HomeMy WebLinkAbout3137 KILLARNEY LN - Building Permits PROJECT ADDRESS: 3137 KILLARNEY LN UNIT: CITY OF COSTA MESA - EUILDING PERMIT PERM NO: EM 0598?4
OWNER'S NAME: MC COrtM :CK, ROBERT G
ADDRESS: 3137 KILi.ARNEY LN PERMIT NO: EM 059824 PLAN CHECK NO; N GOVT; N SUPP ; N
COSTA MESA, CA 92626
CONSTRUCTION TYPE; V-N PERMIT TYPE: ELE MEC PURPOSE: OTR
545-6145
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : C/O FAG INSTALL NEW A/C aM Stpe `(qP.D SQ FT;
ADDRESS: UNIT:
CLAIM VALUE: 4 , 000 , 00 CALC -VALUE; GROUP OCC: R- 3 /
PERMITTEE: WESTCRi4 COOLING ( 714 ) 776-1168
ADDRESS: 628 S . EAST Si' ' COMMENTS; ELEC, WORK IS INCIDENTAL
R
ANAHEIM CA 92 ^� 7E1(*****dF;(*** *;(.*k*7fi(X##XIFiE#%Mx*********i(1ElE#if- •IE%#iE*xetx**);*#-(#tick Xi( XH****xv*ax*K3(
LICENSED CONTRACTOR DECLARATION: I hereby allirm That I a.. icensed der pray''. s 01 Chapte 9(commencing with Section _ Z ONING R E Q U I R h M E N T S
7000)of Division 3 of the Business and Professions Code.and y license i in lull .ce and effect. SETBACKS
CITY LIG.:045939 STATE LIC.5 2 5 0 1 'SS' C20
'_Date://;�/�2 Signaler• _, / - � +�- MAIN BUILDING ACCESSORY BUILDING
WOR ERS'COMPENSATION DECLARATION: Ihere.' rm that I have cm:DILc of 2onsenl to selhinsure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT ' IN REAR: FT IN
Compensation Insurance.or a certified copy there. ction 3800.1 .C). LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT; FT IN
POLICY NO.: EXP.DAT :
COMPANY: PARKING REQ; PROV: PARCEL; 14163318 /NE: REF NO:
0 Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING NOTES>
> Att o4 SIDE Yta-p cr- (SY Pt.trNwiM'1
Date: Applicant; *****************X•*****************#f `****X-## ####***#***3(**********#*#x•it#K** ](
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This -.on need not.•completed' .permit for one hundred MOO)or less). DEVELOPMENT S E. R. V I C h S H .E Q J I It E M E N i 5
I certify that in the performance of the work for which this permit r issued,I sh. not empl.(ny person' any manner so as to become
subject to the Workers'Compensati^onn Laws of California. ZONING APPROVED BY �r DATE;
`Date/ j Signature: -.../.6.Se'._ ._._ - — - '' ' •
NOTICE:If,atter making this declaration,you sho i b'..me subject to .rkers'Compensation provisions of the Labor BUILDING APPROVED BY : ) .- DATE;
Code.you must forthwith comply with such pro'io +or this permit- . .e deemed revoked. ,n,� /�� /
CONSTRUCTION LENDING AGENCY: I hereby affi A there is a c.- ruction lending agency for the performance of the work for APPLICATION ISSUED BY' J ✓t. , 'T VI!." DATE; //S 1�
which this permit is issued(Section 3097.Civ.C. **********�Ei(3E3(•1E3EiFiE****tt•YFf(it M•tt•RiFltftRittejt+r9e A•* stitiYttLIR************* **It X**it st**frit*R***
LENDER: **************#)(**f *******X****3*****M********) **P**********y****K*******##SE*****
ADDRESS: LEGALIZATION: N F E E SUMMARY STRUCTURAL SEGMENT;N
OWNER BUILDER DECLARATION: I hereby allirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish.or PERMIT 3 , 0 0 18 , 00
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed S 0% 25% SM I P/NON-RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500). ISSUE FEE 15 , 00 15 , 00
I. as owner of the property or my employees with wages as their sole compensation, wit do the work, and the BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DU;.
❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTAL S----> 21 , 00 30 , 00 0 . 00 S1 , 00 J1 , 00 ,00
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 tier own employees.provided that such improvements are not intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED• 51 . 00 OVER/SHORT: . 00
improvement
purf within one year of completion,the owner will have the burden of proving he/she did not build or improve
lorthepose osale).
BLDG PMT PLUMBING ELECTRIC MECHANIC 'FIRE SM.I P/TOT GRADING PLAN -CHECK
I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 18 , 00 33 , 00
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projectsw4th acontractor(s)license pursuant to the Contractors'State License Law).I am aware ***************************************#********X-*************3( ra***********ie***
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
❑ I am exempt under Section: B.8 P.C.
for this reason: TYPE QTY DESCRIPTI O N UNIT COST TOTAL COST
Date: Owner: ELE 1 RES APPLIANCE NOT OVErt 1 , 0 HP 3 , 00 3 , 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and MEC 1 I NS T FORC-AIR/GRAV FURN <- 100 K BTU 9 . 00
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a MEC 1 REFRIGERATION $YSTEM <= 10 0 K B'f U/H 9 . 00 9 , 0 0
permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from
these provisions. END OF FEES
Date: Applicant:
I hereby certify that I have read this application and slate that •i above in fray IC:torr¢.t.I agree to comply with all city and county .
ordinances and state laws relating to building construction and ereby autht ze representative of this city to enter upon the above-mentioned
properly for inspection purposes.
--�,Date://ri - 5 '-'....-C7-2 Signatu.../ d� U
Driver's License nr Social Security n:
1641-46 Whim-Building;Green-Coda E •cement:Canery-Applicant:Pink-Revenue:GOldenrOd-Assessor
CONSTRUCTION AND PLANNING POOL & 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. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test
9. Water 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 0 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& .) I 77. FIXED SYSTEM FINAL
29. Insulation 41 l78. FIRE PREV. FINAL
30. Drywall Nailing (i HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat t I 79. FINAL INSPECTION
32. Electrical Power Meter-Final C I I i 80. FOOD CERTIFICATE ISSUED
33. Final Electricl!G{�(.Ldaz1 Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy .>'
I _
37. Final Fa$tory Fireplace
38. Final PI tubing
39. Water Service-Final
40. Gas Service-Final �y •
•
41. Solar DOrnestic'Final ,.
42. BackfloU Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
•
45. Sound Attenuation
46. Handicap Regulations .
47. FINAL STRUCTURE & BUILDING I
48. FINAL PLANNING
49. Electric Release to Edison •
i I
50. Gas Release to Southern California Gas Co I I
51. CERTIFICATE OF OCCUPANCY
No. Date
4�0=q CITY OF COSTA MESA
°u ��y BUILDING DIVISION
F r 'ate. 'eJ DEVELOPMENT SERVICES DEPARTMENT / PERMIT NUMBER
_y,
)• PERMIT j pm (/ 579
'*n„mw P00 00370
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 3137 KILLARNEY LN Status: ISSUED
Suite No Applied: 07/17/2000
Issued: 07/17/2000
Vicinity:
ISSUED BY:
Parcel Nunmber: 14163318
Applicant: NOCK, RON
•
Address: 11612 KNOTT ST
Phone: (714)895-1246
GARDEN GROVE,CA Zip: 92841
Owner: MC CORMICK, ROBERT GEORGE
Address TR
COSTA MESA,CA Phone:
3137 KILLARNEY LN Zip: 92626
Contractor: NOCK PLUMBING
Address: 11612 KNOTT ST
Phone: (714)895-1246
GARDEN GROVE,CA Zip: 92841
License: 707775
•
Arch / Eng:
Address:
Phone:
Zip:
- License:
SCOPE OF PERMIT
1 WATER HEATER CHANGE-OUT.
FEE SUMMARY
AMT QTY AMT QTY AMT QTY
ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0
Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0
Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0
Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0
Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0
Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0
Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0
Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0
Drain. Roof $0.00 0 Shower $0.00 0 Water Heater/vent $12.30 1
Drinking Fountain $0.00 0 Sink, bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0
Expansion Tank $0.00 0 Sink,commercial $0.00• 0 Water Re-pipe $0.00 0
Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0
Gas(1-4 outlets) $0.00 0 Sink,kitchen $0.00 0 Water Softener $0.00 0
Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00
Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00
Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00
Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0
Interceptors(Sand Auto) $0.00 0
TOTAL CALCULATED FEES: $35.80
COMMENTS/SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
•
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
DECLARATIONS
WORKERS'COMPENSATION DECLARATI.....
I hereby affirm under penalty of perjury one of the following declarations:
O I a 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
yIork for which this permit is issued.
have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Cede,for the performance of the work for which this permit is issued.
My workers'co'mpeennsatio nsuranCce carrier�iand policy number are: _ v�9 3
Carrier: C—"C9Cy� C 1 S Policy Number CX.i`- f
(This section need not be completed I/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 C.'• nd agree that if I should become subject I. e workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisl t � /7
Applicant Signature: Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAW " -r SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARS(SI W,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION a/Cb OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under•ro ' for of ha! : ' (commencing with Section 7000)of Division 3 of the Business and Prof ssi•- C•".,and my license is in full
force and effect.Lic.# 411. Class# V
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
subjects the applicant to a civil penalty of not more than five hundred dollars(5500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044, Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044. Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend, will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such Work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑Yes 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 II 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(Duality Management District or from any other air pollution control district or agency? Yes u No
(Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑No
8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Si, 'lure Of Legal Owner(s) D
•n•Or Authorized Applicant ate
JADE I INSPECTION TYPE ME RtfmA$ CODE I INSPECTION TYPF DdIE �JA
1616 Fixed System Final Fire Prevention 206 Final Mechanical y
1266 Pool Spa Final 208 Final Plumbing -' 7''/ • ;
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 ,
2448-46
PROJECTADORESS: 3137 KILLARNEY LN UNIT: CITY OF COSTA MESA - BUILDING PERMIT PhKM NU: H V73J41
OWNER'S NAME: MC CORMICK ROBERT G
num 3137 KILLARNEY LN PERMIT NO: B 053942 PLAN CHECK NO: N GOV! : N SUPP: N
COSTA MESA,CA 92626
CONSTRUCTION TYPE: 5-N PERMIT TYPE: STR PURPOSE: ALT
. ARCHIENGINEER: REG.NO.: JOB DESCRIPTION : RE-SHEATH 6 RE-ROOF/1 /2"PLY 6 ASPH COMP SQ FT: 5, 300
ADDRESS: 0N1T CLAIM VALUE: 5, 300 . 00 CALC-VALUE: 5, 300 . 00 GROUP OCC: R-3 /M-1
PERMITTEE: CHAMPION ROOFS ( 714 )898-8600
ADDREss: 3257 VERDUGO COMMENTS: SMOKE DETECTOR(S) REQUIRED IN HOME.
LOS ANGELES CA 90065 *>ESE�L�E**�E>E*********iE*****rt�E�ETr�P* ***�E***yr�E�t�E**k*****>r***+r*****************Tr******
LICENSED CONTRACTOR DECLARATION: I hereby allirm that I am li .d under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code.and my I .. lull force and effect. SETBACK S
an LIC.: 04 2 72 5 STATE LIC.: 4 29 4 81 4.ss: C-39
Date: [—(�—�� signature: MAIN BUILDING ACCESSORY BUILDING
• FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of eons to self-insure or a certificate el Workers' LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
Compensation Igsura eoc2 eyilie0.cgpy thereof(Section 3800.Lab.8.5/01/ 2
POLICY NO.: STATE
N11 EXP.GATE:
COMPANY: STATE FUND PARKING REQ. PROV: PARCEL: 14163318 ZNE: REF NO:
,,yy PLANNING N6TES>
0 Certified copy is hereby furnished. C1 Certified copy is illi e city Building Division. >
pat —I SA. Applicant: ia
DEVELOPMENT V E L O P M E N T S E R V I C E S R E Q U I R E M E N .T
9 6.p9�'9� S
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not r.completed if the permit is for one hundred(5)00)or less).
I certify that in the performance of the work for which this permit is issued.I shall no •r ploy any person in any manner so as to become ZONING APPROVED BY it
subject to the Workers'Compensation Laws of California. drDATE;
Date: Signature: BUILDING APPROVED BY : ry
NOTICE:If.alter making this declaration,you should become subject to the Workers'Compensation provisions of the Labor DATE: /
Code.you must forthwith comply with provisions or this permit span be deemed revoked. APPLICATION ISSUED B Y• / I� �� 'iE * /�J'/
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for ,�,a�.. „ , _ , air -�-'r, , , , , DATE• 'St +f �"##If.fE
which this permit is issued(Section 3097,Civ.C). **********************. . . ••********4*2
** ***
*******************************,. . . . .***** ** *********************************
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES•' GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 81 . 00 . 53>
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed SMIP/ ON-RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN Ar
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any viatation of Section 7031.5 by
ISSUE FEE
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(S500).
BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID. ';' DUE
I, as owner of the property or my employees with wages as their sole compensation. will do the work, and the TOTALS----> 81 . 53 0. 00 0 . 00 81 . 53 81 . 53 • 00
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State 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 employees,provided that such improvements are not intended or offered for sale. If,however the building or REVENUE DIVISION TOTALS--> COLLECTED: 81 . 53 OVER/SHORT: . 00
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING.'PLAN-CHECK
for the purpose of sale).
81 . 00 . 53
I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon ***********,************************,****,************,********************.********
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
❑ I am exempt under Section: B.&P.C f
lar this reason. TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date; Owner: SFR 5300 REROOF BY VALUE RESIDENTIAL NOZONE , 1 . 00 ' ' 5, 300 . 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES '
25534 and that I on any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a
permit lot construction or modification from the Air Ouabty Management District.Residential construction applications are exempt from 4;
these provisions. 1
Date' Applicant: rI
I hereby certify that I have read this application and stale that the abo .mfor•anon is correct.I agree to comply with all city and county
ordinances and state laws relating to building construction and hereby, thor¢e,Pres: tatives of this oty to enter upon the above-mentioned
property for inspection purposes.
. .r Z 07 0009/471-r,nm;;.•.,3 - •- - -
Date;..9._:.:-_/5.=2/— Signature: 1 OF.TE iii:1; 4 i 7j;',_' - ' -
Driver's License or Social Security C:
1645-46 White—Building:Green—Code Enforcement;Canary—Applicant:Pink—Revenue;Goldenrod—Assessor
CONSTgUC-"cGWJ AND PLANNING POOL & SPA
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
r
1. Temporary Electrical Service yr Pole 52. Pool & Equipment Location
...--
2.
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement C.
kElectrical Conduit:Qtility-Undrgrnd,:"' 4•41 54. Forms
4 Electrical Conduit-t$ndrgrnd. ,t , ' 55. Electrical Bonding
o . ,
•
%5.. Steel Reinforcjq r t - _ 56. Rough Plumbing & Pressure Test
76.alectrical UFER'brnd. i•:-. 57. APPROVAL TO COVER-GUNITE ,
L ;7,a Fyotings __ _ r 58. Eiectrical Conduit-Undrgrnd.
„$:• 'Foundation ''' �. 59. Gas Pipe, 0 Undrgrnd.,Test
-'-19%Water Pipe-Undrgrnd. , 60. Backwash Lines, P-Trap, 0 Undrgrnd. .
10. Structural Floor System 61. APPROVAL TO DECK •
11. Property Sewer Line & House"Con lection 62. Backwash & Receptor-Final
.1' ._. ,
12. Sewer Cap •, 2 _ •
63. •Heater & Vent-Final
13. Roof Drains r" 64. Plumbing System - Final
14. Rough Plumbing ,'• 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electrie'Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrigl-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20n Railgh.Eactary Fireplace r .r' 4 2 - - .- A -'APPROVALS 7 : Permit#
e -c 'ci t > . S•• ' - ! ,- ,z'ti -. x r r
•21`. Ddcts,in Struct r A e ' .t
& _ •a 70. Underground Hydro JO s '�+
22. Duets,!Eentilatinj , 4,• . . 2 71. Product Pl ding'UGas 0Oil
•23,,Gas,Piq'e,-Rough &`fest n S Rr r, �' . 72. Underground Flusti.x _
24r Roof Framing zi< •• - •- y r ; 737 Undergrrid Stora " Tank'0 Gas 0 Oil
25. Robf Sieathing ',.x
e../ .• -• �• _ :_ ' : 74. Overhead Hydro c ':
26'.,T-aer Ceiling (Structural) SF'Monocoat i •u r • - 75: Dry Chemical = K
.. .. _ -S -K , �, - Y -. - , ...
27"Fra a tnd Flashing 76. Dr
s -..:« _ w i Y Stan pipe ::
i., . , •� ,.�:rc.,
28. Lathing'& Siding.* c; 7 rt. u, t >, 77. FIXED SYSTEM-FINAL '
'•29. Insulatl`en ' -1:' S •• '• I `t , . 7i, FIRE PREY. F(N4L .r'. cr w /
•i 30. Drywa I'Naiting-x '> V x ; -HEALTH DEPT. REOUIR-EMENT • •
▪ 31. Plaster Brown CON. 79? FINAL 'ASPECT/1,0N :'
' 32 Electrical PowerMeter-Final .. 80r FOOD CERTIEICY�TE ISSUED
33 Final Electric e.a _ �,>; . Ndtes: - -?, _ 'i,,.
34: Fioal Heating &Air it
oriitng �- r 1'`• I '- S c--"y ..- e
35!'Final Gas P�pc-Test '-' - ! 7 , 11 ` '
r 36.. Hoodor.Canopt% � 'r A ' > ? ..r-• .. ,t. r
' 37 Fin l Fectory Fi'r'eplace ,' % .o n ,� ,i ' °
-• 38. Final Plumbing 4. /5...1') • , ! ' - .
39. Water Service-Final I ,0 ` t- t }
;1 40. Gas Ser,Gice"Final % ,, .t�-,» - is c
v.41. Solar D_om- e'stic-Final+ •• - '
.� 1- . ,. . it _
- 42.' Backfl w Preventer "" y - -
4 t t-. .. ., u. ;>
43. Backflow Irtigation /.:; -' c ` t ., 'x r t-
Y :1 K 1' . 4 t •
•
q 44. Landscape:lrrigation System�,;om •rt _ _'{ i, ;; `u , 'r .)
- ` L ' - I -
• 45.Sound Attenuation --..z, r' ` S ! 1F'y 4
.r _ . y
_ 46„Handicap RRgulatpns c - ` ` ,
•
n 47:FINAL STRUCTURE & Sl71LDING -t)'72 01•5# i S 21 /,81c-
e��
48y FINAL PLANNING i r t•, „
49'Eleitric Release to-Edison i •
• 50,.Gas Release'-to Southern California Gas Co - •;, -
51. CERTIFICATE OF OCCUPANCY .-,
No. - Date
OWNER HARBOR HALL OF FAME HOMES, .INC. DATE f1OV 2 9 1962
JOB ADDRESS 3137 Killarney Lane BUILDING PERMIT NO. 18161
GENERAL CONTRACTOR Lifetime Residential Bldg. Corp. VALUE $ 17,075.00
AP No. LOT 32 TRACT 4356 FIRE ZONE DESCRIPTION OF WORK ReS/Att.Uar.
INSPECTIONS Signature DATE GROUP I & J TYPE V ZONER-1
Soil Lt&/ j_ 6g- "- PERM, ITS ISSUED
Gas f �.� SUBCONTRACTOR DATE I NUMBER
Water i ted i'i 47C.2
Rough Com. Refrig. 0 Air Cond. ❑ ✓✓✓ i
Rough Heating
c ' 111 � ✓.1, 62./
Rough Plumbing W/----.4-6-Cc / //'a%=6? � a-o�/
Miscellaneous q� .-,(�
Prop.Swr.Liner House Con. D St.Swr. 0 _ , -+ - ,i /L` 2. 2 2/'d c3 ,55—/ y
Sprinkling System � �"'
•
ConstructPole 5�1"
Underground 0 Power ❑ �—
Rough Wiring / 4-r,i°.� 1-/-e3 c/-7 //�/-/3 /9/ `-' /
Trenches V Forms LV Steel Rend. ❑ mak✓/•14A.t ,/_maW-/O,
Floor System gale rr T-6 i,--
Bond Beam 0 Steel Reinforce 0
Sheathing on/,,,Q /-7/-63
Frame and Flashing PS6' y_cc-63
Lathing — In El-- Out H 47/544 2,- .d-63
Plaster, brown coat
Refrig. ❑ Air Cond. 0 Final
Heating, Final /Y/�S' V-/6-G3
Plumbing Fixtures, Final. 5 „5--/e,-G3
Final Gas Test /f` S S-/O-63
Electric Fixtures, Final 4Z tr--q e, '
Building, Final /!i/75 r-o-t4
OCCUPANCY p
CORM ram.cm _ 7.R1 18161
18 16 1 FEE/RECEIVED
t2�9�190%
COSTA MESA BUILDING-SAFETY DEPARTMENT Lot 32, Tract 435 R ::t5 t
P. O. BOX 317 COSTA MESA. CALIFORNIA CITY OF COSTA MESA
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
ADDRESS 3/ 37 /1v/Na rnty. 'c94a-
COSTA MESA. CALIFORNIA For Office Use Only
I RECEIPT NO. I 781
OWNER Harbor Hall of Fame Homes, Inc. El
MAIL / RHCHIV BY DATE RHCHVHy_ I DATE ISSUED
ADDRESd.O. Box 2066 I I
JI-'7 ',mi ., 12F9
CITY Santa Ana No.
KI 9-22(_AREI63
DD
OR ENGE EER Jamison W544-0040 COSTA MESA. CALIFORNIA
ADDRESS 225 IID11 St., Tustin FIRE
ZONE TYPE GROUP kik //
CONTRACTOR Lifetime Residential Bldg Co=�YPROVED DATE '
ADDRESS 2131 So. Artesia ZONING
CITY Santa Ana ZONE 1 PLNOS USE OP NEW T
�\( I PLANE BUILDING
STATE TEL. KI 2204 LEGAL I ����� // 7--K, / (�
LIC.No. 2086']6 NO. �- DESCRIPTION ,�—P�(� -6 I -8 J �o
SIZE , NO. OP BLDGS. l
OF LOT 6000 NOW ON LOT O A.P.NO. YL-C— - 0 .
USE OFYARDS EVES
EXISTING BLDG. NOne _ APPROVED ALLOWED
SETBACK LINE FROM 2, �4 1 (CENTER UNH eTd _
CENTER oP STREEr S REAR YAR .50 FRONT -5 Z FT. �� IN.
SIDE YARD I LEFT 5' I RIGHT 51 R.SIDE FT. IN.
DESCRIPTION OF /
WORK - L.SIDE r FT. � N.
N
NEW I X II ALTERATION I II ADDITION I REAR 3 Y FT. 6 IN.
(REPAIR I II MOVING I V DEMOLISH I 9Y,PROVED eo_a.11.,P5DATE h7-})---I...2----
BUILDING 16081 ROOMS 9 STORIES 1
EXTERIOR WALL ROOF
COVERING Plaster I COVERING Shake
USE OF BUILDING AND WORK TO BE PERFORMED
% Single family residence // G
/0 ,2 tY — /S/ a- si,, a a ,
I HEREBY ACKNOWLEDGE TH I HAVE READ THIS APPLICATION THE AMOUNT SHOWN U ER VALUATION IS POR THE
AND STATE THAT THE ABOV IS CORRECT AND AGREE TO COM•
PLY WITH ALL CITY O-•IN '8 AND ATE LAWS R ULATING PURPOSE OP ESTABLISHING A PERMIT FEE ONLY.
BUILDING CONSTRUCT,. . VALUATION 7—
SIGNATURE OF ink i >, �J ^J PERMIT FEE 5 �f ` N
PERMITTEE YYY $ // Et
✓ elf PLAN CHECK $ �nQ/LJ �'N
AUTHORIZED AGENT $ y L �j
N, TOTAL FEE C/ J•