HomeMy WebLinkAbout3026 KILLYBROOKE LN - Building Permits •
alb M 6 - CITY OF COSTA MESA = ilipp
4, ,9 BUILDING DIVISION
j ; �� DEVELOPMENT SERVICES DEPARTMENT • PE IT NUMBER
/1. PERMIT
°•+�P^*- • 00-01346
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(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 3026 KILLYBROOKE LN Status: ISSUED
Suite: Applied: 08/31/2000
Vicinity: Issued: 08/31/2000
Parcel Number: 14116307 Zoning: R1 R1
Applicant: YOUNG, MICHAEL _- - --__ - ISSUED BY:
Address: 01112 E. CHESTNUT w fir''="_�_="2=-✓'-��
• ,..22/51!- --- Phoned 714-753=5444--;--:.~�`
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SANTA ANA CA(-1-r------22---)\,--1 'I Zip:,• 927011 -".-
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Owner: CAMPBELL- ROBERTit \ t__J H / r + C%----.11
Address 3026'KILLYBROOKE / _ - =__=_ � ( � N.-,�
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//,'/CO`/STA MESA;CAK-� �-'" Zip: 92626 ��`�� {� f
Cont/racfo'r: \YOONGStROOFING CO., INC. \` \/ \`\\_\\
EST'Address: 01112-E C�STNUT �� �
�;/ /�J Aja Phone: 714-753-5444 .._X. l,
i.! ,\ r SANTA ANA CA 1,c�' _\f i / �•'
' Zip: 92701 a Licenser 568560 ° 0 �J�x _� \
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I I\t _ TEAR OFF WOOD-SHAKE, INSTALL 7/16”OSB,�.J/ B. .4.11AND`30YEAR;COMP SHINGLES)2500 SF. (MI �—
I t l w<L a .1i ..� x 4�,_., SI ,, ...
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- II \L�t f FEE SUMMARY 2r - !I I O
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Plan_Check. i S0.00 �-"\ z L,-_Calc Valuation: e i�( hg5,600.00
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• 11 Permlt> 5125.25 ) ., -=y mom. &-Claim Valuation: (� s5;fioo.00
�\SMIP-Res:��+ $0.56 '� / I ��
-SMTP Com: k) 50.00 I• ijiy,U 1/4 .t
\�� '4-Ire,' / ) ; `-PLANNING , ZONIN % .1)/
SETBACK V�\� �� ° FG p a o 0 0"U',�o f, %✓� 00
MAIN STRUCTURE\Frontt 0-0� Rearc2�0'0 01Left 20 O_c�ight-----..(05.0-;\, •
'« r`� �� y, 2._-ter �� o �0
ACCESSORY
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Fron>\ 0:2021 ' //y l'Rearr`0=02. :---=Left—'0-0� Right /0-0(2'
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PARKING Existing: z Required:)Ot )i - 11 '--; ; ' ' ;G01 --'
NOTES: �-� � /�a�i
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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 isnot commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days. "' ��-,r- :;� -* ,
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) " -. .
ENSATION DECLARATION:
I h . „ 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 worker ' hon In3�nce car ter and policy number are:
Carrier: ` J 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 t e work for which this permit is issued,I shall not employ any son in any manner so as to become subject to the workers'
ws of California,and a ee that if I should become subject to the workers'compensate visions of Section 3700 of the Labor Code,I shall forthwith
comply with t es - Iqn� e_ 3/ -0a
Applicant Signature: y4� Date:
ECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT EMPLOYER CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE t$100,000h IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN cm"(a 06 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES.
LICENSED TRACT S DECLARATION:
I her irm that -am titan ed under provisions C,hapte9,(aommencing with Section 7000)of Division oft Business and Prof ssions Code,and my license is in full
f ce and effect.Lic.x (a Ed Efv Class C—
ontractors Signature: -732.45.' Dat —3! —D
CO CTION 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.
704.4,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. Businessand 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 ❑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 an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4' If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application 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? (J Yes 8 No
(Section 65850.2 of the Califomia 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 Califomia 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 stale that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signature Of Legal Owner(s) • Date
-.ad
A • •r ' thorized Applicant Date
CODE t INSPECTION TYPE --." INir CODE# INSPECTION TYPE PATE INITIAL$
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final �s � 208 Final Plumbing
200 Final Re-Roof —?4t M 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
OWNER College Mesa Co, DATE 9-15-55
, JOB ADDRESS 3026 Killybrooke Lane BUILDING PERMIT NO. 1763
F. GENERAL CONTRACTOR The Hale CO., VALUE $ 8,000.00
LOT 2h BLOCK TRACT 23111 Single Dwelling •
x GROUP I TYPE V ZONE R11 FIRE DISTRICT #1779
PERMITS ISSUED
. INSPECTIONS DATE SUBCONTRACTOR
,� DATE NUMBER
Footing Trench
`� -t II-MEM
Foundation Forms and Grade to Garage q-j-g ti
Rough Framing ' g- g //- 157"-a% 4 .,
Plumbing,Rough to Slab'- �,- p y---,.y ,374, , ,a 444 .�jh, / /0 -/R -JS 32-2-&
Plumbing, Rough Complete 1tt-,6 - /1 23j-a 3 /
Temporary Pole ff
Wiring,Rough L 11- 2.1-5`J /&-c-' /d-7-•rr /Ss/
Heating,Rough / n
, • Heating,Finali,,`, 9(e21- ") /6- 7-SS 30 Y`j ��
c/Sewer, Ho /Y,�i' Sewer,St. �Q/_ _�` .�._ .� /--,,...?-53-_ 1717%3 .
Septic Tank or Cesspool
Lathing, In /30-7 Ouy( S-'/' j _2$-.4-...—
Plastering / - Il
-. - Plumbing,Final,Fixtures Complete )(Q( j --23.5-6Plumbing,Final Gas Test 80 lt N9•0 3-,23: ' �2e/Ie// JA /
, ��
I„ -
Wiring,Final
inal Nr { 139-1-6
Occupancy o�.a i 3-a3..;,3
*
Form 210 C1-T-1 15001-55 -
• f ,sta Mesa Building Department ( APPLICATION FOR PERMIT
• .+f3 .?l 111 EAST 20th STREET. BUILDING.
' COSTA MESA, CALIFORNIA 1 C^ 7 9
FOR OFFICE USE ONLY 1
r FOR APPLICANTTO FILL IN _ _Receipt No. Permit No. '
Building• 3026 Killybrooke Lane •
17•x°
Costa Mesa, California !calved by Date Reed. Date Issued
Nearest9-/3-55 t.. 1 thss.
Cross St. Baker Avenue Building "
P Address��oZ6 6�.iiGC—:-
Owner College Mesa Co. 1: 1 Costa Mesa, California
Mail
Address 8002 Central Avenue' - Nearest .
• Tel Cross St. _
City Garden Grove No LE 9-2158 ZoneQ� rr No.of Type , ) Group -
Architect or Lic. - :F `T Plans I V ,y
Engineer Davis- & Quigley No. C.-1790 • Approved
by Date '-tee, •
Address 43 Malaga Cove P1aza;Palos Verde•- CORRECTIONS •
•Contractor The Hale ComNoy Lic. -
Company- No. 3422
Address 8002 Central Ave. , Garden Gro.v• '
LegalLot P : .
Description I No. 24 I Block I -.I:Tract 2341 _ --- -- .
(Attach Metes and Bounds) I! • - ,
Size of Lot 7440 I No.of,Bldgs.
Now on Lot None _ _ _ o
Use of I No.of , I No.of + 9
Existing Bldg. Families Rooms - , -:.-- G)
Setback Line from Rear Yard 45' • - _ - Z
•Center of Street 50, Side Yard 6` _ D
. DESCRIPTION OF WORK • - • 1'.i` _- _• . ' r
New • I X I Alteration I. ' III Addition I o,a t t. •`i:'9 ,, _o., c•e LI
Repair I I--Moving I III Demolish I .'... 13,;•4:1 rs•-'' '"' '' '' 'n'I ."a•_.:.1
Building No.of .
Size 1260 , . Rooms 6 Stories 1
Exterior Wall Roof 1, '
Covering Stucco I Covering Shake APPROVALS
Use of New „
Building Single family dwelling with 'Foundation Location Inspector DateForms,Materials, r-,
attarhed gara,g-, ', -Under-Pinning _,,
, • f# Frame: Fire Stops, • U4
Bracing,Bolts s
I hereby acknowledge that I have read this Application =a
and state that the above is correct and agree to comply Lath. Int. o •
with all City Ordinances and State Laws regulating o
building construction. ” Lath.Ext. zn,141'
Signature of THE HALE COMPANY i.~
Permittee Plaster,Int. . :a
-
. Authorized Agt. k12O ;� n I� Plaster,Ext. PR
HERMAN M. HALE s
Valuation Permit Fee $ a0. O O 'Masonry Reinforced
it Plan Check$
4 $ . St 000 Total ! O U Bond Beam N
w
Fee -11 $ a 3. 00 FINAL - j
FORM 204 S-BP-2M 6-55 ` - •
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