.84 Total "3
•
Commercial and
Industrial Space x $ .30 Total
Commercial/Industrial Project is: (Check One)
_ Warehouse _ Motel _ Preschool
_ R & D _ Bank _ Auto Repair
Movie Theater _ Neighborhood Shops _ Hospital
Mini-storage Racquet/Health _ Large Office
Heavy Industrial _ Hotel _ Office Bldg.
Regional Shops _ Medical Office _ Restaurant
Light Industrial _ Office Park _ Fast Food
This project is exempt because
This certifies that the above-named Developer/Applicant has paid school facility fees in compliance with Government Code sections
53080 and 65995. The Building Permits for this square footage in this proposed development may now be issued by your jurisdicfion.
Checks are to be made payable to Newport-Mesa Unified School District.
By: /� lila Din
Authorized Repress tive
The above representation as to square footage is true. Applicant agrees that if it is later detemti :• that such representations are not
true,then this certificate shall automatically terminate and the appro a City/County . • : no'
iQit9 2804/9:45 AN/1 3806.56
RCPTA:01-0129498
Date: 3/0 a 125915
Applicant
•
CITY OF COSTA MESA
U1% P O.BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628-1200
41: DEVELOPMENT SERVICES DEPARTMENT
January 22, 2004
Brian Heinsohn
24331 Muirlands Boulevard #D4-459
Lake Forest, CA 92630
RE: ZONING APPLICATION ZA-03-103
1912 KAUAI DRIVE, COSTA MESA
Dear Mr. Heinsohn:
The minor modification and minor design review for the above-referenced property
have been completed. The applications have been approved, based on the
following project description and findings, subject to the conditions set forth below:
PROJECT DESCRIPTION
The applicant proposes first and second story additions to the existing two-story
house. The first story living area will be increased by 768 square feet, the garage
will be enlarged by 42 square feet, and the second story will be expanded by 1 ,201
square feet.
Exterior elevations are to consist of stucco finish and brick veneer, with
architectural articulation provided by a variety of wall planes, window trims, and
differing roof planes.
The subject property is located on a corner lot, with the right (east) side of the
property abutting a street and the left (west) side abutting a residential property.
The Zoning Code requires a minimum setback of 10 feet for side property lines
abutting a public street; however, the existing house is set back 5 feet from the
street side of the property. The applicant proposes to extend this legal
nonconforming setback by 25 feet on the first floor to accommodate a new entry
and master bedroom at the front of the house. The proposed second floor will be
set back 8 feet from the street side to provide architectural articulation to the
elevation. Minor modifications may be approved to allow a decrease of up to 20%
of the required side yard setback, as well as to allow building additions to encroach
into the required setback no further than the existing main, nonconforming
Building Division(714)754-5273 • Code Enforcement(714)754-5623 • Planning Division(714)754-5245
FAX(714)754-4856 • TOD(714)754-5244 • www.d.costa-mesas,us
ZA-03-103
January 22, 2004
Page 2
structure. Staff feels the necessary findings to support this request can be made
because the residence across from the project site also has a street side setback of
5 feet, and with the placement of the parkway behind the sidewalk, the house will
maintain the appearance of a 10-foot deep landscaped setback.
To minimize the visual prominence of. the second floor, the City's residential
guidelines call for an average 10-foot side setback for the new second-story
construction; a 7.4-foot average side setback is proposed on both sides. Staff
feels that any visual prominence this project may have is offset by the property's
location on a corner and the amount of architectural articulation provided by the
varied wall planes, roof planes, and window treatments (including bay windows).
As a result, the proposed project satisfies the intent of the residential design
guidelines.
The proposed second story windows on the left (west) side of the house are at
least 6 feet from the neighboring property, and with the abutting residence being
one-story, the windows will have views onto the neighbor's roof. Therefore,
privacy of the adjoining neighbor will not be impacted because the proposed second
story windows will be of obscure glass or will overlook a driveway, street, or roof.
FINDINGS
A. The information presented substantially complies with Costa Mesa Municipal
Code Section 13-29(g)(14) in that the project complies with the City of Costa
Mesa Zoning Code and meets the purpose and intent of the Residential Design
Guidelines, which are intended to promote design excellence in new residential
construction, with consideration being given to compatibility with the
established residential community. This minor design review includes site
planning, preservation of overall open space, landscaping, appearance, mass
and scale of structures, location of windows, and any other applicable design
features. Specifically, although the proposed second floor has a 7.4-foot
average side setback, the building mass is broken by a variety of roof and wall
planes, as well as window treatments such that the massive appearance of
the structure is minimized. Privacy of adjoining neighbors will not be impacted
because the windows will be of obscure glass, set back a minimum of 6 feet
from the closest neighboring property, and will overlook a driveway, street, or
neighbor's roof. Any visual prominence is offset by the location of this project
within an area containing other two-story, single-family residences and has
been reduced through appropriate transitions between the first and second
floors to avoid unrelieved two-story walls.
B. The information presented substantially complies with Costa Mesa Municipal
Code Section 13-29(g)(6) in that the substandard side setback will not be
detrimental to the health, safety, and general welfare of the persons residing
or working within the immediate vicinity of the project. Specifically, the 5-
ZA-03-103
January 22, 2004
Page 3
foot setback on the street side of the property is existing and the proposed
first and second floor additions will not increase the nonconformity. The
corner lot to the south of the project site has the same 5-foot setback from
the street; and the proposed construction will maintain the appearance of a
10-foot side setback because of the parkway behind the sidewalk. In
addition, the proposed project has been designed to enhance the development
in the vicinity.
C. The project has been reviewed for compliance with the California
Environmental Quality Act (CEQA), the CEQA Guidelines, and the City
environmental procedures, and has been found to be exempt from CEQA.
D. The project is exempt from Chapter XII, Article 3, Transportation System
Management, of Title 13 of the Costa Mesa Municipal Code.
CONDITIONS OF APPROVAL
Ping. 1 . The conditions of approval and ordinance or code provisions and special
district requirements of Minor Design Review ZA-03-103 shall be
blueprinted on the face of the site plan.
2. The applicant shall contact the Planning Division to arrange for an
inspection of the site prior to the release of utilities. This inspection is to
confirm that the conditions of approval and code requirements have been
satisfied.
3. The site plan shall be revised to show the correct location of the right
side property line and the correct lot dimensions.
CODE REQUIREMENTS
The following list of federal, state and local laws applicable to the project has been
compiled by staff for the applicant's reference. Any reference to "City" pertains to
the City of Costa Mesa.
Ping. 1 . All contractors and subcontractors must have valid business licenses
to do business in the City of Costa Mesa. Final inspections, final
occupancy and utility releases will not be granted until all such
licenses have been obtained.
2. Approval of the zoning action is valid for one (1 ) year and will expire
at the end of that period unless building permits are obtained and
construction commences, or the applicant applies for and is granted
an extension of time. A written request for an extension of time must
be received by Planning staff prior to the expiration of the zoning
action.
3. Development shall comply with all requirements of Title 13 of the
Costa Mesa Municipal relating to development standards for single-
ZA-03-103
January 22, 2004
Page 4 -
family residential projects.
4. Any new mechanical equipment such as air-conditioning equipment
and duct work shall be screened from view in a manner approved by
the Planning Division. All roof-mounted equipment is prohibited.
Any air conditioning units shall be placed a minimum of 5 feet away
from any property line.
Bldg. 5. Comply with the requirements of the California Code of Regulations,
Title 24, also known as the California Building Standards Code, as
amended by the City of Costa Mesa.
6. Prior to or concurrent with the submittal of plans for
grading/building/ plan check/submittal of final subdivision map for
engineering plan check, the applicant shall prepare and submit
documentation for compliance with the State Water Resources
Control Board (SWRCB) Water Quality Order 99-08-DWQ; National
Pollutant Discharge Elimination System (NPDES) Permit No.
CAS000002 for Storm Water Discharges Associated with
Construction Activity (General Permit); the California Regional Water
Quality Control Board (RWQCB) Santa Ana Region Order No. R8-
2002-0010 and NPDES Permit No. CAS618030; and, the City of
Costa Mesa Ordinance No. 97-20 for compliance with NPDES Permit
for the City of Costa Mesa. Such documentation shall include a
Storm Water Pollution Prevention Plan if over 1 acre (if over 5 acres
if submitted prior to March 10, 2003) and a Water Quality
Management Plan (WQMP) identifying and detailing the
implementation of the applicable Best Management Practices
(BMPs).
Fire 7. Provide approved smoke detectors to be installed in accordance with
the 1997 Edition of the Uniform Fire Code.
Eng. 8. At the time of development submit for approval an off-site plan to the
Engineering Division and grading plan to the Building Division that
shows sewer, water, existing parkway improvements and the limits of
work on the site, and hydrology calculations, both prepared by a civil
engineer or architect. Construction access approval must be obtained
prior to building or engineering permits being issued by the City of
Costa Mesa. Pay offsite plan check fee to the Engineering Division.
•
An approved offsite plan and fee shall be required prior to
engineering/utility permits being issued by the City.
9. A site access permit and deposit of $500.00 for street sweeping will
be required by the Engineering Division prior to the start of any on- or
off-site work.
10. Maintain the public right-of-way in a "wet-down" condition to prevent
excessive dust and remove any spillage from the public right-of-way
by sweeping or sprinkling.
ZA-03-103
January 22, 2004
Page 5
SPECIAL DISTRICT REQUIREMENTS
The requirement of the following special districts are hereby forwarded to the
applicant:
Sani. 1 . Applicant shall contact the Costa Mesa Sanitary District at
(949) 631 -1731 for current district requirements.
School 2. Pay applicable Newport Mesa Unified School District fees to the
Building Division prior to issuance of building permits.
Upon receipt of this letter, your project has been approved, subject to the above-
listed conditions. A copy of the conceptually-approved plans are enclosed. The
decision will become final at 5 p.m. on January 29, 2004, unless appealed by an
affected party (including filing the necessary application and payment of the
appropriate fee) or by a member of the Planning Commission or City Council.
If you have any questions regarding this letter, please feel free to contact the
project planner, Hanh Tran, at 714-754-5640, between 8 a.m. and 12 noon.
Sincerely,
f?b,,
PERRY VALANTINE
Zoning Administrator
Enclosure: Conceptually-approved plans
cc: Engineering
Fire Protection Analyst
Water District .
Building Division
Laurent Khaiat
23025 El Caballo
Lake Forest, CA 92630
Jean Getts
3057 Club House Circle
Costa Mesa, CA 92626
•
•
M CITY OF COSTA MESA
'a �) BUILDING DIVISION
F' ^�"`. ' DEVELOPMENT SERVICES DEPARTMENT
4• - PERMIT PERMIT NUMBER
fid•
698-02005
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 1912 KAUAI DR Status: ISSUED 0
Suite: Applied: 11/03/1998
Vicinity: Issued: 11/03/1998
Parcel Nunmber: 13951102 Zoning:
Applicant: MARSHALL, ANDY
Address: '
Phone:
Zip:
Owner: BROWN, DOUGLAS G
Address BROWN,HELEN M
COSTA MESA,CA Phone:
1912 KAUAI PL Zip: 92626
Contractor: A 1 ALL AMERICAN ROOFING
Address: 1218 E PAMONA ST
Phone: 714-543-5400
SANTA NA,CA Zip: 90720
License: 693307
Arch/Eng:
Address:
Phone:
Zip:
License:
SCOPE OF PERMIT
T/O EXISTING AND RESHEET, REROOF WITH 20 SO OF EAGLELITE TILE, ICBG#4660, ROOF CERT
ATTACHED TO PERMIT.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $9,740.00
Permit: $162.25 Claim Valuation: $9,740.00
SMIP Res: $0.97
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $163.22
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:
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
WORKERS'COMPENSATION DECLARATION: ••
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Cartier: Policy Number:
(This section need not be completed it the permit is valued at one hundred dollars($100)or less.)
❑ 1 certify that in the performance of the work for which t s 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 hat if I sho d become subject to the workers'compensation provisions of Section 3700 of the I�bor Code,I shall forthwith
w
comply with these pr isns. ,// !/ 9(,\(J�
Applicant Signature: ✓ (A✓ /- Date: /(/
WARNING:FAILURE TO SECURE WOR S'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARS($100.000),IN AD ON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business apd Professions Code,and my license is in full
force and effect tic,# C p)3 D / Class L
Contractor's Signature: (n7"--'J`/.1 /14/TA. Nl Alel 1 Date: — K
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 then 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:
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 end 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? ❑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 ❑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? 0 Yes 0 No
8 (If Nes',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.
✓(�/}�i�< Laron (,e 7/7 / //_ ate
/\J • And/Orr"'A---u�(ff.ahhhoo"""rzz9ed Applicant Date
CODE I INSPECTI(ONTYPE DATE WEALS ggg):U INSPECTI2LHEE 9!115 ME=
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final e /__ 208 Final Plumbing
200 Final Re-Roof 1,i'If1 yf� 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
2446.46
G (II)
Engineering Geology,
Soil and Rock Engineering, Geohydrology Q�h
GEOTECHNICAL CONSULTANTS, INC.
❑ 1128 West Glenoaks Boulevard, Glendale, California 91202 • Phone (213) 245-6931
•
run 1905 East 17th Street, Suite 208, Santa Ana, California 92701 • Phone (714) 547-5413
FIELD MEMORANDUM
DATE November 8, 1967
Clubhouse Road Joint Venture
2850 Mesa Verde Drive
Costa Mesa, California ouRJOBCS7029
ATTENTION: Mr. Don Ellis
SUBJECT:
Utility Trench Backfills in
Front, Side and Rearyard Areas
Tract 6384, City of Costa Mesa,
California
GENTLEMEN:
In accordance with your request we have reviewed
the locations and depths of the subject trench backfills on
the basis of surface conditions present on the completed lots
and the information provided by Mr. Ron Bannister of your
organization.
In that no trenches were noted which either closely
parallel any wall footings, or which cross any graded slopes,
we conclude that the degree of compaction of these backfills
could not effect the stability of the existing residential
structures or of the graded slopes.
GEOTECHNICAL CONSULTANTS
INC.
COPIES TO: Jackson E. Goffman
Jennings-Halderman-Hood (1)
. NyCITY OF COSTA MESA, CALIFORNIA
•
June 7, 1967
•
Republic Homes Corporation
2850 Mesa Verde Drive
Costa Mesa, California
ATTENTION: Mr. McAllister
0 'SUBJECT: .Tract 6384, Clubhouse Road Joint Venture
Dear Sir:
•
This letter is to advise -you that all trenches
for utilities shall be compacted, tested, and ap-
proved by the City 'Engineer for the City of Costa
Mesa.
All slopes will have to be planted before any
final approvals are given on the residences.
Yours very truly,
VEDWARD P. HORROCKS
. Sr. Deputy Building Official
EPH:dh -
/t ke : 4/s / I YG� > v� .. 9 cc//�
,nS�i3//e O i-f!moiKk/L' Y $
June 7,. 1967
Republic Homes Corporation
2850 Mesa Verde Drive
Costa Mesa, California
\ _____- —
ATTENTION: Mr. McAllister
SUBJECT: Tract 6384, Clubhous Road Joint Venture
Dear Sir:
This letter is t advise you that all trenches
for utilities shall be ompacted, tested, and ap-
proved by the City Engi er for the City of Costa
Mesa.
All slo e will have to be planted before any
.s4i,,
final approve are given on the residences.
Yours very truly,
EDWARD P. HORROCKS
Sr. Deputy Building Official
EPH:dh
I
i
1
I
i
lyPll y!�y,
%Atw.au� 'trk1in CLUB HOUSE ROAD JOINT VENTURE
s Lt —J
2850 MESA VERDE DRIVE • COSTA MESA, CALIFORNIA • TELEPHONE: 549-0395
May 23, 1967
City of Costa Mesa
Department of Building and Safety
Post Office Box 1200
Costa Mesa, California
RE: Tract 6384
Gentlemen :
We hereby request the right to use A.B.S. plastic
pipe for the waste and vent systems on Tract 6384.
The plumbing will be installed according to the
F.H.A. Code and the City of Costa Mesa plumbing
standards.
Very truly yours,
CLUB HOUSE
ROAD JOINT VENTURE
David C. McAllister
Vice President
Construction
DCM: cla
.,U .Lf &E/b, Mit. "I " y af_.10
JOB ADDRESS 1912Kanai Place BUILDING PERMIT NO_46773
ENERALCONTRACT�ORgyePtttatrr Cnnst. Drmipar>y DESCRIPTI�IefWORK pt;ya}p q,;m p001_w�Spa
/ o. 139-511-02 LOT 1en TRACT .63.84FIRE ZONE VALUE $ 13,non no
I�_. ECTIONS I Signature Dote GROUP it TYPE J ZONE R 1
PERMITS ISSUED
col Location C. C_ /0-13 nil: SUBCONTRACTOR Dote 1Nu_b.r f S_gnmer_
RRRIForms _
Main Drain2—
Steel Reinforce
Elec. Bond Electric
Approval to Cover _ C -C- /e•la 19 6t,u4/�cua.'1I.t Ct Q -)(Citi)A
Underground Electric C •C• /D-2,r.7t I
C• C• Jo 13 .--re Plumbing
Gas Piping Test �Ly 1 !/
Filtering System LinesI
3 �1 A..l Ot7G/ l_O'M.6L' Q-A&-)T 7q509
Backwash Lines and Recep.
Electrical Final
wee
HP—or hd Vent Final CANCEL1F. System Final Backwkw assh and Recep. Final
Fencing Final C„C.. 12•!$-7
1
K67 � 5753 9/27/78 t gig)
66. I T1
OSTA MESA BUILDING-SAFETY DEPARTMENT 5753- 9Y27/78_ 96- $IICKW
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 5753 OD004467 73 tN"
APPLICATION FOR STRUCTURAL PERMIT
ror
Applicant to Fill in Completely — Use Ink Only
RECEIVED BY DATE RECEIVED �+}
LDING/912 ��v� I n/ Ki -�
RENS 7 L (\r r` G 7)//p��//y/YYY�p'
OWNER tG6YS A.P.NO. /3 / - S/I- OZ
ref?j
MAILs.,9=4/e-__n� ��// BUILDING p LJ II ^�
ADDRESS S!'�lr[ ADDRESS / / /zG�/,i�r` L1 V1„O• fV�J
CITY NO.TEL. TRACT (p33W1 LOT / BLOCK
d..r7//f �7 F.���
CONSTRUCTION NEW ADD ALTER RFPAIR MOVING OFMOLISH
LENDER
BRANCH
OWNER
ADDRESS /�/�J VALUE
ARCHITECT //��"" � /' TELE• S•�L211 USE / 147.,,#)e, $
OR ENGINEER ,Q&, O4A NO.
FIRE /
ADDRESS ZONE TYPE GROUP
APPROVED
CONTRACTOR 5E.G7/5f770/9-TE/( Cozad T. G o- BY DATE
—
ADDRESS 2 9151•2 tiVeZete q,C ees°
TE
Lenp ZONE pp NO.OF USE OF NEW
CITY 069o. ,' 2Z( r SOY,/—S1/Y /c. 1 PLANS Z BUILDING Poo4—
F STATE CITY /y/ YARDS APPROVED YARDS APPROVED
LIC.NO. 3p )/ 3 NO
/7r LIC. N7 (�/!/ MAIN BUILDING ACCESSORY BUILDING
W SIZE [� NO.OF BLDGS (FROM C/L STREET)
6. OF LOT �x /()-(_) INOW ON LOT FRONT FT. _ 7? FT. O
4$ USE OF
CA EXISTING BLDG. /4/107✓7/ia R.SIDE FT. -` FT. 0
Vl
F y Separate permits are required for L.SIDE FT. / FT. 0
electric,plumbing and heating work.
Ci _REAR FT. _ tr FT. O
USE OF BUILDING AND WORK TO BE PERFORMED
F DISTANCE BET. BET.MAIN&
I. MAIN BLOCS- ACCESS.BLDGS.
///fff��, VAR.# DATE
[� r C.U.P. APPROVED
/WC;w /1'-t iCt_9ca Z Q _ �z /
..1 APPROVED 04,3/21...4/4—
t�R I RATE 9/Zb /77
12
W
0 I hereby acknowledge that I have read this application and state n
Ln
X that the above information Is correct and agree to comply with m
ti• all laws regulating building construction, and I shall not employ
Z any person in violation of the workman's compensation laws of 2
Ythe State of California.
3 I hereby certify that I am properly licensed as a contractor under SO. FT. N
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m
Chapter 9, and that such licenses are In full force and effect,or I THE PURPC6E OF ESTABLISHING A PERMIT FEE ONLY: "
am exempt from the provisions of the State of California Business ,- iO
VALUATION PERMIT FEE $ /�� e
and Professions Code, Division 3,Chapter 9. —di
Signature• of ///� p0 PLAN CHECK $ y ea �- 0
Pormlttoe �i.� / �� VS Od TAX $ . ?/ LL
Authorized Agent .../ O O
TOTAL PAID $ g/ a '1 7
Lot 1 - Tract 6384
Plan2-BR
2701 KS.Y 25-67cNsa
PAI!QO i 393'> 'x`� 147.00
COSTA A BUILDING-SAFETY DEPARTMENT
P. O. X 917 COSTA MESA. CALIFORNIA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
BUILDING
ADDRESS 1912 Kauai Place
COSTA MESA. CALIFORNIA •
ForOffice
RECEIPT NO, (� /Office Use Onllly��'d/1J
OWNER Club House Road Joint Venture O77
DR
ADESS 2850 Mesa Verde Drive RECg1VED/BY II DATE R E a V-Eg,71 Dt EBDE9
7
CITY Costa Mesa TENO. ADDRESS
AUILDING
DDRESS
OR
ARCHIT'MEER E.G.Kaltenbach ECT No .:547-804 COSTA MESA. CALIFORNIA
ADDRESS 1823 E. 17th St , Santa Ana ZONE TYPE Y GROUP Jr1
CONTRACTOR Republic Homes Corp. BYPROVED DATE ///////J
ADDRESS 2850 Mesa Verde Drive ZONING . /�^^v/
zo� NO.OF USE OF NEW fµ VV
CITY Costa Mesa '11 -j I PLANS I BUILDING p A14 ajail/
uciaO. 197838 No: 549-0395 DESCRIPTION p f ] 7A �n; I` �
SIZE NO. OF SLOGS.
OF LOT 60. 72 x 100 ' I NOW ON LOT A.P.NO. -
USE OF
EXISTING BLDG. YARDS EVES
APPROVED ALLOWED
SCENTER OFI NE STREETM 46 ' REAR YARD 27. 5' (CENTER LINE Ste
`` FT. /` IN.
SIDE YARD I LEFT 5' I RIGHT 5 ' R.SIDE 33 FT. [_/[-.- IN.
DESCRIPTION OF WORK
L.SIDE C FT. IN.
NEW I X II ALTERATION I II ADDITION I REAR X71 .7 Ft IN.
REPAIR I II MOVING I D DEMOLISH I APBY ,16A -1) ',C
l • DATE r/c
MEWING 2491sq. ftgeMe 8 STORIES 12
EXTERIOR WAL( Wood& I ROOF Wood &
COVERING Stucco COVERING Rui 1 t-Up HOLD FOR SPECIAL RnEQUIIREMENTl
USE OF BUILDING AND WORK TO BE PERFORMED 2-12-e. ( <7 /'A /1
.>:y.,, t/d---77
2/ J) 021V9 2 y.5--3I HEREBY ACKNOWLEDGE THAT I HA READ THIS APPLICATION THE AMOUNT SHOW DER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CI ORDINANCES AND STATE LAWS REGULATING
BUILDING CONS ON. /�/g7�y[,(O VALUATION 769 :SIGNATURE 07 / /. 2 �/ O^ PERMIT FEE $ /d
PERMITTEE 7 y N
•C / / - $ / PLAN CHECK $ ,/ /.y— 41'
AUTHORIZED � gc
® TOTAL FEE $ /7 / — 0
l
eli.lrMmLOM CVIkIPPMU JMrGI I Ims.nI
P. O. BOX 1200 5754 9/27/78 I 2.O[ 71
Costa Mesa, California 5754 9/27/78 I2.03CK71
I
ELECTRICAL=PERMIT ..
APPLICATION . TRACT NO. PERMIT NO.
• 4461.4
ELECTRICIAN ;3C-f>G.cT _s7 f.'- G c-,, S r; LC?, LOT NO DATE ISSUED
ADDRESS 2477 Y2 A'/24,, c.q/L ./2 O. BUILDING USE.
-(J
an ,{:%o . /vi L C S TEL. NO. 3%-G',j 9;CIG/P��a
STATE LICENSE NO. ?:,'J/? CLASS. -- -s
BUILDING / f/ it./qC-1/9 LICENSE NO. ADDRESS _/� ./aUl9
NO. ITEM 1 EACH NM COSTA MESA, CALIFORNIA
af
Dwelling, Sq. Ft. $ CROSS ST
ST. .r
O 4 ( .r.
LU Garage, Sq. ft. OWNER /--.---
y-F y J FL`�1.Ni,
QFin} 20 Outlets, each ADDRESS IL Jqn/C -1 C)"
J Outlets, Additional .,.-0\)y TEL N0.5-jn- 3c C /
First 20 Fixtures, each
I HEREBY 'ACKNOWLEDGE THAT I HAVE READ THIS APPLI-
>. - CATION AND'SYATE THAT THE ABOVE IS CORRECT AND AGREE
J Fixtures, Additional TO'COMPLY'WITH ALL CITY ORDINANCES AND STATE LAWS REG-
CC _ .y {FIATING ELECTRICAL WIRING.
Ill
TIFY THAT I POSSESS THE
D
LL Dryer ' \`•4 CALIFORNIA CLASSIFICATION OR I AM MOVE LEGAL OWNER STATEOF
O --NI'
^y v THE SINGLE FAMILY RESIDENTIAL PROPERTY DESCRIBED ABOVE.
CC Fon F•2
S1 of /v J
"7s �/
_
Z Heater111
RRMITREE
IOven, Domestic ♦ 110 ORM 41,-noECH yaMET
I— Pole, Construction�� 3� CT '. ',
n i d:jram.f•,%. Y K'
l >
s
et Range. O«rp,c irk' `" L+ ;t .,sem
d M ( , _ tF t j� _V, mal`
cc / '
X / L- ter(/4� �CVU WMr ton KW
B lir O I J''
Motors (See Schdutel 4e-, 2"-Jr
V_) —
= HP
H - -4
HP Sub-Total Fees -
HPAPPROVALS
_
n TOR 1 DATE
eaI,
Meters,
. f TEMP. POLE pnF„D I C. C. /0 now/at -, /.3 , "
Permit Fn _ 300 UNDERGROUND CONDUIT e- /0 5•7!J
Sub-Total Fees FIXTURES
- __ POWER
Total fes /. - re) UTILITY CO. NOTIFIED
e - , FINAL . /
CMF 0313-46,rev.7/75 For items not listed refer to Fee Schedule BLDG. PERMIT NO. L�,7 : 0.3
Mi I uwI. 'Inn, UnrnYuna
' I 'MITAPPLICATION h PERMIT O
TRACT NO. RE/{!L, ,W.BY7481
CONTRACTOR -)C t LOT NO. DATE ISSUED
BUILDING USE 91-Z-4'- '
Address 2YS 92. A/.cf /r G� /a
ii v.
/Clf
City ) Zip Code Building 7
��.1�' _ / !e es
Address)1/4\P-1/..:. 6.1}0N I
State License No. :33c 7/3a Class. e-- 3 Owner K et S
3 Mail
u City License No. Tel. No. Address Salit.47r
1 NUMBER TYPE OF FIXTURE OR ITEM FEE
D Bathtub City Tel.No SY�'-3d E/
Laundry Tub or Tray I hereby acknowledge that I have read this application and
1 Automatic Washing Machine state that the above is correct and agree to comply with all
> City Ordinances and State Laws regulating plumbing.
•
Shower I certify that I possess the above valid State of California ciassi-
jSink, Bar fication or I am the legal owner of the residential property de-
✓ _ Sink, Kitchen scribed above.
L Wash Basin(Lavatory) I certify that I have obtained a permit from the State Division of
S. Water Closet(Toilet) Industrial Safety for excavations,other than swimming pools,five
feet deep or deeper and into which a person is required to descend.
✓ Drinking Fountains
1 -Floor Drains Signature QJ; j�� ��i /
Permittee 't
•
z Interceptors
L
✓ Receptors INSPECTION R_E__..Q..LD ..,.._
Sinks,Commercial or Industrial
Sinks, Floor .yam, .s CP").) v f
-
Sinks,Service lainiMinalliaZNIMI
S / Swimming Pool Ty/A eta q Or ) ILIMIMt
1051
ii Urinals
1 Dishwasher
x Garage Disposal
7 Water Softener
D Water Heater and Vent DATE it •—
re
Y Gas System ...Outlets...
n Roof Drains APPROVALS
Water Piping Alteration — isvccT0R DATE
= Backflow Preventer • U/G Soil
I- . Lawn Sprinklers (Res or Non-Res) U/G Water
PropertySewer. .. Feet Services--Water 0 Gas ❑
House Sewer Connection _Rough Plumbing CL - L. /O - 13 77 b
Cesspool,Septic Tank Sprinkler System
Sewer Cap Gas C, C. /d ,2 -
a `
Miscellaneous _Property Sewer
Pool Receptor C /u - 3 I 7 -
Filter System f
_ Sub-Total Pool Heater i 7 ti.-`I [•
Reinspection Fee Miscellaneous p Cog,. ` Cr /J--2.,b--7 5
Processing Fee g ,EJCJ
Final Gas •
TOTAL FEE 614,6 Plumbing Final
Utility Co. Notified - '//� �-7
CMF 0450-46 MO. PERMIT NO. 4/t!' a j-5