HomeMy WebLinkAbout1691 NEW HAMPSHIRE DR - Building Permits 4`, F9 \ ' CITY OF COSTA MESA
� � BUILDING DIVISION
> 4 l �r DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER
F 1 w.nar�•g•a
o! PERMIT, P07-00011
Itbepo 6.
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa BLSIMBING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
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Job Address: 1691 NEW HAMPSHIRE DR Status: ISSUED
Suite No Applied: 01/11/2007
Issued: 01/11/2007
Vicinity: GARAGE
Parcel Nunmber: 13961217 •
Applicant LA PAGE, RICHARD
Address: 12025 ARROW ROUTE - _ ISSUED BY:
- - "•Phone: 760-219-09.09._=
RANCHO CUCAMONGA_,.CA - _ )' Zip: 91730
7,-.<2 7--.... v.------ t
Owner: CHARUCRINDA PACHANI.ET '
Address ,'AL/" \ \ .--•- .
/ • COSTA MESA,CA,• .• Phone: - . - -
j1691 NEW HAMPSHIRE DR' Zip: 92626
., /•//27;{:.1,
/ /
Contiactoi: ALL-PRO PLUMBING CORP
7
Addres_sa 12025ARROW ROUTE -
1 .
/i 7/.--/v Phone: >888-615-3330
"-----/ RANCHO CUCAMONGA,CA I Zip: -;91730 -
`.License: 778137 • -
- IY; ;' i , ^*` - SCOPE OF PERMIT ;
). „ /pi;•WATERHEAT ER CHANGE OUT(SAME LOCATION)FOR A SFD. ,," ',
FEE SUMMARY
.1 i __.-' AMT QTY;'_ ..r__ .!' {'_, _ -AMT rQTY - - i - . AMT -QTY
iISSUErFEE • i $23.50 ( „_,f; ,,Laundry Tub 7 Washer.,,,j $0001 '-0 • Sump Pump ' $0.00 "0
Backflow irrigation.0 'I, i $0.00 0. - et Landscape Irrigation.-_-.1:.::: $0.00-,'0 -." - - . 'Swimming Pool $0.00 .0
Backflow Preventers')1 $0.00., 0\ P-Trap $0.00 '0, Trap Primer $0.00 '0
ii
Bathtub 1 ,1 i'' ', $0.002 0 ', Pressure Regulator $0.00 /07. • Urinal ' - $0.00 •'0
Clarifier System • • • $0.00 0 _ --•Process�Piping(per 10 ft). - $0.00 "�0 ,, Vacuum Brkr Bkf]ow(1-4)- -$0.00 •- 0
Connect(ice,Soda,etc) ' $0.00 . 0 ---2Receptors-- -- . .. • - -$0,00�;0=.It. - • Vacuum Brkr Bkflow(5+)4. $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
Draini,Floor`� \\\Ci, $0.00 0 ; Sewer Connect '$0.00' 0 ,Waste and Vent System $0.00 0
Drain;Rainwater", \+•' i$0.00 0Sewer 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 10.00 0 Sink,bar ....., $0.00 0 Water Piping.(Inst or Rep.) $0.00' 0
Expansion Tank ,..-"/ \$0.00 0 Sink,commercil $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) , $000`x-. 0 Sink•kitchen•' - ` $000`- :0 _ _ Water Softener- .'•.$000 0
0
Gas(Over4 outlets) - -` $0.00 \,-0 i.--. -y' Sink service/mop i $000 '.i•0- ;•"OTHER $0.00
Gas RepipeV`'v ,$0.00 'v`0 - `b Spa(private);, - $0.00 0 VIOLATION ti ' $0.00
Gas Service Vv ,,$OAO , `0::::,,-:%`7 "Spa(public) - $0.00 ' 0 =PLAN CHECK- ' $0.00
Interceptors(Grease,Oil) x$0.00/', 0 '-=�,C - . „'-• "REINSPECTION % , / $0.00 0
Interceptors(Sand-Auto) $0.00' -.0 . � - S-
VNZ� >` > "- �� _ TOTAL CALCULATED FEES: $35.80
'- ' 7 '"-•I .COMMENTS./SPECIAL CONDITIONS '
. _-
;i •
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord.Noy 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(6/00)
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.
Ati 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' •mpensatio ur:. = :mer pol> mbar are: /f ///] 5'2/
Carrier %r (//O / / '� •RPolicy Number: /Zf9/Qi [ S
(This section n.ei"t be completed it the permit is valued at one hundred dollars($100)or less.)
❑ I certify that in the performance of the work for which this it is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,nd gree hat i s ecome subject to the workers'compensation provisions of Sectio 3700the Labor Code,I shall forthwith
comply with these provisions.
Applicant Signature: _ p LE.- Date: Q
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO GRIM PE IES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND OOLIARE($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 pr'visions of hapter 9(commencing with Section 7000)of Division 3 of the Business d Professions Code,and my license is in full
force and effect.Lic.# Class# to
Contractors Signature: ar'�ar Date:
LA—2 /
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: 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 fore permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the properly,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 properly 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 properly,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 ❑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:
CIO_ 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 any�r�e do work which would require a permit from the Division of Industrial Safety,as noted above nless such person has a
permit to do sr h9R9thg.Qfvist6n //
Signature: L t ( (/J (`/G�_.�j Date: / l/!r(/ 7
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 f 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 tNo
(Section 25533 of the California Health and Safely 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 U'No
5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this a plication apI�ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? al Yes SL?No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residentialobuilding 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 R/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 yrNo
8 (If yes",attach certificate of compliance from the�+approp a air pollution control officer).
CERTIFICATE OF COMPLIAN • rti that nde alty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials n mi n/y./ p
Signature: r Y 14�1 Date: I "2
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 pro.: y for inspectio�•oses.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Alrof4,11rOf Legal Owner(s) ate
/ p
(And/Or Aulh+rued Applicant Date
CODE I INSPECTION TYPE PAN INITIALS CODE. INSPECTIONTOE MATE INTrTIAL$
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing Z"a'0 7
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place • 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
CITY OF COSTA MESA
4
BUILDING DIVISION
4t 1.1.c/tint,. ,•
1 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
1 1 w�.4g i
PERMIT
• niinh_nnnai
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
MECHANICAL PERMIT •
T ( ;
Job Address: 1691 NEW HAMPSHIRE DR i. Status: ISSUED
Suite No Applied: 01/29/2004
Issued: 01/29/2004
Vicinity: GARAGE '- ' S \ r. . 7- I
Parcel Number: 13961217 TISSUED BY: AP,
Applicant: ELLIS, JOE
Address: 3801 LENAWEE AVE
Phone: (310)253-5229 '
CULVER CITY,CA Zip: 90232 - ' '
Owner: CHARUCHINDA, PACHANI ET , .
Address: AL
COSTA MESA,CA Phone:
1691 NEW HAMPSHIRE DR Zip: 92626 ,
Contractor: - ORANGE COUNTY SERVICES INC DBA GEORGE BRAZIL PLU
Address: 3801 LENAWEE AVE ,
Phone: (310)253-5229
CULVER CITY,CA Zip: 90232
License:679898 •
•
SCOPE OF PERMIT
CHANGE-OUT OF A 100K BTU FAU INTHE GARAGE OF AN EXISTING SFD.
1 INST FAU>100K BTU ' / _ ' .
NO OTHER WORK AUTHORIZED WITH THIS PERMIT. - - - • -
- FEE SUMMARY -
_ Quantity __ - - Quantity"
ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0
Inst FAU<100 k BTU $0.00 0 Repair/Alt Refrigeration Unit $0.00 0
Inst FAU>100 k BTU $18.20 1 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
1 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems
1 Gas Piping $0.00 0 Up to 3 hp/100 k BTU , $0.00 0
Factory Fireplace $0.00 0 - - 3 To 15 hp/500 k BTU.- , , , ' ,$0.00 0
Hood w/Mech Exhaust $0.00 0 - , 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
r t • r-
t
- i J' ,.
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
2448-48(8/00)
DECLARATIONS (< ) ( -) .
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations: ,
O 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.
////�1�� My workerss''s°_m nsati n Insure a carrierandpolicy number are: // /�
Carrier: 'Ch7 tU/ ✓(f Policy Number: /4/�3 z7 &/
(This section need not be tompleted it the permit is valued at one hundred dollars($100)or less.) . -
❑ I certify that in the perform.Ice of the which •'s permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of la a " sh.uld become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these pr.• - - /✓�/)
Applicant Signature: ��� Date: - (� 19 47
WARNING:FAILURE TO SECURE W'/ERS'ODMPENSATI. COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),I ADDRION TO THE•• 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 , •ter 9(commencing with Section 7000)of Division 3 of the Business Pro iypq Code,and my license is in full
force and effect.Lic.# $ Lir t. Class# (i I�LJ
.Contractor's Signature: / / ' Date: /— 2/ -KV-1
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,end 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.). '
O 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.).
O 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 Drivers 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 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 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 Calif omia 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 apermit 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 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 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.
Q.j re •,1 e ) / n�f-� t¢�
DaL!
�a r Authorized Applica / -Date ..
CODE I INSPECTION TYPE PATE INTmALS CODE( INSPECTION TYPE PATE s48
1616 Fixed System Final Fire Prevention 206 Final Mechanical r�- S-co 41 it
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
CIix OF COSTA MESA REQUEST FOR OCCUraNCY
TRACT NO. 6 5-5?)._ DATE 7-2 2 - 7 2-
LOT NO. /1—.1
ADDRESS /6.9/ `77OIiI %2^M/� Il p D-4
90 GA1.
The developer of the above entitled tract desires to sell the above set
forth lot prior to the time that the tract has been completed and its streets
accepted by the City of Costa Mesa.
The undersigned, by executing this agreement, acknowledges that
(he-she-they) (was or were) advised that this tract has
not been given final inspection nor has it been accepted by the City of Costa Mesa
as having complied with the conditions of approval which were imposed by the City
at the time the final tract map was approved.
The City assumes no liability for the enforcement of the conditions
necessary for approval other than those conditions protected by surety bond.
The undersigned agrees to indemnify and hold the City harmless from
any claim resulting in damage or personal injury to the undersigned by reason
of the aforementioned uncompleted condition.
L"'"----116:44.-: /
BY AirdC�..'(4k
Purchaser
BY (21,_
Developer and/or autho 'zed
representative
BY
Lender
OWNER MODULAR Technology, Inc. DATE 7-15-71
JOB ADDRESS 1691 New Hampshire Drive BUILDING PERMIT NO. 33310
GENERAL CONTRACTOR Same DESCRIPTION of WORK Res.w/att.gar. _
AP No. LOT 41 TRACT 6582 FIRE ZONE VALUE $29, "300.00
INSPECTIONS Signature Date GROUP 1 & J TYPE V ZONE R-1
SOIL 4/ —`-7/ SUBCONTRACTOR PERMITS ISSUED
GAS
Date Number I Signature
WATER PI bi
ROUGH PLUMBING 04. /�/Ji y( ( ��/�7/7X-
PROP. SWR. LINE ROUSE CON. Ian' ,t, 277,°j!J"� � qL���j j/-/9-7 6
SPRINKLING SYSTEM •`�
MISCELLANEOUS yy,y
ROUGH HEATING AND AIR CONDITIONING Z31 n/
TEMPORARY SERVICE OR POLE ••
UNDERGROUND ❑ POWER ❑
ROUGH WIRING 7�js/ 1.1.7/ �( Heatin. a�d Ven�� �j v
TRENCHES S FORMS 21 STEEL REIN F. 0 �5�l���>�` �j�7Ir�tny yp/�l/f��m��T/��L/
FLOOR SYSTEM a%.( OF . A/%%%/,/`21"/L�i///S�a aff,IS
BOND BEAM LI STEEL REINFORCE n ) ^�
SHEATHING /�/ez
f( j'7
FRAME AND FLASHING ` I �'y
LATHING - IN OUT I� q.4/�
PLASTER, BROWN COAT i/Q�STRUCTURAL, FINAL /
,fes�/ p/y����/�J+Elec Hir
_
HEATING, VENT., REFRIG. AND A.C., FINAL rZeX 1aTiTif3�JL/ J7 ME1M7�
PLUMBING, FINAL AND GAS TEST rarra �
r
ELECTRIC, FINAL S/" L
BUILDING. FINAL Q.9 On J
33310Pii iU19t* 15225
�u� 207iO
PAID 11
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
For Applicant to Fill in Completely RECEIVED) BY DATE RECEIVED DATE ISSUED
BUILDING -If—ADDRESS 1091 NPv Hantpshanp Tin (9- 6_12- /, -/�7/
PERMIT NO.
OWNER Modular Technology, Inc. . A.PNO.No. 33310
BUILDING
Z MAIL ADDRESS 16 1 N9r-H�#�
ADDRESS 11.04 E. 17th Street Q
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a U CITY Santa Ana NNLu ui O. 547-9673 TRACT 6582 I LOT 41 BLOCK
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CONSTRUCTION NEW I ADD I ALTER REPAIR MOVING DFMOLISH
2 N LENDER
am X •
J D BRANCH
JV) OWNER Modular Technology, Inc.
mJ ADDRESS W/h VALUE ca9/-31"`—
'J < OR ENGINEER Kermit Darius, AT-CO ARCHITECT ' A NO.644-711 USE Residence - $ 1 y q0
UQ V FIRE U 171-,9-
W cc ADDRESS 3111 2nd Ave. , Corona Del Mar ZONE TYPE .GROUP
0. 1-9
APPROVED U
aumILIJ O CONTRACTOR Owner BY DATE
Z
J cc ADDRESS Same ✓l
W W TEL. ZO NO.OF USE OF NEW flA
ZH CITY Same NO. � (PLANS 1.---- BUILDING
STATE CITY YARDS APPROVED YARDS APPR VED
ul
cc)cc LIC. NO. 252549 LIC. NO. 1690 MAIN BUILDING ACCESSORY B ILDING
SIZE NO.OF BLD(->S. (FROM C/L STREET) y
OF LOT 50 X 100 I NOW ON LOT FRONT 414 FT. C/.--- FT.
USE OF
EXISTING BLDG. -- R SIDE /OFT. FT.
I- SIZE OF NO.OF
Z NEW BLDG. 1782 SF ROOMS 7 STORIES 1 L.SIDE O .T. FT.
EXTERIOR WA ROOF
V COVERING `der Plans COVERING Wood Shingles REAR /S FT. FT.
J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN&
a MAIN BLOCS. ACCESS. BLOCS.
0
O Construct new residence with C U.P#V,� -(✓ 3 AP ROVEDS-7tr-w g
I- attached garage. BY
APPROVED �a^=[�' nr/- /I /
OI hereby acknowledge that I have read this application and state HOLD FOR SPECIAL MIRE/MENT5
✓ that the above information is correct and agree to comply with _
It all laws regulating building construction, and I shall not employ �)
F any person in violation of the workman's compensation laws of .cJ�---
N the State of California. /, LAO. FT. "if/(J U 9. 9
Z c:2 I hereby certify that I am properly licensed as a contractor under N/ S /1 0
the State of California Business and Professions Code, Dlvisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: 'm
IC
am exempt from the pr ions of the State of C lifornia Business
and Professions Code ision 3,Ch Ater VALUATION /) �(.}1 Ti
PERMIT FEE $ /0. , aro
Signature of //// �r [o
Permittee /�n,L/L/�P /� $1p, ..O PLAN CHECK $ �[/ i E
Authorized Agent ( v'f/3�\ IS�, LL
TOTAL FEE $
OWNER CHARUCHIMDA, Pat DATE 3-15-73
JOB ADDRESS HaD.
Drive
BUILDING PERMIT NO. 36228
GENERAL CONTRA
CTOR1691New HaD. W. McFerran DESCRIPTIONofWORK Patio Cover
AP No. 139-612-17 LOT La TRACT 6582 FIRE ZONE VALUE $ X50.00
r 'INSPECTIONS Signature Date GROUP ,T TYPE 'TV ZONE D1
'soli_ PERMITS ISSUED
GAS SUBCONTRACTOR
WATER -- Date 1 Number Signature
Plumbing
ROUGH PLUMBING
PROP. SWR. LINE ❑ HOUSE CON. ❑
SPRINKLING SYSTEM
„MISCELLANEOUS
"ROUGH HEATING AND AIR CONDITIONING
TEMPORARY SERVICE OR POLE
UNDERGROUND fl POWER ❑
ROUGH WIRING Heating and Vent.
TRENCHES 0 FORMS 0 STEEL REINF. ❑
FLOOR SYSTEM
BOND BEAM n STEEL REINFORCE n
SHEATHING
FRAME AND FLASHING
LATHING - IN n OUT n .
PLASTER, BROWN COAT
-
STRUCTURAL, FINAL •
HEATING, ,VENT., REFRIG. AND A.C., FINAL 11111
PLUMBING, FINAL AND GAS TEST n
ELECTRIRIC, FINAL
BUILDING, FINAL
36223 PAID
nn 5Q8 y;:, 5.5O
j "l R 15-73c:.....
COSTA MESA BUILDING-SAFETY DEPARTMENT
•
• P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
• For Applicant to Fill in Completely
/ �/ pi,a) /� �/ .REpEIVEp BY/ DATE RECEIVED DATE ISS ED
BUILDISNGS�/6 / ////] 'p ,a) '/9/9!/��(/,2577 -c/ ,,,,, /S��7 'W
OWNER S7 /'Ir 1 ' ',n nue TY�/''//,F//1'�y'/ n - A. NO. f 3Gf/- (d al -/7 73
PEflrBUILDING /,//rl(Qdl.[ /J)MAIL
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ADDRESS //6 iI A)64)) 6 //T//// -#/e, ADDRESS /b / / .d Lily"I�� / VV
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d U CITY c / NO.
ZNEW ADD ALTER REPAIR MOVING DFMOI ISH
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am •J D BRANCH
JN OWNER 4T /4�2ocAc', 44
m J ADDRESS /n/` ,,V-ALUE
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LU '� . APPROVE , /
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J¢ ADDRESS / D ,',e,t,) ,D,F 44f f1
W W - ZONE /f/ NO.Of OF NEW r'--
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O= CITY NO. Z PLAN$ BUILDING
- � . ten
— ( S-7 471—S�y
W STATE ���� �� CITY YARDS APPROVED YARDS APPROVED
zn 0 -LIC. NO. LIC. NO. MAIN BUILDING ACCESSORY BUILDING
SIZE NO.OF BLDG&. (FROM Cpp/�L^yS�7(rRR�E )
OF LOT • l NOW ON LOT RONT.d '�"FT. FT.
USE OF
EXISTING BLDG. ,5i T/ 1n R SIDE FT. F
' I— SIZE OF / ,!'� NO.OF �/.�{��/�j tp/
Z NEW BLDG. /33 ROOMS STORIES L.SIDE 0.-LE' FT. F
UEXTERIOR WALL I ROOF .t "'I:
_ COVERING COVERING REAR ed.—.0.3ed.—.0.3FT.�) FT. • 1
J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. .BET. MAIN&
S MAIN BLDGS. ACCESS. BLDGS.
OL5---1/X• '7 6 /( yN//) C UUP.# APPROVED
I— �,-.• / / APPROVED
Cl) - LC�G-/A l � V ATE
2 - 604
I— I�
0 I hereby acknowledge that I have read this application and state
D that the above information is correct and agree to comply with
CC all laws regulating building construction, and I shall not employ 10-
I— any parson in viblation of the workman's compensation laws of
U) the State of California. 0
Z I hereby certify that I am properly licensed as a contractor under SO. FT. o
rho State of California Business and Professions Coda, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY;
cc
am exempt from the provisions of the State of California Business VALUATION
and Professions Code,Division 3,Chapte �� N
`PERMIT FEE $ gl
Signature of ( //� r (JO m
Permittee ` ✓��� <�1 $ �T SO •LAN CHECK $ • E
• Authorized Agent �� J 0- 6/Y/4-4: `J IL
TOTAL FEE $