HomeMy WebLinkAbout3070 KILLYBROOKE LN - Building PermitsCITY OF COSTA MESA
BUILDING DIVISION.
77 FAIR DRIVE. COSTA MESA, CA 92626 • (714) 754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca-6s. -._ --_.......... _"'.1.
t p ''a11%I IT t'fli''i:;y5
� B FOR INSPECTIONS CALL: (714) 754-5626 j
°.a. PERMIT NUMBER: BC11=00116-"
PERMIT TYPE: B COMBO STATUS: ISSUED
Sub Type: RES -ALT DATE ISSUED: 07/19/2011
ISSUED BY: RMD
JOB ADDRESS: 3070 KILLYBROOKE EN CM _ .- -- Suite/Unit: i=
APN: 14103402 •-- Zoping:R1,'.;: _
Vicinity: KITCHEN if Primary Occ�-',
Const Type: V -B SQ' FT 0 - Valuation $25,000.00-'' ���.?.. - �•`)
SCOPE OF WORK: INTERIOR KITCHEN REMODEL TO AN EXISTING SFD. WORK TO INCLUDE: VAULT KITCHEN CEILINGS,
INSTALL (2) NEW SKYLITES; REMOVAL & AN'EXISTING NON -LOAD BEARING WALL BETWEEN KITCHEN AND DINING AREA
TO ENLARGE KITCHEN SPACE, FRAME UP AND CLOSE AN EXISTING WINDOW OPENING, CHANGE OUT EXISTING WINDOW
WITH A NEW
BAY WINDOW, RECONFIGURE KITCHEN AREA AND CHANGE OUT KITCHEN HOOD, 20 LIGHT FIXTS, 15 OUTLETS, 6
SWITHCES, 1 WATER LINE, 1 DISHWASHER, GAS OUTLETS (1-4), 1 BAR SINK, 1 KITCHEN.SINK. NO ADDED:'SQUARE
FOOTAGE.
NEW 200 AMP MAIN PANEL AND'1 60 AMP PANEL
OWNER: CAREY, MICHAEL P . - , Address: 3070 KILLYBROOKE LN
i; •:•. ;
Phone: 714-925-0854 -- y['. City/State/Zip: COSTA MESA, CA ;� - -
APPLICANT: FLETCHER, JOHN - - - - Address:2725 SANDPIPER - - - •Uhlt�' "•`�,
Phone: 714.852.3386 t. City/State/zZip: COSTA MESA, CA -
CONTRACTOR: FLETCHER CONSTRUCTION License No: , 925791
Phone: 714-313-0313 - - _ Address: 2725 SANDPIPER DRIVEUnit:' - - ,, t•,,.,•
Cell: City/State: COSTA MESA. CA - - .. ZpCode 92626
ARCHITECT: '
ENGINEER: M FRED MARZARA
COMBINATION PERMIT FEE SUMMARY,,
Building Plan Check: „
Building Fees:
Electrical Fees:
Mechanical Fees:
Plumbing Fees:
SMIP Residential:
SMIP Commercial:
Bldg Std Admin Fund -
.TOTAL FEES:
License No.
License No.C59094
$254.31.
$391.25
$160.10
sir $34.15
$68.85
$2.50
$0.00
$1.00
$912.16
PHONE: _
PHONE:
,•— I
"Refer to fee receipts for all fees paid for project '
HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279
`Monday thou Friday -7:00 am thou 7:00 pm. Saturdays -9:00 am thru 6:00 pm. Prohibited all hours -Sundays and the following Federal holidays:
New Years Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day and Christmas Day :..i r
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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. -
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.
CODE #. INSPECTION TYPE DATE INTITIALS CODE# INSPECTION TYPE DATE- t4"'Q ,�. INTMALs
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266
Pool Spa Final
200
Final Re -Roof
201
Final Block/Retaining Wall
202
Final Factory Fire Place
203
Final Sign
204
t.
x.Final'DemolitZn
208 Final Plumbing
210 Final Electrical
212
Final Fire Prevention
220
Final Planning Approval
222
Final Site
250
Final Building/Occupancy
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. `
❑ 1 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:
(This section need not be completed it the permit is valued atone hundred dollars IS 100) or 1i
Policy Number:
rEl� 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 Ce, shall fo
wit comply with these provisions.
y._ 9- -
Applicant's Sgnalure at
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECTAN AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($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 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. .
- ass
Con actor's Sig ature Z: J
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
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:
Data
3057-46(3/07)
s
Owner ID verified by driver s license. ❑ Yes ❑ 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.
Applicant's Signature Date
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future building occupant need to file and
certify a Business Plan for emergency response to release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires. with some
exceptions, that a Business Plan be filed with the Costa Mesa Fire
Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at standard temperature and pressure).
2. Does or will the applicant or present or future building occupant need to file
a registration form for acutely hazardous materials? . ❑ 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
fling 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 ❑ 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 permit for such construction
or modification 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? ❑ 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. -
S,gnamr eg ens)
' G �
Ardor Auth ized Ap (cant
Date
D7 It
I �
CITY OF COSTA MESA
A`ogTw MF . , BUILDING DIVISION -
i0 77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
•� - FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER: BC11-00116
PERMIT TYPE: B COMBO STATUS: ISSUED
Sub Type: RES—ALT DATE ISSUED: 07119/2011
ISSUED BY: RMD
JOB ADDRESS: 3070 KILLYBROOKE LN CM '- . Suite/Unit:
APN: 14103402iI.._-Zoning:R1;
Vicinity: KITCHEN Primary Occ:.
Const Type: V -B SQ. FT: 0 - Valuation:._ $25,000.00
SCOPE OF WORK: INTERIOR KITCHEN REMODEL TO AN EXISTING SFD. WORK TO INCLUDE:,VAULT KITCHEN CEILINGS,
INSTALL (2) NEW SKYLITES,-REMOVAL OF ANEXISTINGNON-LOAD BEARING WALL BETWEEN KITCHEN AND DINING AREA
TO ENLARGE KITCHEN SPACE,;FRAME UP AND CLOSE AN EXISTING WINDOW OPENING, CHANGE OUT EXISTING WINDOW
WITH A NEW - - -
BAY WINDOW, RECONFIGURE KITCHEN AREA AND CHANGE OUT KITCHEN HOOD, 20 LIGHT FIXTS, 15 OUTLETS, 6
SWITHCES, 1 WATER LINE, 1 DISHWASHER, GAS OUTLETS (1-4), 1 BAR SINK, 1 KITCHEN SINK. NO ADDED SQUARE
FOOTAGE
OWNER:
CAREY, MICHAEL P
I Address:
3070 KILLYBROOKE LN " - - -.- - Unit: -
Phone:
714-925-0854.-!j
City/State/Zip:
COSTA MESA, CA - - -,
APPLICANT:
FLETCHER, JOHN
- "- Address:
2725 SANDPIPER - - Unit:
Phone:
714-852-3386 -
': City/State/zZip:
COSTA MESA, CA - -
CONTRACTOR: FLETCHER CONSTRUCTION - - License No. 925791
Phone: 714-313-0313 Address: 2725 SANDPIPER DRIVEUnit:
Cell: . ' - _,� City/State: COSTA MESA, CA
ARCHITECT:
ENGINEER: M FRED MARZARA
COMBINATION PERMIT FEE SUMMARY
Building Plan Check:
Building Fees: .
Electrical Fees:
Mechanical Fees: -
Plumbing Fees:
SMIP Residential:
SMIP Commercial:
Bldg Std Admin Fund
TOTAL FEES:
License No.
License No.C59094
$254.31 -
$391.25
$99.10
$34.15
$68.85
$2.50
$0.00
$1.00
$851.16
ZipCode 92626
PHONE:
PHONE:
'Refer to tee receipts for all tees paid for project
HOURS FOR CONSTRUCTIONIACTIVITY: EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279
Monday thru Friday -7:00 am thru 7:00 pm. Saturdays -9:00 am thru 6:00 pm. Prohibited all hours - Sundays and the following Federal holidays:
New Years Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day and Christmas Da
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: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
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.
CODE Al.
INSPECTION TYPE
1616 -
Fixed System Final Fire Prevention
1266
Pool Spa Final
200
Final Re -Roof
201
Final Block/Retaining Wall
202
Final Factory Fire Place
203
Final Sign
204
.Final Demolition
DATE INTITIALS
CODES
INSPECTION TYPE
206
Final Mechanical
208
Final Plumbing
210
Final Electrical
212 Final Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Building/Occupancy
DATE INTITIAL6
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 selflnsure foc 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 Insurancecarrierand policy
number are:
Carrier:
(This section new nor de evmpleled Athe permn is valued atone hundred dollars ($100) or less)
,P,,�o,liic/cy Number: -
drf"I certify that in the performance of the work for which this permit is
Tissued, 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, sh n with comply with these provisions.
lAdyicanfs Signature Dal- e-;�-
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 DOLLARS
($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 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. #
ConV�ado0, ignatuh, Date,
W—.
CONSTRUCTION LENDING AGENCY:
❑ 1 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:
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 (he 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
properly who builds or improves thereon, and who contracts for such project with
a contractors) license pursuant to the Contractors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
Signawre
3057-46 13/07
i
.. Owner ID verified by driver � ncense. ❑ Yes ❑ No
Driver's License No. Expires:
Verification of Ownership by (type of document, i.e. - property tax t+j or deed):
/
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION!
❑ 1 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, a 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.
AppLcanfa Signature
Division of Industrial Safety Permit Number:
Date
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future building occupant need to file and
certify a Business Plan for emergency response to release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some
exceptions, that a Business Plan be filed with the Costa Mesa Fire
Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater than a weight of
500 pounds, or a volume of 55 gallons. or 200 cubic feet of compressed gas
at standard temperature and pressure).
2. Does or will the applicant or present or future building occupant need to file
a registration form for acutely hazardous materials? ❑ 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
fling 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 ❑ 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 permit for such construction
or modification 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
infonnation 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 ❑ 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 appropdate 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.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: A
certify under penalty of perjury that I have read this application and state that
the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
the City of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspection.
Signature of LI w r s
Antl/or Authorized Applicant
Date
(f`r Dale
�'- SOL' mast lospecticn and Testir- Inc.
441 Commercial Way La Habra CA 9063.
+? e.t
r (562) 941-2990 (714) 526-8441 Fax (562) 946-0026
3p� o cC + u. 7�U rD4-. L j
Act( oottb
ir;;
REGISTERED INSPECTOR'S DAILY REPORT
SWIT Job No.
0--P�\0
D*e
TYPE OF ❑ Reinforced Concrete ❑ Structural Steel Assembly
INSPECTION ❑ Post Tensioned Concrete ❑ Post Tensioned Concrete, 13 Quality Control
REQUIRED El Reinforced Masonry - ❑ Asphalt .p Other
Job Address•�.�-� `�. \ �\ �COOv� 1,�1, i ��DST %� �.'if•
Job Name`wJ`✓ �� Tract No. Lot No.
+`
PennNo
' . 1, �\\('
O
Issued By
Type of Struc ure ;
Architec�,Yom,
Material Descrippti�on Arad ,`source ��\0� (
En inee;.,
'
1-3
` -.�
Contractoojq\ Q'�G.'(?J`
Inspector(s) Nam IN w10 I
Subcontractor
TESTS PERFORMED
TYPE OF SAMPLE
SLUMP
QUANTITY IN SET
ADDITIONAL REMARKS ON SAMPLES
INSPECTION SUMMARY - LOCATIONS OF WORK INSPECTED, TEST SAMPLES TAKEN, WORK REJECTED, JOB PROBLEMS, PROGRESS,
REMARKS ETC. INCLUDES INFORMATION ABOUT -AMOUNTS OF MATERIAL PLACED OR WORK PERFORMED NUMBER, TYPE 8 ]DENT. NO'S
OF TEST SAMPLES TAKEN: STRUCT. CONNECTIONS(WELD MADE H.T. BOLTS TORQUED CHECKED, ETC.
-'Nv-e- \ Ovq- toN
50-v'y e2C+ t`'c- vVz-1Vp -�JJh i`�s'�1J \oC?s1'tot.rs
,ta s 3'12ocGv�s taS t Cor+c ,
1Y11T0 R -W, clwwa. GV'� StCCiW+`•
S1 a�7i ' W 2 o(ZrltmS A S\Y•+ie-IcoJ !�C \--o 6Q7:"N
erg \\ �e Ssoct c�N�"�tJeSS �"' W +Y��Xv s1. � b�oWtJ i41R
Xz h5 "+ C5:,
v.N4. \-Jorlc 1 5 Pest, »tP\rlr+, Sct• citzsp�-
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE OBSERVED TO THE BEST OF
MY KNOWLEDGE ALL OF THE ABOVE REPORTED WORK
UNLESS OTHERWISE NOTED_ li HAVE FOUND THIS WORK TO
COMPLY WITH THE APPROVED PLANS, SPECIFICATION, AND
APPLICABLE SECTIONS OF THE GOVERNING BUILDING LAWS.
CONTINUED
ON NEXT PAGE ❑ PAGE OF
TIME IN
TIME OUT
REG. =HOUR
HOURS
CYLINDERS
\2! 4rr\
-
Approved by
_ Z1 Project Superintendent
SIGNATURE OF REGISTERED INSPECTOR
SPECIALTY NO. AGENCY
-30—
QpOFESSIp�, �
k ��FRF D M,4 F?�.
5 � 2
No. C 59094
i
Exp. w—
FIELD CORRECTION FOR:
CAREY RESIDENCE
3070 KILLYBROOKE LN.
ADDRESS OF BUILDING:- 3070 KILLYBROOKE LN
OWNERSNANEIFIGIM: ROBINSON, 'GERRITT M
3070 KILLYBROOKE LN
COSTA MESA,.CA 92626
{ 545-6583
lA APPL. NAILING ADDRESS:
ARCNRECT OR ENGINEER:
MK OR ENG.'S ADDRESS: -
CONTRACTORs NAME CRANK BROS ROOFING CO
CONTRACTORS MNUNG 126 COMMERCIAL WAY
ADDRESS: COSTA MESA
92627
LICENSED CONTRACTORS DECLARATION: I hereby affirm under penally d perjor
(commenm0 with Sectom J7000) d Division 3 d the B'usiiroro and Prdestidvs Cod?,
cf^uc. No,4 05 93 LIC- CLASS: G 3 9 u.� .91 V
LIC. NO.:
UNIT' CITY OF COSTA MESA - BUILDING PERMIT
PERMIT NO: B 073802 ;PLAN CHECK NO: N'
CONSTRUCTION TYPE: V -N PERMIT TYPE: STR _
SOB DESCRIPTION T/OFF & REROOF W/ COMP. SHINGLES.-
UNT:
(714)548-5569
CA uc.w: 408677
UNIT:
that I am licensnd under prmmoons of Chepla 9
w�QQmy Ifull torics and effw.
86 P: 06#46
OW R BUILDER DECLARATION: I hereby affirm under penalty d perjury that I An mQmpt from the Conlractom anlALait' Uw
wing reason (Section 7031.5 Business and Prdessions Code: Any cry d county which requires a perms to constdd, alter, imj r
demolish, or repair any, structure, prior to to issuance, also requires the apdicad for such permil to file a signed Mamant that M or else
is licensed p ..t 1. the provisions of be Contredora Lassos Law (Chapter 9 (oo rommung with Sedion 1000) of Dbeon 3 of loo
Busineae end Prdemom Code( or used hat or she's exempt thaehomnd athe base for Ihe dinged exemplian. Any violation of Section
1031.5 by airy applicant for a Permil subjects 1M applicant to a cod Penalty of rot more then lee hundred dollars (SSogp.
0, I, sm owner of the proper or my employees wen wegm as Ihek sob oompen.edion, will do the work, and the structure a nd intended
or offered for sole (Section 1044, Business and Professions Coda: The Contractors Uot me Law does not applyto an ownerd proper
who builds or mprovas thereon and who does such work himself or homed or through he or her own employees. provided that such
imPraysments we riot intended or offered for sale. If, however, the buddirq or im,sommenl is sok within one year of completion, the
owrerbuiker will have the bunden of Proving he or she did red bulk or improvs for the purpose d safe).
L as owner of the property, sin exdusN)* contredk0 with licensed contractors to noatrtw the project (Section 7044. Busirtme and
Prolessiorre Cade: The Commdors Lmeree Law does red up* to an owner of property who builds or improves tM1ereoo and wise
contracts for wroh projects out a conlredods) Ioensnd punuent to the Contsedom L_icenae Law).
I am exempt under Section: B. 8 P.C., for this reason:
Data � � Owner:
I de hereby candy that I sin aware of and understand the requirements of California Naellh and Safety Code Sections 25505, 25533, and
25534, and that I or say future Wftn oocupant will / wit not force oat) need to comply with sak Bede codes and the requirements for
e lxrmilldmmttudionamodi!cation hmntha Aiugly arapemenl Chewid. Residential mrmruot. appicatvn w exempt from these
provision..
Date: Applicant:
WORKER'S COMPENSATION DECLARATION: I thereby Winn under penelty of perjury ore of the following dederations:
I have end wit mantevi a cendoate d oonsenl to self -insure W workers' compeneatbn, m provknd for by Section 3100 d IM Lobar
Code, for the Performance of IM wmrk for which this permit as isued.
have end wit mantan woMere' cdnpansalW imunnm as; required by Section 3700 of the Labor Code. W the parformaoe of the
this Perms is issued. My wdkers' compensation insurance canor and policy numbor we:
Cama STATF F17ND EXPIRES
Polmy Number: 285-951TWIT994 01/01/96
(This section need not be completed 0 the pam0 is for one hundred dollars ($1001 or knee)
V
ndint perfor lance d iM work Nor which this perms s issued. shat t am*any manna co m to
aubledo the chore' amnpensetion bee d Cdibma, d apneaIahou bac abed toIhenso rat/wsm of Section a>00 d the Labor Lada, I 1 fM1v' M1 m N wi isms•� Appliun ro eepure wosnanSo,miseoyert.dm/ro/pere/tluendrosthpuaaddlanInltlon rof roaat/pn,damaaprov/dsdr/nof Ms Labor COW, Int.1, and attorney'• lana.
CONSTRUCTION LENDING AGENCY: I hereby affinm under Pendry of perjury that there is a construction bndinng agency for the
performance of the work for which the Perna Is Issued (Sedan 3097, Civ. C). .
LENDER'S NAME:
LENDER'S ADDRESS:
I cent that I hem read this eyy�pYeawp and stat Iha M.@Wve idormation is coned. I agree to comply wish all any and county ordinsnces
and state lam relating to b rp conch lion an hereby a;: rite represenlativea of this city to enter upon the above -menton pmpar
for insposion rposes.
UR; Y O B
Print Nem � r
Dae: l
(5151-460P) Whd"uikvO ASdatv: Green -Fr: Canary-Applicanl: Pink -Revenue: Goldenrod -Aa.
PERM NO: B 073802
GOVT: N SUPP: N
PURPOSE: OTH
SQ FT: -4,187
CLAIM VALUE: 4,187.00 CALL -VALUE: 4,187,00 GROUP OCC: R-3 /M-1
COMMENTS: SMOKE DETECTORS ARE RQEUIRED IN EVERY BEDROOM & HALLWAY p
1E iE iE iE iE jE iE dE iEkiE*ih lE if lE lE iE•lEiE*NE*iE iE RE*iE RE*1E iE 1E 1E iE iE**iE 1E RE iE*iE**RE*iE iE iE*1E 3E**RF**iE***iE �+�"/�►��®�i,
Z O N I N G R' E Q U I R E M E N T S SM rjjMC
S E T B A C K S 11
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDY9dP UIR E®-
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RIGHT: FT IN LEFT: FT IN RIGHT: FT IN
PARKING REQ:_,} PROV PARCEL: 14103402 ZNE: REF NO:
PLANNING NOTES>,' 4.'
>
1E RE lFRE*lE*9F*1ElFlE 1i RF3E#E1FlF*iE iE**1E i6 iE iE lE**RE RE RE lE lE iE fE iE 9E lENE**9E NE*iE iE*1E*iE*iE iE*RE***NE**dE iF iF iE*NE Nf 1E RE NE 9E 1E lE 9E 4E 4E
D E V E'L 0 P M E N T S E R V I C E S R E Q U I R E M E N T S
ZONING APPROVED` BY�'
'DATE: y
BUILDING APPROVED BY : DATE: _7
APPLICATION ISSUED BY:L/Eye"L Rte— DATE: 71
iF 1E iF NE if 1E*9E RE NE 9E 9ElE 1E1E NE iE iF*iE iF NE 3FiF jF 3F�3F�F'iF iFIFiF��F7F'� 7F'iE 1E ijiFiFij�F�Fif7f'3f 7f7F �FiF3F{F iE iE if lE iE 9E iE iE iE iE iE iE
LEGALIZATION:N' F E•E S:"U M M A R Y STRUCTURAL SEGM,NT:Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT •72,00 .50
PLAN SMIP/NON-RES.
ISSUE FEE '
BUILDING -DIV-'> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE
-TOTALS ---- >_ 72,50 0.00 0.00 72.50 72.50 .00
REVENUE DIVISION TOTALS--> COLLECTED: 72.50 OVER/SHORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN -CHECK
72.00 .50
1E iE iF 9E iE*!FlE 0E RE 9ElE iE RE*lE1E*1E RE 1E iF iE OE iFlF*iE iE***1E*♦E♦E 1E dE NE**NF**iE*NE iElE iE fElE*NE RE*1E*iE NElE*NE NE*iE*NE 9E*!E *RE RE lE lE lE 1E NE
I N D I V I D U A L F E E B R E A K D O W N
TYPE, QTY_. D E S C R I P T I O N UNIT COST TOTAL COST
SFR 4187_ REROOF BY VALUE RESIDENTIAL NOZONE 1.00 4,187,00
END OF FEES
01 OD188407-00188408 TOT 72,50
DATE: 03/15/95 TIKE: 14:3!
• CONSTRUCTION AND PLANNING ; _
' •";
-
_ - rP90L & SP.A-
- APPROVALS Permit # I ,!--
=•Date
Inspector
i�_
APPROVALS Permit
Date ;
Inspector
_.
I. Temporary. Electrical Service or;Pole,,' - `
_ _
52 Pool & Equipment Location
-
- - •'
.I -
2. Soil Pipe-Undrgrndi •• - - ,�.�,
,.
53. Steel Reinforcement
3._�Eleetrical Conduit UtifityUnilrg�nd. '•
Forms, - - j:�-- -
- j
e -N'
_54.
_
--
•-4:-Efectrical Conduit-U6drgrnd. ' %, '"
-
c
55., Electrical Bonding. _ t.-
}
i+
/ .,
--5._Stee1 Reinforcement ^ -
56: Rough'Plumbing & Pressure Test
I
may.
6^�Electrical UFER=Gon2Y. - •
-
`-
57r., APPROVAL TO COVER-GUNITE -
t �•
-
: rj
n'Eootings '
58. Electrical Co-ndyttwUndrgmd:
�'\ +',�
x.
.,
71o8:.)Foundation tv
59. Gas Pipe, O Undrgrnd.,•Test
F9C`1Nater Pipe-Undrg`rnd.-60.
Backwash Lines,;P�'irap; [I-Ugdrgrnd.
f
'u10SStructural Floor System'61:
APPRO_ VAL,TO:,DECK !•` ' =
X11.
•
Property Sewer Line & Housee:Con e -&ion
-
.' ''
`- •--__
'62. Backwash & Receptor Fjnal,
r, s �- \' a y
,%I
I
12, Sewer Cap _,rte '•'.i
a-
:63: Heater& -Vent -Final
-
-
13. Roof Drains t -.
69: Plumbing System - FiTi ,
74. Rough Plumbing =J�' '
65; Electrical -Final
_
.15. Rough Electrical -Conduit
_ l -C •
!66. Solar System=Fina_I•
n, ,• ..•, . -
16. Rough ElectricWirin9 'phi
- --
67.� Fencing & Access.Apprdval
l -
j.
17. Rough Wiring Sign
APPROVED ?FO:R.PLASTERING
X68.
18. Rough ElectricalWT Bar Ceilin9-g_,
9
69l POOL(SPASYSTEMSFINAL -
1
19.`13o gh Heating& AiConditioning
�'
-� ✓ -
;' -FIRE- DEPT. REO'UIR,'EMENT
y^
it#yr
20. RougRFz' oFi[aca
'
21. 6Lcts7in,Structurer
70. 'Undergio_una Hydro
22. Ducts; Ve"ntilaiin 9,,., "'C
r,
H ' ;
Proc!4heipi ng C7 Gas d Oil
_ -
r •rG
;=� *
.71 .
23. Gas Pipe Rougfi &Test tM::
>. tT; V
4 F _.'
72. Undergrciund Flusfi= •+ -
24. Roof Framing' - " "r
;: �' C
U7 ,•�* •
; 73:• Undergrnd. Stor-og2 ank4�b Gas 0061
25. Roof_Shea`_thing �^::_�'�:_(,✓'
u
•17gv�OverheadHYdro'
v
26. T--BarTCeiiin Structbra0 & Mohdc,
g j
a G7
C ?!'r.
'
75> Dr Chemical � � C'
_ Y '-+�- Cn
27. Fra meand Flashiri 9r� ��^."�
_
"' *
:r "<
_• '-� _
76. Dry Standpipe `,r x
-+28. Lathing &;Siding i-+ct:
1, Z
k
77•:: FIXED SYSTEM SINAI
29. Insulation _ _ _S
c r
ty
78' FIRE PREY. FINAL J ^
T'30. Drywall Nailing''•y
;
"
-EALTH'DEPT,IREGUIREMENT
r�
Plaster BrowniCoattl
5 i t•
i
�� t+79
FINAL INSPECTION a
D p
-32. Electrical�Power Met&r Fi,al f '
^%
{K t180jFOOD
CERTIFICATE ISSUED_
-na
Notes: ."33.F
_
~
V:
v34. Final9ieeting'& AinConditioning. [ c:
x.
_• _
X35.
Final Gasi�Pipe Test w
fi
5y
m36. Hood•or Canopy Z. t*•": I
737.'U I "Cr
Final:Eactory Fireplace
X M
38. Final -Plumbing r+ t'•: I n.
K ^' 1
J39. Water Ser`tvice-Final- * I v
s
n40, Gas Service -Final =* m �'-'• S
-+ TI
I '+
(='-' r'- -� •'
41. Solarpomestic-Final''S
`''` • -
42. Backflow Preventer¢, i„
f
Ix
_43. Backflow Irriga4.
tion's �. j;' "
tr_-
1 4_4! Landscape;lrrigation,Sy-eem'Trh;fu t;
•,r•; C
O Gr'
s .,.i, -
r-
45. Sound Attenuation-'";
' C�
te,F' `,7 i,
46. Handicap Regulatior5�', L"_ O
7:
r 1:
__r: •`- c=> -
47.1 FINAL STRUCTURE &'BUILDING
f� ,.p
,
a 'uc7 •,.,, ',.
48. FINAL PLANNING
U
49. Electric Release to Edi-son',A..'
150. Gas Release to`SouthEil CPtifornia Gas Co
?
G = ^•
--+ "' r= "'
51. CERTIFICATE OF (YeCUPANCY
S 'r
' ' c.; �T•c -
No pate
y
OWNER C..7ie..e M--- r.- - / DATE
JOBADDRESS 3070 Killybrooke BUILDING PERMIT NO. 1772
GENERAL CONTRACTOR The Hale CO VALUES 8,000,00
LOT 33 BLOCK TRACT 2341 Single Residence
GROUP
TYPEy ZONE R4 FIRE DISTRICT #1788
INSPECTIONS
DATE
SUBCONTRACTOR
PERMITS ISSUED
DATE
NUMBER
Footing Trench
Foundation Forms and Grade Garage
q _ 13-$:
�} c.
�to
i
Rough Framing
Plumbing, Rough to Slab •'"x—_f--
Plumbing, Rough Complete
_
a�„c,e,%,�-n,•Sin/�.G'��+.�G.
/0
Temporary Pole
Wiring, Rough
nn
/
Heating, Rough
Heating, Final zl�
Sewirf- se .L Sewer, St.
',?7//ezo G �°
//x„7.3-SY...�e'Z'R'Z
.
Septic Tank or Cesspool
,
p ,G �.
Lathing, In /'� Out lr C."6
�.-'Z.. 2--9(3
Plastering
Plumbing, Final, Fixtures Complete �% ,�i
Plumbing, Final Gas Test2 nit�
3_
Wiring, Final J
?-1 /•�
s�'1-,,
Occuoancv .N. Ai.
_
pasta Mesa Building Department
-' •tk" 111 EAST 20th STREET
",•°
COSTA MESA, CALIFORNIA
FOR APPLICANT.TO FILL IN
Building ''
Address 3070 Killybrooke Lane
Costa Mesa, California
Owner College Mesa Co.
Mail
Address 8002 Central Avenue '
Tel: 1,
city Gar en Grove No. : LE 9-2158
Architector - - Lic. ''
Engineer Davis & Quigley No. ='C-1790
Address 43 Malaga Cove P1aza,Palos Verdes
Contractor The Hale ComCity Lic.
pa nY No. 3422
Address 8002 Central Ave. Garden Grove
Legal Lot (-
Description I No. 33 1 Block I Tract 2341
APPLICATION FOR PERMIT
788 BUILDING
FOR OFFICE USE ONLY
_ } ---Receipt No.-. _ Permit No.
Rece v , by I Date Recd. to Issued
h 9 Ei4I' 5':19551
3"ding
tddress 5070-C.(.�i}
Costa Mesa, California
r— r1 Plans
roved
Type
n
I
(Attacn metes and tlounos)
No. of Bldgs.
Size of Lot 7440 Now on Lot None
Use of No.of No.of
700
Existing Bldg. I Families I Rooms
- -- -
Setback Line from 501 Rear Yard 451
_
z
Center of Street Side Yard .7.1
y
DESCRIPTION OF WORK
_
r
New I X I Alteration I Addition
—or 4?
Repair I I Moving I I Demolish I�
Building No. of'
Size -x1270 ' Rooms 6 Stories 1
Exterior Wall - -
Roof
-
Covering Stucco Covering [lock
I
APPROVALS
Use of New
Building Single family dwelling with
Foundation Location
Inspector Date
Forms, Materials,
attached garage:
Under -Pinning
•
Frame: Fire Stops,
.gin
Bracing, Bolts
=�
I hereby acknowledge that I have read this Application
-
and state that the above is correct and agree to comply
Lath. Int.
min
with all City Ordinances and State Laws regulating
Asim
building construction.
Lath. Ext
�h
signature of THE HALE COMPANY i
D
Permittee.
Plaster, Int,
n�
'
Authorized Agt. Plaster, Ext.
HLEXAN M. HALE
Valuation Permit Fee $` • =i O • O O
Masonry Reinforced
'i -
Rd', c1
O.O CJ Plan Check $
Bond Beam
N
-..a
$ "1 Tota
- Fee. $
FINAL,_--
FORM204 S -RP 2M 6-55
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Show location -and distances from
/ar.si9 II
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Show location -and distances from
/ar.si9 II
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Ito .0
amo�q
Psi.
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Show location -and distances from
property line and between buildings.
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