HomeMy WebLinkAbout1988 KORNAT DR - Building Permits F 9 CITY OF COSTA MESA
• BUILDING DIVISION
':
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations: ..
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
o I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Cartier: Policy Number:
(This section need not be completed it the permit is valued at one hundred dollars($100)or less.) 1
: ;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 worker‘'
compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shaltOT+thwith
comply with these pro; ions.
Applicant.Si nature:• L - s' CDat? Z.r^CZ--
UllaWARNING:FAILURE TO SE ORKERS'•• *' SATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(5100.000).IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS 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.It Class#
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($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.).
=-'1 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 nder sec. Business and Professions Code for this reason:
Signature: •A-- CDate— 6 - 2S" `0 i
Owner ID vent driver's titans 0 Yes 0 No DD`iver's:Ucense.No. dzpires:_ "3 2^oy
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? 0 Yes 0 No
(Section 25533 of the California Health and Safety Cade,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 apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ 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 under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by Califomia 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-describedproperty for inspection purposes.I a.ree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Sign�:Of Legal Owner(s),__-, Date
And/Or Authorized Applicant Date
CODE S INSPECTION TYPE PAM 1NTrTIALS CODE it INSPECTION TYPE Mir JNTITIAL$
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site /
204 Final Demolition 250 Final Building/Occupancy L/
6014 CITY OF COSTA MESA
t 411-11BUILDING DIVISION
> • ` DEVELOPMENT SERVICES DEPARTMENT ERMIT NUMBER
k 110411 PERMIT /E02-00745
q s
%Pa di
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
•
Job Address: 1988 KORNAT DR Status: ISSUED
Suite No Applied: 08/08/2002
Vicinity: Issued: 08/08/2002
Parcel Nunmber: 13944105
Applicant: SWINGEN, RICHARD ISSUED BY:
Address: 181 W ORANGETHORPE AV
SUITE B Phone: 714-223-7848
PLACENTIA,CA Zip: 92870 •
Owner, MAGLIONE, JOHN W
Address 1988 KORNAT DR
Phone: - '
COSTA MESA,CA Zip: 92626-3530
Contractor: P'R COSNTRUCTION
' Address: 181 W ORANGETHORPE AV ,
SUITE B , Phone: 714-223-7848
PLACENTIA,CA - - � Zip: 92870 _ -
License: 673267
' SCOPE OF PERMIT
ADD 766 SQ FT TO FIRST FLOOR OF AN•EXISITING DWELLING.ALTER INTERIOR OF DWELLING.
ADDITON TO INCLUDE A FAMILY ROOM AND EXPANSION OF-KITCHEN-AND LIVING ROOM AREA AND 2 ,
FIREPLACES.RELOCATE LAUNDRY TO INSIDE OF DWELLING FROM GARAGE.ALTER ROOF LINE AND
CHANGE OUT WINDOWS AT FRONT ENTRY OF DWELLING.ADD 209 SO. FT.COVERED PATIO AT REAR
• OF DWELLING AND 50 S F OF COVERED PORCH AT FRONT.ALL CONSTRUCTION IS ON THE FIRST
FLOOR.ALSO INCLUDES REROOF OF EXISTING HOUSE AND 5 NEW SKYLIGHTS,REF:B01-01180. .
ELECTRICAL TO INCLUDE:42 LIGHT FIXTURES,30 OUTLETS,33 SWITCHES, 1 RELOCATE AND
SERVICE UPGRADE TO 200 AMP. "
•
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 $38.06 42 up to 50 kva/kw $0.00 0
Recept Outlets $29.30 30 up to 100 kva/kw $0.00 0 ,
Switches $31.49 33 over 100 kva/kw $0.00 0
Non Res Appl $0.00 0 Low Voltage Equipment $0.00 - 7/0
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 1 hp $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
Pole Light Pkg $0.00 0 Reinspection Fee $0.00
Sign Circuits $0.00 0
Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $152.85
Intermed Pole $0.00 0
C MI6ICM 3 PSr rant. 6ChDr i 11/4,14
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia 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
244648(WOO)
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations: •
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
I h and will maintain workers'compensation insurance,as required by section 3700 of the Labor Cade,for the performance of the work for which this permit is issued.
y workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed it the permit is valued at one hundred dollars($100)or less.)
•
0 I certify that in the performa of e 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 Ca' is d agre that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these Prov' s. ` -0
Applicant Signature: - Date: /VI 7 !)Y
WARNING:FAILURE TO SECURE WORKE COMPENSATIO COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADD IONTO-ME 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.Lia# Class#
Contractors Signature: Date: — a o
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to tile a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑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.
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 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this Li a plication a ppermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 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 under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No
(If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If'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.
,2inature Of Legal Owner(s) r/ K_Ddy
AndlOr thorized Applicant xV Date
cobs# INSPECTION TYPEPATE 'BMW.* CODE( INSPECTION TYPE PALE ll1T AL$
• •
1616 Fixed System Final Fire Prevention _ 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing -. //-2702
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
Oil Ilfs9 CITY OF COSTA MESA
4 BUILDING DIVISION
. • .4r1 DEVELOPMENT SERVICES DEPARTMENT PERMIT UMBER
Ft ` 1 t
11.411,./
� PERMIT
' ,a ,,t�' 02-00509
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 1988 KORNAT DR Status: ISSUED
Suite No Applied: 08/08/2002
Issued: 08/08/2002
Vicinity:
Parcel Nunmber: 13944105 _ _ - ISSUED BY: (/
Applicant: SWINGEN, RICHARD
Address: 181 W ORANGETHORPE AV
SUITE B, Phone: 714-223-7848
PLACENTIA,CA Zip: 92870 '
•
Owner: MAGLIONE, JOHN W
Address 1988 KORNAT DR
Phone:
COSTA MESA,CA Zip: 92626-3530 '
Contractor: PRCOSNTRUCTION �,.- •
Address: 181 W ORANGETHORPE AV -
SUITE B Phone: 714-223-7848
PLACENTIA,CA Zip: 92870
License: 673267
Arch/ Eng: . -
Address:
Phone:
Zip:
License: -
SCOPE OF PERMIT
ADD 766 SQ FT TO FIRST FLOOR OF AN EXISITING DWELLING.ALTER INTERIOR OF DWELLING.
ADDITON TO INCLUDE A FAMILY ROOM AND EXPANSION OF KITCHEN AND LIVING ROOM AREA AND 2
FIREPLACES.RELOCATE LAUNDRY TO INSIDE OF DWELLING FROM GARAGE.ALTER ROOF LINE AND
CHANGE OUT WINDOWS AT FRONT ENTRY OF DWELLING.ADD 209 SQ.FT.COVERED PATIO AT REAR
OF DWELLING AND 50 S F OF COVERED PORCH AT FRONT.ALL CONSTRUCTION IS ON THE FIRST
FLOOR.ALSO INCLUDES REROOF OF EXISTING HOUSE AND 5 NEW SKYLIGHTS. REF:B01-01180.
PLUMBING TO INCLUDE:RELOCATE KITCHEN SINK,RELOCATE WATER HEATER,RELOCATE
LAUNDRY TUB. ,
FEE SUMMARY
.AMT QTY AMT QTY AMT QTY
ISSUE FEE $23.50 Laundry Tub/Washer $9.80 1 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 Bkftow(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 $9.80 1 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
e,..,e�,.l.,,. gnian, a .,pa ryuu„‘,/ see $e.ee
1410tFPGI Icfrh ablihbriz�j5®(a�x(�]� this Qermit shall comply with all applicable handicap access requirem TJ�flbrnia statute&@ 8 rel£)ed
rA**RNfRAI@l 403948,YQ10 21-9@) Orn u T S n
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within T80�ays o it workER suspended o'r abandoned
fpr a'wind of Ian days
INSPECTIONS: In order for the work authorized • 1-,p A - •_ •P- •_ �' -- I s •.rk must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
244646(&00)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations: -
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
❑ I certify that in the perto nc I 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 do a Be that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these 'Si �/_r' /09-
Applicant
-./�^ '
Applicant Signature: /Y Date: �O/ OV rf7l
WARNING:FAILURE TO SECURE WO ERS'COMPENS ION COVERAGE IS UNLAWFUL AND SHALL SUEUECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(S100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060E THE LABOR CODE,INTEREST,AND ATTORNEYS 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.a / ' Class k
Contractor's Signature: /1- '��A " Date: ,SV- 0
CONSTRUCTION LENDING AGENCY:
O I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
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 and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. 0 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:
O 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? 0 Yes 0 No
(Section 25533 of the Califomia 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? ❑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 apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? la Yes LJ No
(Section 65850.2 of the Calif omia Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If yes',attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
' above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
S' slurs Of Legal Owner(s)
/� plicant �— 0 __ TDatg_
U ��„
And/Or Au nzed Applicant Date
CODE I INSPECTION TYPE Me INTITIALS CODE( INSPECTION TYPE PATE MAO
1616 Fixed System Final Fire Prevention 206 Final Mechanical ��`s�
1266 Pool Spa Final 208 Final Plumbing -. I Z'//-CZ .f
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
ell Ws 9 CITY OF COSTA MESA
4 BUILDING DIVISION
}:j ", DEVELOPMENT SERVICES DEPARTMENT PE MIT NUMBER
4. //s . PERMIT
Soypa 6b
M02-00355
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
MECHANICAL PERMIT
Job Address: 1988 KORNAT DR Status: ISSUED
Suite No Applied: 08/08/2002
Issued: 08/08/2002
Vicinity:
Parcel Number: 13944105 ISSUED BY:
Applicant: SWINGEN, RICHARD
Address: 181 W ORANGETHORPE AV - '
SUITE B, " - Phone: 714-223-7848 - -
PLACENTIA,CA Zip: 92870 - . , .
Owner MAGLIONE, JOHN W /"
Address: 1988 KORNAT DR , '
Phone:
COSTA MESA,CA Zip: 92626-3530
Contractor , PR COSNTRUCTION
Address: 181 W ORANGETHORPE AV .
SUITE B Phone: 714-223-7848
PLACEN_TIA,CA Zip: 92870
•
.. License:673267
SCOPE OF PERMIT
ADD 766 SQ FT TO FIRST:FLOOR OF AN EXISITING DWELLING.ALTER INTERIOR OF
DWELLING.ADDITON TO INCLUDE A.FAMILY ROOM AND EXPANSION OF,KITCHEN AND LIVING
ROOM AREA AND 2 FIREPLACES.RELOCATE LAUNDRY TO INSIDE OF DWELLING FROM GARAGE.
ALTER ROOF LINE AND CHANGE OUT WINDOWS AT FRONT ENTRY OF DWELLING.ADD 209 SQ.
FT.COVERED PATIO AT REAR OF DWELLING AND 50 S F OF COVERED PORCH AT FRONT.ALL
CONSTRUCTION IS ON THE FIRST FLOOR.ALSO INCLUDES REROOF OF EXISTING HOUSE AND -
5 NEW SKYLIGHTS. REF:B01-01180.
MECHANICAL TO INCLUDE:1 GAS(1-4 OUTLETS), 1 FAU CHANGE OUT,2 FACTORY ,
FIREPLACES, 1 HOOD W/EXHAUST.
FEE SUMMARY
QuantityQuantity
ISSUE FEE $23.50 . ' " ".Repair/Alt Absorbtion Unit ., - $0.00 0
Inst FAU<100 k BTU $14.80 1 Repair/Alt_Refrigeration Unit $0.00 0
Inst FAU>100 k BTU .. . $0.00 0 Ventillation System , $0.00 0
Repair/Alt Cooling/Heat $0.00 ---0 , - ' Evaporative Cooler' $0.00 0
Inst/Rep. Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0
Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0
Refrig Sys>100 k BTU $0.00 0 • Compressors/Absorption Systems ' ,
Gas Piping $0.00 0 Up to 3 hp/100 k BTU . $0.00 0
Factory Fireplace $21.30 2 3 To 15 hp/500 k BTU $0.00 0
Hood w/Mech Exhaust $10.65 1 15 To 30 hp/1,000 k BTU $0.00 0
VAV Box $0.00 0 . 30 To 50 hp/1,750 k BTU $0.00 0
Vent Fan/Single Duct $0.00 0 • Over 50 hp/Over 1,750 BTU . $0.00 0
Appliance $0.00 0 - Boilers
Fire Dampers $0.00 0 Up to 3 hp $0.00 0
Smoke Dampers $0.00 0 . 3 To 15 hp $0.00 0
Inst or Relocate Appl Vent $0.00 0 ' - 15 to 30 hp' $0.00 0
Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0
Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0
Floor Furnace $0.00 0 Other Mechanical Fee
Floor or Suspend Heater $0.00 0 Investigation Fee $0.00
Plan Check Fee $0.00
Reinspection Fee $0.00
TOTAL CALCULATED FEES $70.25
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
2446-48(8/00)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations: •
I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Carrier: Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars($100)or less.)
❑ I certity 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: •'nia,and agr•:that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these pro,).. s. / C//‘---- O Q Qy,0U
Applicant Signature: ._ii.a I. Liv- Date: 0- 9
WARNING:FAILURE TO SECURE WORK RS'COMPENSAT• COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION TO THE 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 provision 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.# Class# Cy g
Contractor's Signature: Date: Q — 'Q 7 -
CONSTRUCTION LENDING AGENCY: '
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
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 California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater then a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health 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? Yes 0 No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(It"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 Califomia Health and Safety Code Section 42303 been made? 0 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.
�,— Il+tur• •f Leal Owner(s) i/_ -Date�j , And/Or Auth• zed Applicant �U( Date
CODE/ PISPECTION TYPE PATE DOOM CODES INSPECTION TYPE MAI L=ALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical alk et c'J]t
1266 Pool Spa Final 208 Final Plumbing -.
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall . 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition , ... 250 Final Building/Occupancy
/-2 3,5 Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. . -
RMIT NO. � ' TRACT NO. LOT NO. UNIT NO. 0352.- 7/29/86 5. - TL
CITY OF COSTA MESA CONST UCTION PERMIT
Project Address /912 g0,)PN4 T +y. a� ? - -
s
Applicant's Mailing Address R4/4 gmLi TYPE OF CONSTRUCTION LI NEW Li ADDALTERATION LI REPAI R
D t i 9 1+7 6 Y6— 714
ID CONVERSION iii DEMOLISH 0 OTHER
Owner's Name �'y T L3/C,$0. one S A.P.qW I Zone
Address
/ 9 Os
n DESCRIPTION OF WORK/USE OF BLDG.
KnTr 7Tr QzC S Main Building: Accessory Building:
Arch/Eng. License No. TYPE OF PERMIT 0 GRADING 1:1 FOUNDATION LI STRUCTURAL E Front ZO
Address T _ 0 TENANT ❑ ELECTRICAL C PLUMBING III MECHANICAL A Rear -' N
Contractor's Nam An-1 '/ L, < / Phone 7 % 25 LI OTHER
•S2—T�'�F ) �r C Right N
' Address Imailingl &rS-s' L/9s-S( A/[id. hil - �Cln(((��, PROJECT DESCRIPTION SQ. FT. OCCUPANCY K Left G
//__ CONSTRUCTION TYPE VALUATION S $
City License NO. o W LLS---; 4 •(� ZONE GRADING CU.YDS. ACRES R
• LICENSED CONTRACTOR DECLARATION Ping. Ref.'{p • Parking Req./Provided E
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: QM
with section 7000) of Division 3 of the Business and Professions Code, and -�- _
my license is in full orce a d effect. 9 RFCFI.V1—'1 JUL 2 1 1988 •
T
U e se lass _ _ Li nse No.l4�trz.. r S
F PLUMBING FEES /
l� •
Dn4slf - Signature Zig 7u 2- f
N.\ WORKERS'COMPENSATION DECLARATIONBar Sink Showers ELECTRICAL FEES
hereby affirm that I have a certificate of consent to self-insure or a certificate
.1 Workers' Compensation Insurance, or a certified copy thereof (SectionBackflow Preventer Service Sink
1 3800, Lab. C.) p /� Automatic Washer Transformer ❑ 15-50 KW
Policy No, ?O�9/ . Company 'L�- t Backflow Irrigation Sewer CapC 50+KW
e. Construction Pole Sub.
Certified copy Is hereby furnished. •
• s
Cer fed y is lied with the city ilding Divisions •(� �L.-.// Bathtubs Sewer Connection 1 Cooking Unit r Meter ❑up to 100 amps
Date r Applicant �/n//L m A �/ G • _ _
E%EMP X10 FROM RKE RS'COMPENSATION DECLARATION - Clarifiers - S•lar Collectors Dishwasher Meter ❑Over 100 amps
(This section need not be completed if the permit is for one hundred ($100) or
less). Dishwasher .r Piping Dryers ❑Gas ,❑Electric Sub Panel
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 Drinking Fountains �a. ank Fan Motors❑0-1 HP ❑1,4-B
Workers' Compensation Laws of California.
Date Signature Floor Drains S i,•i•• Pool w/Spa F.A.U. Inc.Solar❑9-15 HP 016-15+
'NOTICE: If,after making this declaration,you should become subject to the - •\;�
-
Wotkers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal �� Fixtures •
comply with such provisions or this permit shall be deemed revoked. Microwave
CONSTRUCTION LENDING AGENCY •
Gas Service Outlets Water Clo' i Device Boxes Pole Li ht
I hereby affirm that there is a construction lending agency for the performance f- B
of the work for which this permit I5 issued• (Section 3097 Civ. CJinterceptors / Water Heater 2 'ae Outlets Range
Lender's Name- -
Lender's Address - - Kitchen Sink - Water Service � •t SwitchesSign
OWNER BUILDER DECLARATION - - - • -
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash
following reason (Section.7031.5 Business and Professional Code: Any city or _ Garbage Disposal 'Standing Sections
county which requires a permit to construct,alter,improve,demolish or repair i P-Trap • LaundryTrays - '
any structure, prior to its issuance, also requires the applicant for such permit - • •y Generator ❑05 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 taw(Chapter 9 (commencing with Section 7000)of - •
.r;Division 3 of the Business and Professions Code) or that he/she is exempt ) •
.'t 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 i, ,
¢natty of not more than five hundred dollars($500).
U 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 isnot intended or offered iReinspection Fee J $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 her031. • DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I ❑ I
sale. If, however, the building or Improvement is sold within one year of com- Canopy Type II 0 . Zoning Approved By Date
pre the owner will have the burden of proving he/she did not build or,Im- Duct- Under Ground
prove
for the
- Building Approved By Date
tpurpose of sale).
❑ i..as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System +j Application Issued By_ _�_ Date
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 ❑100,000 BTU )'rY 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 ❑ Multiple ❑ System Repair/Alteration BUILDING PERMIT $ - SMIP $
proof otheir 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. ICBG# Fire Dampers
RegistersPLUMBING $ %tr. v 0
ISSUANCE $
Date OwnerENERGY P.C. $
Heating System&Ducting PLAN CHECK 25% $
I hereby certify that I have read this application and state that the above 00-100,000 BTU 0100.000 BTL • GRADING S
information is correct. I agree to comply with all city and county ordinances ELECTRICAL §
and',state laws relating to buildin onstruction, and hereby authorize repre-
sentatives of'this city to t u on the above-mentioned property fo • •
inspection purpos}�ly/ ('�5/ MECHANICAL $ TOTAL FEE $ �'��
Signature A/!/ {e � � Date //�[I XJ
Drivers' License or SS / ,
Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25%, $
- - - -
CMF 0865-46,rev. 10/84 White - Building: Canary -Applicant; Pink -Accounting; Goldenrod -Assessor
CONSTRUCTION AND PLANNING POG_ 4 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 OF 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, ❑ 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 O Gas CI Oil
23. Gas Pipe-Rough &Test 72. Underground Flush •
24. Roof Framingn
�, ',. 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing u'��y ..•i 74. Overhead Hydro
26. T-bar Ceiling (Structural) & Monocoat ' C a75:- Dry Chemical
•27. Frame and Flashing 76rrDjy Standpipe
28. Lathing& Siding • 77. FIX D SYSTEM FINAL
29. Insulation 78. FIRE PREV.-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: g-5-44 cgcr G42O- c,C•J
34. Final Heating &•Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace •
38. Final Plumbing fp (-6-if6 a9
39. Water Service-Final ri
40. Gas Service-Final I;1
41. Solar Domestic-Final L`!
42. Backflow Preventer -7'
•
L43. Backflow Irrigation
Ir44. Landscape Irrigation System '-
35. Sound Attenuation r•S'
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 SAMAR CONST.CO. DATE NOV 4 1963
JOB ADDRESS 1988 Kornat DriveBUILDING PERMIT NO. 20828
GENERAL CONTRACTOR cancer Const.Co. VALUE 522,656.00
AP No. LOT 91 TRACT 11-341 FIRE ZONE DESCRIPTION OF WORK Res.w/Btt.Gar.
INSPECTIONS Signature DATE GROUP I & JTYPE V ZONE Rl
Soil -4=4Z/3.67 SUBCONTRACTOR PERMITS ISSUED
Gas DATE NUMBER
Water f- /2-/S-C7
Rough Com. Refrig. ❑ Air Cond. 0
Rough Heating g 43-///-6 /e-." Zr .. A�! a 1964
Rough Plumbing 7,"i' 2�J./-1VI }ee-t—c- - 2 1°V 4 1 i969 •
Miscellaneous I..�, ` p
Prop. Swr. Line 0 House Con.0 St. Swr. 0;c*nw 3-17-6y c ' *ti) l_�nc'. ^�-- (c_t • ,l, �1.
Sprinkling System r •7 ' 'f
Construction Piste L G GY ,e .;c..( C2cc. ,- .3- “, . > / c y6�iy
Underground �J Power 0
�Gft� /G /!� ,C, / ,r
Rough Wiring S2ijL%64 X6201_ tta-2 /„?-/b-G? a402/ 1
Trenches p-- Forms W Steel Reinf. Z-. 9' //4^� /3
Floor System �FC� ��
Bond Beam ❑ Steel Reinforce 0
Sheathing 4-I B-69
Frame and Flashing r
2-71-Ey
Lathing - In r Out.p- 3/3."44
Plaster; brown coat
----
Refrig. 0 Air Con. Final
Heating, Final .5"--7/ S"6?
Plumbing Fixtures, Final £ /rte
Final Gas Test /5-' S'-/S-!,4
Electric Fixtures, Final xe42--_
Building, Final 717,72r 6.-- 8-fic/ 1
OCCUPANCY -• j ,
Form BU4-5M-4-63-S-B P
• . 20828 FEL RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT OCT 1 7 1963
P.O.BOX 917 COSTA MESA,CALIFORNIA FINANCE DEPT.
ip
9''YC.
For Applicant to Fill In Completely A109P r fT
Tr. 4341 TYPE OR PRINT Lot 91 BUILDING
BUILDING For Office Use Only
ADDRESS 1988 Kornat Drive
RECEIPT NO. PERMIT NO.
COSTA MESA. CALIFORNIA 20828
REC[IV{D EY DATEII� I�� NdVE3SUHU /
OWNER Samar Construction CO. k-, /o// u�J 1%3
MAIBUILDING
ADDLRESS .653 Minorca Drive ADDRESS
FIRE /(1
CITY Costa Mesa no' Ki 90395 ZONE TYPE GROUP r/V,Iy"
APPROVED
OR CENIGI ER E.G. Kaltenbach TR'547-8046 BY DATE -
ADDRESS 1823 E. 17th St. Santa Ana ZONING
ZONE NO.OP UBEOFNENI /r ATE:
gar.
I PLANE 2 BUILDING ti/a .gar.
CONTRACTOR Same as Owner
LEGAL Lot 91, Tr. Eiggi8E 4341
ADDRESS DESCRIPTION
CITY A.P.NO.
NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
LIC.NO. 197838 TEL
NO. 90'TO SIDE 9 REAR P.L
EAVES
OF LOT 71 x 98 I NO.OP
NOW ON LOGE 0 ALLOWED (U.B.C.REQUIREMENT)
YARDS APPROVED YARDS APPROVED
USE OF MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG. --�
(FROM C/LST EET)_ r
SETBACK LINE FROMI FRONT FT. SO g\ - Fr.
CENTER OF STREET 55 REAR YARD 42 /
SIDE YARD LEFT 6 I RIGHT 6 R.SIDE C, FT. FT.
DESCRIPTION OF WORK L.SIDE
NEW X ALTERATION _ ADDITION REAR.//FF. 9 7 FT.
DISTANCE BET. BET.MAIN e
REPAIR MOVING DEMOLISH MAIN BLDGS. ACCESS.BLOCS.
BUILDING NO.OF VAR.* DATE
SIZE 7 17 ci ROOMS 9 STORIES 2 C.U.P.$R APPROVED
EXTERIOR WALt.`•ooao, I ROOF Slake& APFROV % IIo _i `/_6 .�
COVERING StUCCO COVERING ..• - BY L ,,I• .La A DATE
USE OF BUILDING AND WORK TO BE PERFORMED
Single family residence and attaced
garage. p
43 B _ J c �'�78a Fr. (T LY' y0 �'^
LPlan
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION I8 FOR TH8ND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OP ESTABLISHING A PERMIT FEH ONLY.LY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATIONUILDING CONBTRUCTIOPERMIT FEE $
IGNATURE OF / { �../ERMITTEE x/17 fon ' "l�-I^/ / / PLAN CHECK $ — o
UTHORIZED AGENT $ / (J'_
LL
TOTAL FEE a
V