HomeMy WebLinkAbout2000 KORNAT DR - Building Permits CITY OF COSTA MESA -
4 BUILDING DIVISION
F•- DEVELOPMENT SERVICES DEPARTMENT P MIT NUMBER
PERMIT B03-01194
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(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.cEigILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 2000 KORNAT DR Status: ISSUED
Suite: Applied: 07/14/2003
Vicinity: Issued: 07/14/2003
Parcel Number: 13944108 Zoning: R1 R1 I
Applicant: GOMEZ, PAUL ISSUED BY: Y
Address: 2626 NEWPORT BL
Phone: (949)548-1645
COSTA MESA,CA Zip: 92627
Owner: SADEGHIPOUR, JAMSHIO
Address 2000 KORNAT DR
Phone:
COSTA MESA,CA Zip: 92626
Contractor PETRONELLA ROOFING
Address: 2626 NEWPORT BL
Phone: (949)548-1645
COSTA MESA,CA
Zip: 92627 License: 460707
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF EXISTING WOOD CHAKE AND BUILT-UP ROOFING.INSTALL MIRA VISTA LIGHT WEIGHT TILE.ICBG 5209.INCLUDES ATTACHED
GARAGE.NEW BUILT-UP ROOFING BY CERTAINTEED.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $5,200.00
Permit: $125.25 Claim Valuation: $5,200.00
SMIP Res: $0.52
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
•
Total: $125.77
PLANNING & ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations,(Ord. No.92-28,§ 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626 •
2446-46 WOO)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
O I have nd 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
wo r which this permit is issued.
ave 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: y Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars($100)or legs.) 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 workers'
compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 370 of the Labor Code,I shall forthwith
comply with s.
Sign ,
Applicant Signature:e: 7 g,pWl1wyG/eq Date: ---/ -0---)
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES 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 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#
- -Contractors Signatu Date: affreg y
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: 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 end 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(3500).):
❑ 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 end 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,faisework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of industrial Safety,as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes ❑No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time hes 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 a future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the Califomia Health and Safely 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 Califomia Health and Safety Code been fully complied with? ❑Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes U 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 El 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.
/
/ �iIgn t Oct Legal Owner(s)
---7 / (y e
And/Or thorized Applicant to
CODE A INSPECTION TYPE ' PATE l&El8LI ' Mat INSPECTION TYPE PATE INRTIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final J 208 Final Plumbing
200 Final Re-Roof. 0 3 6 210 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
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
PERMIT3191 12/05/84 90517111111r
CICIOH ST•
•
A-MESA C NSTRU TION PERMIT
X000 - lGL177 NO. TRACT NO. LOT NO. UNIT NO.
.• Project Address (/ � ,� f � t � l
• Applicant's Mailing Address O OL2d / Y TYPE OF CONSTRUCTION LJ NEW LJ ADD LI AERATION IJ ERATION REPAIR
1\..nL ❑ CONVERSION ❑ DEMOLISH ❑ OTHER /� A.P.�6 Zone
Owner's Name/ P4 �� rad Phone. O'�OCCS DESCRIPTION OF WOR /USE OF BLDG. 7- UZ7- O6.A/_� .
Address -aC�n / -...'SA — A 75 b '" �_ E Main Building: Accessory Building: •
Z
Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION LI STRUCTURAL T Front 0
Address � ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear N
i Contractor's Name IC,F-e-r I zMG'x✓o �_'Phone!55 -7Y,10 ❑'OTHER A -
�1 c- PROJECT DESCRIPTION SQ. FT. ?Oo OCCUPANCY C Right N
r Address(mailing) �6 n E � �G�1s- -C�-� s:!7. .1.��7C'
�a0 qa - CONSTRUCTION TYPE VALUATION$ r,'sSo g Lett - R
LICENSED CONTRACTOR DECLARATION
City License No. ` 1 ZONE GRADING CU.YDS. ACRESIPing. Ref.# Parking Req./Provided E 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: 0M
with section 7000) of Division 3 of the Business and Professions Code,and
my license is in full force and effect. ���502 S
License lass _ Licen e No.
Date i Signature �':..$- ' s+
PLUMBING FEES
WORKERS'COMPENSATION DECLARATION Bar Sink Showers
rij.nereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES
Workers' Compensation Insurance, or a certified copy thereof (Section -
Backflow Preventer Service Sink
Automatic Washer Transformer 0 15-50 KW •
--'500, Lab. CJ. - y, - ❑ 50+KW • -
Policy No. Ci067.5-3 trig( Company ;-- '7ur� Backflow Irrigation Sewer Cap Construction Pole Sub.
0_Certified copy is hereby furnished. v
Certified copy is ile with the city B 'Wing DivisionA. / Bathtubs Sewer Connection Cooking Unit Meter Oup to 100 amps •
Date /�- l � P ApplKERS' C ` former 0 15•COMPENSATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps
(This section need not be completed if the permit is for one hundred ($100)or •
-
less). Dishwasher Solar Piping Dryers OGas ❑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 Solar Tank Fan Motors 00.1 HP Ol h-B
Workers' Compensation Laws of California.
Date Signature Floor Drains Swimming Pool vv/Spa '
NOTICE:If,after making this declaration, you should become subject to the F.A.U. Inc.Solar 0915 HP 016-15+
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures Microwave
comply with such provisions or this permit shall be deemed revoked. -
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes Pole Li ht
I hereby affirm that there is a construction lending agency for the performance g '
of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets
Lender's Name Range
Lender's Address Kitchen Sink Water Service Switches Sign
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 P-Trap Laundr Tra s
any.structure, prior to its issuance, also requires the applicant for such permit y y Generator 00.5 KW 05-15 KW Trash Compactor
to file a signed statement that he/She Is licensed pursuant to the provisions of Roof Drains
the Contractor's License Law(Chapter 9.(commencing with Section 7000)of
Division 3'of the Business and Professions Code) or that he/she Is exempt
herefrom and the basis for the alleged exemption. Any violation of Section •
031.5 by any applicant for a permit subjects the applicant to a civil
enalty of not more than five hundred dollars($500). t
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 is not Intended or offered - Reinspection Fee I $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES
License Law does not apply to an owner of a property who builds or Improves
thereon, and who does such work himself/herself or through his or her own Boiler DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or Improvement is sold within one year of corn- Canopy Type II 0 Zoning Approved By - Date
pletion,the owner will have the burden of proving he/she did not build or im- Duct- Under Ground
rove for the purpose of sale). Building Approved Byr - Date ,
• I,as owner of the property, am exclusively contracting with licensed con- Duct-Structural Application Issued By Date `�'f 5
tractors to construct the project (Section 7044,Business and Professions Code: T
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating DO-100,000__ ■ 11 Irl B SU ARV OF FEES
builds or improves thereon,and who contracts for such projects with a con-
tractors) license pursuant to the Contractor'?License Law). I am aware that Exhaust System 0 Multiple❑ BUILDING PERMIT $ -C'� SMTP $ t SO ,
proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ _ _ PERMIT
O I am exempt under Section B.& P.C.for this reason Firepl/Fact.Bit. ICBG# 1111 Fire e PLUMBING $ ISSUANCE $
Date Owner Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $
I hereby certify that I have read this application and state that the above ❑0-100,000 BTU 0100,000 BT GRADING $
information is correct. I agree to-comply with all city and county ordinances ' ELECTRICAL $
and state laws relating to building construction, and hereby authorize repre-
sentatives of this city to enter upo the above-mentioned property for PLAN CHECK 50%
inspection purpo s. _
Signature �./ ' a.. . ..-1---' s _ M Date /.-2'� MECHANICAL $ TOTAL FEE . $ - O
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 POS S SPA -
APPROVALS - Permit# Date Inspector • APPROVALS Permit # Date Inspector
Iiit1. T.erriporary Electrical Service or Pole 52. Pool & Equipment Location
• . 2. -Soil Pipe-Undrgrnd. 53. Steel Reinforcement _
3. Electrical Conduit Utility-Undrgrnd: 54. Forms - •
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding -
• 5. Steel Reinforcement - 56. Rough Plumbing & Pressure Test
•
- 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE .
7. Footings - . 58. Electrical Conduif-Undrgrnd.
87 Foundation 59. Gas Pipe, 0 Undrgrnd., Test
•
9. Water Pipe-Undrgrnd. . •
60. Backwash Lines,P-Trap, ElUndrgrnd.
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 -
36. Rough Electric Wiring • • 67. Fencing & Access Approval
• 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling •
69. POOL/SPA SYSTEMS FINAL •
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
- ' 20. Rough Factory Fireplace APPROVALS. Permit#
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough &Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing I 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical •
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE 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:
34. Final Heating & Air Conditioning
35. Final.Gas Pipe-Test -
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing.
39. Water Service-Final
~
40. Gas Service-Final •
41. Solar Domestic-Final •
42. Backflow Preventer
43. Backflow Irrigation .
44. Landscape Irrigation System
45. Sound Attenuation • - -
46. Handicap Regulations - -
47. FINAL STRUCTURE & BUILDING /sy// VC/ -
48. Special Requirements Completed - ( -
49. Electric Release to Edison - - - - - • .
50. Gas Release-to Southern California Gas Co -
51. CERTIFICATE OFOCCUPANCY -
\ •
No. • Date
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
TRACT NO. LOT NO. UNIT NO.
CITY OF COSTA MESA CONSTRUCTIONA/ PERMIT — PER I NQ._ 7 a 74/ A.P. Zone
Pro' Address Co /� Q ��� S Main Building: Accessory Building:
A scent's Mailin AddressyT•YPE OF CONSTRUCTION U NEW U ADD U ALTERATION U REPAIR E Z
Owner's '/4y e.."7—re—A--7- c c' 4upr cOBO.! ❑ CONVERSION ID DEMOLISH ❑ OTHER T Front Q
Owner's Names O 2 NIX Phon DESCRIPTION OF WORK/USE OF BLDG. A Rear N
Address a
TYPE OF PERMIT U GRADING LI FOUNDATION Li STRUCTURAL I C Right N
Arch/Eng. License No. K G
Address ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING MECHANICAL S • Left R
y ❑ OTHER E
Contractor's Nam O he pn¢sj 30-L:av Z� Ping. Ret.# Parking Req./Provided E
•PROJECT DESCRIPTION SQ. FT. OCCUPANCY
Address(mailing) Z/`ee0 • C�` 2 � a"-i Planning Notes: t( fh M
CONSTRUCTION TYPE VALUATION$
City License No. D-.22 U: U1:f. AL249- 7.3—
ZONE G D G CU.VDS.
� - u :ACRES _ $;
LICENSED CONTRACTOR DECLARATION .'' • a• -- I,-1i:
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks:
with section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force asp effect. ELECTRICAL FEES
`- _ 0 15-50 KW
License Class e- /�.., '+t nse o. / V -4
Date - �l Signature
� �! PLUMBING � FEES Automatic Washer Transformer
WORKERS'COMPENSATION DECLARATION Sink Showers Construction Pole Sub. ❑ 50+KW
' 'eby affirm that I have a certificate of consent to self/re or a certificate
orkers' Compensation Insurance, or a certified copy thereof (SectionBackflow Preventer Service Sink Cooking Unit Meter ❑up to 100amps
.,, Lab. C.)
Policy No. Company Backf low Irrigation Sewer Cap Dishwasher Meter Clover 100 amps
Certified copy is hereby furnished. Dryers ❑Gas ❑Electric Sub Panel
Certified copy is filed with the city Building Division. Bathtubs Sewer Connection
Date Applicant Fan Motors❑0-1 HP ❑1%-6
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors -
(osis section need not be completed if the permit is for one hundred($100) or Dishwasher Solar Piping .. F.A.U. Inc.Solar ❑9-15 HP ❑16-15+
1 certify that in the performance of the work for which t 5 permit is Issued,I . Fixtures
shall not employ any person in any ma so as t me subject t he Drinking Fountains Solar Tank Microwave
Date ,, Cgtn Sae{ tj0[s�a Si af Call ,� Device Boxes
Date rs lrw Signature I Floor Drains Swimming Pool w/Spa Pole Light
NOTICE: If,after making this declarat on,you should become su ct to he e Outlets Ran
Workers' Compensation provisions of the Labor Code, you m forthwith Floor Sinks Urinal 9
comply with such provisions or this permit shall be dee d revoked. Switches
CONSTRUCTION LENDING AGENCY Gas Service OutletsSign
I hereby affirm that there is a construction lending agency for the performance Water Closet
of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Garbage Disposal Standing Sections
Lender's Name
Lender's Address Kitchen Sink Water Service Generator 00-5 KW 05-15 KW Trash Compactor
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
county which requires a permit to construct,alter,Improve,demolish or repair P-Trap Laundry Trays
any structure, prior to its Issuance, also requires the applicant for such permit
to file a signed statement that he/she Is licensed pursuant to the provisions of Roof Drains
the Contractor's License Law(Chapter 9(commencing with Section 7000)of
. -.;',vision 3 of the Business and Professions Code) or that he/she is exempt Reinspection Fee $15 Issue Fee
$ 3
:ra.efrom and the basis for the alleged exemption. Any violation of Section
'1.5 by any applicant for a permit subjects the applicant to a civil
Lte alty of not more than five hundred dollars($500). DEVELOPMENT SERVICES REQUIREMENTS:
U I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 Zoning Approved By Date
compensation, will do the work,and the structure Is not intended or offered
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES Building Approved By Date
License Law does not apply to an owner of a property who builds or improvesyq
thereon, and who does such work himself/herself or through his or her own Boiler Hood or Type I CI
Issued By Date_/ a Sl✓
employees, provided that such improvements are not intended or offered foryP
sale. If, however, the building or improvement is sold within one year of com- Canopy Type II ❑ SUMMARY OF FEES
pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground
prove for the purpose of sale). BUILDING PERMIT $ SMIP $
❑ I, as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System PLAN CHECK $ PERMIT
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00.100,000 BTU 0100,000 BTU PLUMBING $ ISSUANCE $
builds or Improves thereon.and who contracts for such projects with a con-
tractors) license pursuant to the Contractor's License Law). I am aware that Exhaust System CI multiple CI System Repair/Alteration PLAN CHECK 25% $ ENERGY P.C. $
proof of their Worker's Compensation Insurance should be provided to me.
ELECTRICAL $ GRADING $
IDI am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG dk Fire Dampers
9 PLAN CHECK 50% $ MICROFILM $
Date Owner Heating System& Bwttiag Registers MECHANICAL $ /((/"O6 // ��
1 hereby certify that I have read this application and state that the above / SO-100,000 BTU ❑100,000BTU— TOTAL FEE $ ,,'7-
information is correct. I agree to comply with all city and county ordinances' PLAN CHECK 25% $
and state laws vela ' g to b g construction,and hereby authorize repre-
sentatives of i t upon .••ve.mentioned propert f r N.
ins ectio .. La' - 7.:7 W
Signature /'�/ / -t DateCI �aD299r 0-Q�1D�4f�� TL�� ' �..��
�`� - Reinspection Fee $15 . Issue Fee c $
Drivers' Licen • or ss �` 1 DATE: 01/24/S9 TlflE: 14:2i
0865-46,rev. 5/88 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor
I
.1 1,., p STRUCTION AND PLANNING POO SPA
- ROVA LS 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 UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. :Footings • . 58. Electrical Conduit-Undrgrnd. •
8. Foundation / / 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. - . 60. Backwash Lines,P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK ,
11..Property Sewer Line & House Connection 62. Backwash & Receptor-Final . _ _
12. Sewer Cap / 63. Heater & Vent-Final
13. Roof.Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
r
•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 I1
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test Il 72. Underground Flush
24. Roof Framing .1 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural).& Monocoat 75. Dry Chemical
27. Frame and Flashing76. Dry Standpipe
28. Lathing & Siding 77. FIXED 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 1 ha
33. Final Electric Notes:
34. Final Heating & Air Conditioning i/40/69 n ,
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final r "t
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co .. -
51. CERTIFICATE OF OCCUPANCY
No. Date
OWNER SAMAR COLSI.CO. DATE Nov 4
JOB ADDRESS 2 Kornat Drive BUILDING PERMIT NO6320831
GENERAL CONTRACTOR Samar COnat.CO. VALUE $ 23:0.00
AP No. LOT 94 TRACT I. 41 FIRE ZONE DESCRIPTION OF WORK Res.w/att.Gar.
INSPECTIONS Signature DATE GROUP I & J TYPE V ZONE RI
Soil 7 a.-/2-G) PERMITS ISSUED
Gas - / SUBCONTRACTOR DATE NUMB: )
Water Y" `e 2-/k-a _—
Rough Corn. Refrig. 0 Air Cond. 0
Rough Heating
n___,2.-)/-44.4 „,_ ; n E 19••
Rough Plumbing z-/� / 7 OV 2 1963t{3xrtiits- .
Miscellaneous / 1
Prop. Swr. Line 0 House Con. 0 St. S . 0 s>')74f gib-CIO\ANC. , `One. -C id{ mak(- ILkoi.
Sprinkling System ' .
Construction.Bole, - -,ad - e - /- -G���r',ae - /-3- 6 cc' --2 i 6 D'.
UndergroundlPower ,0 �@ G ' k
Rough Wiring ,%j5 •/ Ws 7,-777-43,0v2s-4 C&e2 /e7-/6-6 6 .
Trenches'p- Forms OY Steel Reinf.,,m- _ d' / -/F
Floor System J. 1 2
Bond Beam 0 Steel Reinforce 0
Sheathing A'/liy 9,-(c-C-7
Frame and Flashing /p/5 2.--,/-r y
Lathing — In.1 - Out l7— �'Q6fl( 3-/i -by
Plaster, brown coat i1+4-2t? v-5-Ct: •'
Refrig. 0 Air Con. 0 Final
Ileating, Final '# T_tf•oy
Plumbing Fixtures, Final s--/T-4.Y r
Final Gas Test It r-i"-cy
Electric Fixtures, Final , . :_l_ S-f-_4y
Building, Final ' c--/it-49
OCCUPANCY /
Form BU4-5M-3-63-5-B P
20831 FEE RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT OCT 3. 7 1963
P.O.BOX 917 COSTA MESA,CALIFORNIA FINANCE DEPT.
For Applicant to Fill In Completely AP9EJ Ai6J dig&
Tr. 4341 TYPE OR PRINT Lot 94 BUILDING
For Office Use Only
BUILDING 2000 Kornat Drive
ADDRESS
RECEIPT NO. 2083 I
COSTA MESA, CALIFORNIA GG
RECEIVED BY DATE RECEIVED DATE ISSUED
OWNER Samar Construction Co. /o�/�� NOV 4 1263
BUILDING
MAIL ADDRESS
ADDREB81653 Minorca Drive V / 1
TEL. ZONE TYPE GROUP tY
FIRE
an Costa Mesa No. Ki 90395 0
ARCHITECT TEL ABY
PPROVED DATE
OR ENGINEER E.G. Kaltenbach NO. 547-8046
ZONING
ADDRESS1823 E. 17th St. Santa Ana ZONEp� NO.OF USE OF NEW
Ill I PLANS 2 I BUILDING w/att.gar.
CONTRACTOR Same as Owner
LE°ALDESCRIPTION Lot 94, Tr. 4341
ADDRESS -liar
A.P.NO.
CITY
NOTE: NO RAVE OVERHANG SHALL BE LESS THAN
STATE 197838 O O TEL.
NO. •
90"TO SIDE A REAR P.L.
LIC.N
EAVES
OSIZE
F LOT 70 X 101 I No.oP BLOT •0 ALLOWED (U.B.C.REQUIREMENT)
NOW ON LOT
YARDS APPROVED YARDS APPROVED
USE OF --- MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG.
(FROM C/LST EET) I
SETBACK LINE FROM 1I�
CENTER OF STREET 501 REAR YARD O39 FRONT /� FT. +5 YL - -
SIDE YARD LEFT 5 I RIGHT O R.SIDE Ph FT. FT.
DESCRIPTION OF WORK L.SIDE SFT. I FT.
NEW X ALTERATION _ ADDITION REAR FT.1-9- 9C- FT.
DISTA✓✓✓✓✓✓NCE••BET. BET.MAIN Q
REPAIR MOVING DEMOLISH MAIN SLOGS. ACCESS.BLOCS.
NV
tl•ROOMS 8STORIES 2 CAU.P.# • APPROVED
SIZE
EXTERIOR WALL.00d& I ROOF Shake& APPROVEd/y! 1 4 DATE /Q/�_6 3
COVERING S}u co COVERING Shi male BY 11 I'�..
USE OF BUILDING AND WORK TO BE PERFORMED
Single family residence with attached Dir
garage.
Plan S --I /n/SQ.FT. (L 5706 9
42 ARS /Deb' B",
1 HEREBY ACKNOWLEDGETHAT I HAVE READ THIS APPLICATION THE AMOUNT SNOW UNDER VALUATION IS FOR THE E
AND STATE THAT THEHE ABOVE 1° CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O
PLYBUILDING WITH ALL
CONBTCITYflUCTI fOolrANCEB AND STATE LAWS REGULATING VALUATION
0 f " DPERMIT FEE $ 75---
/-
SIGNATURE OF B
PERMITTEE /�AJo- /�.11/1" $ 1 / (//- 5-
/v / / '
0
AUTHORIZED AGENT
TOTAL FEE $ /./02/