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HomeMy WebLinkAbout1919 KAUAI DR - Building Permits • • > ' CITY OF COSTA MESA 4 BUILDING DIVISION >:J ,, , DEVELOPMENT SERVICES DEPARTMENT PERMYT NA ER t PERMIT � a 1/602-01350 4 e# (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 1919 KAUAI DR Status: ISSUED Suite: Applied: 08/22/2002 Vicinity: ROOF Issued: 08/22/2002 Parcel Number: 13951303 Zoning: R1 R1 ^� Applicant: SELL, RON ISSUED BY: ^ L,t�/./l Address: 18032 LEMON Phone: (714)528-1758 YORBA LINDA,CA Zip: 92686 Owner: WHITE, JERRY DEAN TR Address 1919 KAUAI PL Phone: COSTA MESA,CA Zip: 92626 Contractor: SELL ROOFING COMPANY Address: 18032 LEMON Phone: (714)528-1758 YORBA LINDA,CA Zip: 92686 License: 323842 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT REMOVE EXISTING ROOF. INSTALL 1/2"OSB,30#FELT,COMPOSITION SHINGLES.2000 S.F. INCLUDES ATTACHED GARAGE.WORK ON PITCH AREA ONLY. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $3,900.00 Permit: $97.25 Claim Valuation: $3,900.00 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $97.75 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) WOR RS'COMPENSATION DECLARATION: I hereb affirm under penalty of perjury one of the following declarations: ❑ I,iaO$and*ill 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. (L ) I have end will maintain workers'compensation insure s,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'corn n do Insuran rrier and oafEv number are: o Y (This s%r � C �,'+Polloy Number: 6 S� (this section need not be comple ed if the permit is valued at one hundred dollars($100)or less.) O 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,an gr e that If I s uld be e subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these 6 provisions. ` _ pUr ! rApplicant Signature: > �l {Dater 3 I -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($1110,000),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.l.a�licensed under provisions of C_hpptV(commencing with Section 7000)of Division 3 of the Business and Prohssions Code,wild my license Is In full force and effect.Llc:q, • `f' Class ti-?.? .D ( Cbntracto�gnature` Ara_ — •— �/ 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: 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 end 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($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors license Law does not apply to an owner of property who builds or Improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or Improve for purpose of sale.). O I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five($)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 then thirty-six(38)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare en RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application eggermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? DI Yes LJ No (Section 65850.2 of the Calitomia 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 Duality 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? ❑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 MD 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 . s and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspe •g.oses.I a e not to upy or allow occupancy of any building authorized by this permit until final inspection. S. a r�� al Owner s) lie a-ktl_ SEl/ S�- 0 (And/OTAutho ized Applicant_3- (,Date CODE# INSPECTION TYPE DEE IIffl1LD CODE( INSPECTION TYPE PATE ______ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final p 7 .,(�. 208 Final Plumbing • 7 200 Final Re-Roof I '&Z girt- 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 F . CITY OF COSTA MESA 4 6g BUILDING DIVISION ' o y .4 S DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER J PERMIT lira en"�`� E05-00417 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1919 KAUAI DR Status: ISSUED Suite No Applied: 05/03/2005 Vicinity: LEFT SIDE/REAR SFD Issued: 05/03/2005 Parcel Nunmber: 13951303 . Applicant: WHITE, JERRY ISSUED BY: +c Address: 1919 KAUAI PL Phone: 714-434-1734 COSTA MESA,CA Zip 92626 Owner: . WHITE, JERRY DEAN TR Address 1919 KAUAI PL Phone: COSTA MESA,CA Zip: 92626 Contractor: OWNER-BUILDER Address: Phone: Zip: License:000000 SCOPE OF PERMIT CHANGE-OUT OF AN ELECTRICAL SERVICE TO 200A IN THE SAME LOCATION AT AN EXISTING SFD. NO OTHER WORK AUTHORIZED WITH THIS PERMIT. 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 $0.00 0 up to 50 kva/kw $0.00 0 Recept Outlets $0.00 0 up to 100 kva/kw $0.00 0 Switches $0.00 0 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 $30.50 1 Misc.Conduit $0.00 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 Sub panel to 200a $0.00 0 Plan Check 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) I • WORKERS'COMPENSA O DE&ARATION: 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: Polity 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 C 'Jamie.and agree that I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provi ns. Appllgatlt:Slgn�t'u-re: �. ///�_ D'atii: -C 3 - WARNING :FAILURE TO SEC E W KERS'COMPENSATION VERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100, ),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 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.0 Class 0 Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code), Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit 5 bjects 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�xe pt under sec. Business and Professions Code for this reason: jq?ier ID r'e /*pkat-a�;'�-J'3-0s /0 Owner ID v= 'd b driver's c ❑Yes 0 No DdveYs'ClcejLse.No: ��� 71*• (Ask 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)of more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,faisework,or demolition or dismantling thereof,will be more than thirty-six(36)feel high.(Chap.3.2,Grp 2.Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the Califomia 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? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification from the South Coast Air Duality Management District or from any other air pollution control district or agency? U Yes lJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed tinder this permit be within 1-500 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 Alr 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-des 'bed property for insp ction purposes.I agree not to occupy or allow occupancy of any building authorized by this pe mit ntil final inspection. are OF-egal Ovine ) 1 94yr-r--, And/Or Authorized Applicant Date RODE I INSPECTION TYPE PATE INTmALS POE INSPECTION TYPE. LAB IMAg 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical /c/,d'o! -.(y(�,{{��� 20t Final Block/Retaining Wall 212 Final Fire Prevention rit../�id.t4tLri 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy .. Ph'bne: (714)754-5230 Fax: 1) 754-4856 MESA, BUILDING SAFET' 'VISION ' •' t/_ r 7!{`/ For Inspections Call: ,)754-5244 OUS PLACE ON THE JOB c.�p�(„q TDD: (714)754-5244 a 4:, hmartinez@ci.costa-mesa.ca.us NOTICE �_t! Y grdi� HENRY MARTINEZ :dole inspections, call (714)754-5626. Provide the following information: .#. P �iV 1, COMBINATION INSPECTOR lumber,4) Day and date you need the inspection. Hours: 7:00 to 7:30 a.m. e gbaane- CITY OF COSTA MESA,CALIFORNIA / U Owner 11T _, Tit--- Law/7 Contractor LL 77 FAIR DRIVE • POST OFFICE BOX 1200 • 92628-1200 ~ ...--.._._------- -_---__ - _ Job Description A _ Type: Group: 3 -S--- NEW — NlanEW Check No. IsEPe Date: SJI ""'v NEW ADD ALTER REPAIR MOVMG DEMOLISH PERMITS EXPIRE 180 DAYS (6 MONTHS) FROM ISSUE OR LAST INSPECTION CONSTRUCTION APPROVALS Item# STRUCTURAL Date Inspector Item# POOL&SPA Date Inspector 3 -Job Site Consult 94 Pool&Equipment Location 4 Footings/Ufer Ground 96 Steel Reinforcement 6 Slab • 100 Electrical Bonding - , 8 Structural Floor • 102 Rough Plumb,&Pressure Test 11 Pre-Inspect Roof 104 Approval to Cover-Gunite • 12 Roof Sheathing 106 Elec Conduit-Underground 14 _-T-Bar Ceiling-Structural 108 Gas Pipe/Underground Test I:• 16 Shear Panel ' 110 Backwash Lines, P-Trap, 18 Frame&Flashing Underground • 20 1 Lathing&Siding 112 Approval to Deck 22 -Insulation 116 Pool Plumbing System-Final 24 -Drywall Nailing 118 Pool Electrical-Final • 26 -Plaster Brown Coat 122 Fencing/Access/Alarms Approval 30 Pre-Grout 124' Approval for Plastering • . 33 Disabled Access 126 Pool/Spa Systems-Final • _ _d� FIRE DEPARTMENT APPROVAL • 1610 Overhd Hydro/Overhd Rough * 1612 Dry Chemical • 614 Dry Standpipe ELECTRICAL 1616 Final-Fixed System 36 -Ufer Ground 38 Elec Conduit-Underground,;, ; FINAL INSPECTIONS 44 , Rough Elec-Wiring (Mast be completed prior to requesting occupancy.) ._ .`Elec.Conduit . Call(714)754-5626 for the following: Date Inspector y Bar C it � ' , 200 JFinal Re-Roof . 20 P Final Block/Retaining Wall • 203 Final Sig;1 - 204 Final Demolition • We • 206 Final Mechanical : • . '_ 208 Final Plumbing / r//jr� • IANICAL 11 : r ''-.1 Final Electrical /c// gig.7 f Call(714)327-7400 for the following: • Date Inspector • .-4>• —. 2121•Firial Fire Prevention Call(714)754-971 two(2)working days Date Engineer prior to final. . • .it 2i6 Final Public Evs.Dept.Approval I • _ • . Call(714)754-5307 for the following: Date Inspector rireplace 2181 Fina CMS Approval, - _ Call(714)754-5245 for the following: Date Inspector Test 220 I Final Planning Approval • • I Call(714)7545626 for the following: Date Inspector ,. • 222 Final Site --- r e: 250 Final Building/Occupancy 4 .,CE REVERSE ati o. - t .,CE 1V Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. . CITY OF COSTA MESA c,ONSTRUCTIB PERMIT - PERMIT NO. TRACT NO. LOT NO. UNIT NO. 8017 �,// J� Project Address 14 14 /rQ U c .��II 1- �/��� / - / //� 5.OLl FL Applicant's Mailing Address gee f6nT1'r TYPE OF CONSTRUCTION U NEW U ADD U ALTERATION U REPAIRIt 4){L ss ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# Zone Owner's Name / t Phone . DESCRIPTION OF WORK/USE OF BLDG. Address 13-R-...4""C- S Main Building: Accessory Building: TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL E •Front Z pArch/Eng. �1License No. B - N O Address /- `- ./� / ❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL B Rear - N 1* Contractor's Name / irrs-%k �• `^^S Phone �• ❑ OTHER _ - / gJ 9'yoc - C Right - - N n /� \ PROJECT DESCRIPTION SQ. FT. OCCUPANCY " Address(mailing) y m<<<✓� C u r't}/'ZJr Wn aCS -i/1/ CONSTRUCTION TYPE VALUATION $ S Left . G 77\\ License No. 7zzSR ` I City �jT J ZONE GRADING CU.YDS. ACRES ,,,\"Y1111T"`,,, LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided E I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: Q with section 7000) of Division 3 of the Business and Professions Code, and • M my license is in full fort and effect. • T License Class CLicen j o._� S. Date ).-�y-y�s a� am Signature / PLUMBING FEES i '-'ORKERS'COMPENSATION DECLARATION Bar Sink Showers ereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES Workers' Compensation Insurance, or a certif d copy hereof (Section Backflow Preventer Service Sink ' 3800, Lab. C.) Automatic Washer Transformer 0 15:50 KW o icy No. SAI g/a ' Company 01A Backflow Irrigation Sewer Cap Construction Pole;Sub. 0 50+ KW Certified copy is hereby Turn(shed. (J --� _ IIe(y�pl�'Cer ilieSkCop�y'�y�Is filed with the city Builldin Division. Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps bate t .y_};4 Applicant/� /��CCj^^j--//,� EXEMPTION FROM WORKERS'COMPENSATI�ATlO N . Clarifiers Solar Collectors Dishwasher Meter Clover 100 amps (This section need not be completed it the permit is for one hundred ($100)or • - - less). Dishwasher Solar Piping Dryers OGas DElectric Sub Panel , I certify that in the performance of the w k for which this permit is issued, I shall not employ any person in any r so as to become subject to the Drinking Fountains Solar Tank Fan - Motors❑o-1 HP OVA-8 Workers' Compensation Laws of Califo Date Signature Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar 09-15 HP 016-15+ NOTICE: It,after making this declare on,You should become subject to the Workers' Compensation provisions o the Labor Code, you must forthwith Floor Sinks - Urinal Fixtures Microwave comply with such provisions or this-permit shall be deemed revoked. - CONSTRUCTION LENDING AGENCY 'Gas Service Outlets • - Water Closet Device Boxes ' I hereby affirm that there is a co nstrur�m n lending agency for the performance Pole Light of the work for which this pe s Issued (Section 3097- Civ. C.) Interceptors - Range Water Heater Outlets Lender's Name Lender's Address - - Kitchen Sink Water Service • Switches Sign _ OWNER BUILDER DECLARATIO ' I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories I W 0.+Cr- _ vane_r • Garbage Disposal •Standing Sections following reason (Section 7031.5 Business and Professional Code: Any city or _ - county which requires a permit to construct,alter,Improve,demolish or repair P—Trap any structure, prior to its issuance, also requires the applicant for such permit Generator 00-5 KW ❑5-15 KW Trash Compactor to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains - the Contractor's License Law (Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code) or that he/she is exempt - . •herefrom 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 • enalty of not more than five hundred dollars($500). LJ I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 - Issue Fee • $ 3 compensation, will do the work, and the structure is not intended or offered - Reinspection Fee I $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES License law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own Boiler Hood or Type I 0 DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such improvements are not intended or offered foryp - - Zoning Approved By Date sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0 pletion, the owner will have the burden of proving he/she did not build or Im- • Duct-Under Ground Building Approved By Date LIrove for the purpose of sale). (� �� y/y/ /G�/ I, as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By "'-""�" Date O// `q tractors to construct the project (Section 7044,Business and professions Code: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU SUMMARY OF FEES builds or Improves thereon,and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMIP $ proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT ❑ 1 am exempt under Section B.& P.C.for this reason Firepl/Fact.Bit. ICBO# PERMIT ISSUANCE $ PLUMBING $ Date Owner _ - Heating System& Ducting PLAN CHECK 25% $ ENERGY P.C, $ I hereby certify that I have read this a plication and state that the above 00.100,000 BTU 0100,000 BTL- ELECTRICAL $ GRADING $ information is correct. I agree to comply with all cit and county ordinances and state laws relating to building construction, 'ereby authorize repre- PLAN CHECK 50% $ MICROFILM $ sentatives of this cit to -rater upon e ab. entioned property for inspection purposes. �/ - t, y- MECHANICAL $ Signature purposes.," _ 4` �• Date 24 7 X7 - • TOTAL FEE $ �UC� Drivers' License or 55 � Reinspection Fee I $15 Issue Fee $ 3 PLAN CHECK 25% $ - CMF 0865-46,rev.4/84 White-Building;Canary-Applicant:Pink-Accounting;Goldenrod-Assessor s/. CONSTRUCTION AND PLANNING POG. SPA APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole _ 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE • 7. cootings - 58. Electrical Conduit-Undrgrnd. . . 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. :Rater Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap - 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING • 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas ❑Oil • 23. Gas Pipe-Rough&Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing& Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing W'* GgO 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation44. .Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY • No. Date OWNER Lis BRYANT, CHARLES DATE 2-26-68 ,JOB ADDRESS 1919 Kauai Place BUILDING PERMIT NO. 28247 PrNERAL CONTRACTOR capitol Masonry Contr. DESCRIPTION OF WORK 2 Block Walls .co. LOT 24 TRACT 6384 FIRE ZONE VALUE $ 705.00 INSPECTIONS Signature Date GROUP J TYPE III ZONE R-1 Soil PERMITS ISSUED d Gas SUBCONTRACTOR Date I Number I Signature `I Water Plumbing Rough Plumbing Prop. Swr. Line [' House Con.I] Sprinkling System Miscellaneous Rough Heating and Air Conditioning _ Temporary Service or Pole Underground 0 Power {] Rough Wiring fg�3 PY� Heating and Vent. TEy' EI (Q� renches Forms Steel Reinf. Floor System Bond Beam ID Steel Reinforce ❑ Sheathing Frame and Flashing Lathing— In 0 Out 0 I .r, Brown Coat S.._ctural, Final Electric Heating, Vent., Refrig. and A.C., Final Plumbing, Final and Gas Test 0 Electric, Finale / Rni!din2_ Final /0/ /.` 2. J/—/..c7 8247FEB 26-68P'—x°00 534 d*****6,00 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 9M26 For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING For Office Use Only BUILDING py awl-A) ADDRESD /' I awl-A) 28247 RECEIPT NO. (� COSTA MESA. CALIFORNIA nErroy, 447:1:2L RIZEIVED_ DATE ISSUED OWNERride /9/9 ' MAIL IQ/�j Ka.* / ADDRESD /1/�F J ADDRESS N,/.�/.'/p/1�'/- �l�I,,� FIRS'2? /�J T CITY C '//1(�(. NO.Sy6 3,574 ZONE <.J TYPE. id GROUP �,/ ��Q '- -HITECT TEL ByPME. jQ�C.) 71 DATE 0202/t it NGINEER NO. 7 N4^U'_!v ZONING cl n La ADDRESS w CONTRACTOR / yK �/ L zox PLANE 2_, I BUILDING ar ` NO.OF USE OF NEW t LEGAL DESCRITON a-c/ --f-le a 327 / ADDRESS //' �4.14. ^lir CITY Cl3k 471.114t. . A.P.NO. �y p. NOTE: NO RAVE OVERHANG SHALL BE LESS THAN STATNO. 25a a S6 118-, s11-6-0 9Al SO'TO SIDE a REAR P.L. EAVES SIZE I NO.OF SLOGS. ALLOWED (U.B.C.REQUIREMENT) - OF LOT NOW ON LGT YARDS APPROVED YARDS APPROVED USE OF MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. (PROM C/L STREET) SETBACK LINE FROM FRONT FT. ----FTC---- CENTER OF STREET REAR YAL2D SIDE YARD I LEFT I RIGHT R.SIDE FT. O FT. DESCRIPTION OF WORK L.SIDE FF. _ OFT. ei / ALTERATION ADDITION �� REAR FT. FT. DISTANCE SET. BET.MAIN& MAIN BLDQS, ACCESS.SLOGS. REPAIR MOVING EMOL.ISH BUILDING NO.OF VAR. DATE SIZE ROOMS STORIES C.U.P.# APPROVED EXTERIOR WALL I ROOF BPROV[D (.1 � COVERING COVERING YDATE��F gf USE OF BUILDING AND WORK TO BE PERFORMED h a G ' `Grua ., /3s' / 2/v -.39s rf ' 6-enee, •— S3' "RI &)4TF_ 50. ) °5 (n SQ.FT. 1 I HEREBY ACKNOWLEDGE THAT I NAVE READ THIS APPLICATION - THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THIS ABOVE IS CORRECT AND AGREE TO CON• PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. F11 PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION 0 BUILDING CONSTRUCTIO 4- 4}.,n SIGNATURE OF //J� PERMIT FEE $ !/v p PERMITTEE �t � �� 7D7 i610 --. ° $ PLAN CHECK S AUTHORIZED AGENT TOTAL FEE $ e•in Lot 2 - Tract 6384 ' Wan 2-AR KAY At*1117.CO 2ayr::�'0 errs,;001416 COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 317 COSTA MESA. CALIFORNIA For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING BUILDING T� ADDRESS 191 9 KRt1R•yl ACP cm COSTA MESA. CALIFORNIA For Office Use Only ,(� owNElClub House Road Joint Venture I RECEIPT No. I ryslrry�r Yi'o MAILRECB gY/ D RECEIVED DATE ISSUED ADDRESS 2850 Mesa Verde Drive ED/7- I r-2,2_/ , 4- 22_47 CITY Costa Mesa NEo`549-039: BUILDING ADDRESS ARC'" TE ORINEER E.G. Kaltenbachn47-8046 COSTA MESA. CALIFORNIA ADDRESS1823 E. 17th St . Santa Ana FIRE 1" /��t �/ ZONE TYPE V GROUP r,•/ � YJ / CONTRACTOR Republic Homes Corp- APPROVED ✓✓✓ U BY DATE ADDRESS 2850 Mesa. Verde Drive ZONING dL.r/- Costa ZONE NO.OF......,....1 USE OF NEW (1 -' CITY Costa Mesa R)I PANS'. n— i BUILDING ,' LICTNO. 197838 TEL 549-0395 /LEGARIPTIGN / 8-C(� 77R. 6-3 d '{ OF LOT 60 x 100 'SIZE I NO. OF BLOTS. NOW ON LOT A.P.NO. USE OF YARDS EVES EXISTING BLDG. - .. APPROVED ALLOWED SETBACK LINE FROM (CENTER LINE/S�T.) CENTER OF STREET 47 I REAR YARD 26. 5 1 FRONT , 1FT. IN. SIDE YARD I LEFT 51 I RIGHT 5 ' R.SIDE .7. FT. IN. DESCRIPTION OF WORK /"..-- L.SIDE //]_ FT. IN. NE I X II ALTERATION I II ADDITION I REAR >6,A (FJ IN. REPAIR I II MOVING I II DEMOLISH I BYPROVED(/f' ` ® �! DATE �-ii-6'/ BUILDIN NO OF 1 KJJ �'1 SIZE G2491s . ft}aOOMS 8 STORIES 17 EXTERIOR WALL Wood ROOF {{oOd RL COVERING St17ee; CovEIIING ul t-Up USE OF BUILDING AND WORK � EEJTOO ESE PERFORMED / /4)1-F7 / / 7 09 .2 99/ /9 95-.3I HEREBY ACKNOWLEDGE THAT I HAVB�READ THIS APPLICATION THE AMOUNT SHOWN O NDER 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.ITY ORDINANCES AND STATE LAWS REG fJ1TING c /ys BUILDING C7`" 'UCTION. p_ VALUATION / J SIGMA •-: / PERMIT FEE $ N PERMI >_i/ _ ao 0 'Ph / / $ (2 '� PLAN CHECK $ v' , AUTHOR •E,6j •'/ - . / 9 — o TOTAL FEE - I.