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Home My WebLink About3221 MINNESOTA AVE - Building Permits(714) 754-5273 • Faz (714) 754-0856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 JobAddress: 3221 MINNESOTAAV Suite No Vicinity: FURNACE Parcel Number: 73908106 ApplicanC Address: Owner: Address: COOTER,LYLE 12922 HARBOR BL GARDEN GROVE, CA OLSON, MARK A 426 EL MODENA AVE NEWPORT BEACH, CA MECHANICAL PERMIT Phone: (714)530-7320 Zip: 92840 Phone: Zip: 92663 Contractor: JIM WAYNE EICHAMN EMPIRE PLUMBING HEATING 8 A/C Address: 12922 HARBOR BL GARDEN GROVE, CA FURNACE CHANGEOUT ISSUE FEE Inst FAU <100 k BTU Inst FAU >700 k BTU Repair/Alt Cooling/Heat Inst / Rep. Recess Wall Htr Refrig Sys <100 k BTU Refrig Sys >100 k BTU Gas Piping Factory Pireplace Hood w/Mech Exhausl VAV Boz Vent Fan / Single Ducl Appliance Fire Dampers Smoke Dampers Insi or Relocate Appl Vent Air Handlers < 10000cfm Air Handlers > 10000cfm Floor Fumace Floor or Suspend Healer $23.50 514.80 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 so.00 $0.00 $0.00 so.00 50.00 50.Oo $0.00 50.00 50.00 $0.00 Quantiry 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Phone: (714)530-7320 Zip: 92840 License: 652877 SCOPE OF PERMIT FEE SUMMARY Status: ISSUED Applied: 11 /26/2001 Issued: 11126/2001 ISSUED BY: ' Repair I Alt Absorbtion Unit Repair / Alt Refrigeretion Unit Ventillation System Evaporative Cooler Commerci a l I ncinerator Domestic Incinerator Compressors / Absorption Systems Upto3hp/100kBTU 3To15hp/500kBTU 15 To 30 hp / 1,000 k BTU 30 To 50 hp / 1,750 k BTU Over 50 hp / Over 1,750 BTU Boilers Upto3hp 3To15hp 15to30hp 30 to 50 hp Over 50 hp Other Mechanical Fee Investigation Fee Plan Check Fee Reinspection Fee TOTAL CALCULATED FEES COMMENTS / SPECIAL CONDITIONS Quantity $0.00 0 50.00 0 50.00 0 $0.00 0 50.00 0 $0.00 0 $0.00 0 50.00 0 50.00 0 50.00 0 50.00 0 so.00 0 50.00 0 50.00 0 50.00 0 30.00 0 50.00 50.00 50.00 538.30 NOTICE: Tha work authorized by this permit shall comply with all applicable handicap access requiremenis under Ca�ifornia statutes and related regulations. (Ortl. No. 92•28, § 7, 72-21-92) EXPIRA710N: This permit shall automatically expire and become vold it work is not commenced within 780 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under [his permlt to be considered legal, such work must comply with all applicable codes, antl all requlred inapectlona and final epprovel must be obtained. Failure to obtain inspections antl final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 75M5626 2aae-ae Iarool WORKERS'COMPENSAnONDECLARAnON: � _ I hereby eHirm untlor ponelry ol per�ury one of the lollowing declaretions: ❑ I heve entl will moinlain a certlficala ol consent to self-Insure for workers' compensetion, e5 provlded lor by sectlon 3700 0l lho Labor Code, for Itie pertortnence o1 the wark lor which Ihis pertnit is issuetl. � 1 have and wlll malnteln workers' compensetlon Insurenca, as required by sectlon 3700 of Ihe Labor Code, for t�e perfortnanca ol Ihe work tor whkh Ihis pertnil is IssueO. My workers' compensation Insurence cerrler entl poliry number ere: r_ �Certier: - �� ./ N. ( r/' � , Policy Number: �� l7%� % S 1(This�section need not be canpleted i/ the permit Is ve/uetl e! one huntlred dollars ($100) or /ess.) ❑ I certlly thet In the peAarmance of the work for w�ich this Dertnit 19 issued, I shall not employ any person In eny manner so es to become Suh�Oct to the workers' compensetlan lews ot Calllomia, end egree thet II I shoultl become sub�ect to the workers' compensatlon provisions ot Sectlon 3700 ot Ihe Lebor Cotle, I shall forthwith � comply wlth those proWslons. ApPlicam Signeture: !��ete:� — � �� Zc�i i WARNINO: FAILURE TO SECURE WORKE ENSAiION COVEMOE IS UNLAWFUL AND SFU115UBIECT AN EMPLOVER TO CRIMINAL PENA�TIES AND dVIL FlNES UP TOONE HUNDRED TFIOUSAND DIX.LARE (E100,000), IN / DdT10 1 TO iHE COST OF COMPENSATION, DAMAGES AS PflOVIDED FOR IN SECiION 3lOB OF THE UBOR CODE, IMEREST. AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aHirtn thet.l.am Ilcensed under provislons at Chepter 9(commencing with Section 7000) of Divisian 3 oLthe Business flnd Pmfessions Code, entl my Iicense Is in full torce ena eNect Lic: a° Ciess a' l�� Z� e S G Contreaors Signalure: � Date: // Zl fs m� CONSTRUCTON LENDING AGENCY: ❑ I hereby eHirtn that Nere Is a wnstruction lending epenry for the peAarmance ot the work tor which thls parmit is Issued. (Sec. 3097, CIWI Coda). Lentlers NflmB: Lentler'S Atldress: Signature: Date: OWNER-BUILDER I heraby effirm thel under penely of per�ury thet I em E%EMPT FROM THE CONTRACTORS LICENSE LAW tor Ihe fdlowing reason (Sec. 7031.5, Business en0 Professions Code: Any ciry or counry which reqWres e permit to wnstruct, elter, improve, demolish, or repair eny swcWre, pdor to its Issuente, elso raquires t�e eOD��ent tor such pertnit to tile e signetl stetament Ihet he or she is IlcanseA pursuent ro Ihe provislons ot the Contrflctors LJcense Law (Chapter 9(commendnp wlth Seclirn 7000) ot DMsion 3 af the Business entl Prafesslans Code) or thet he or she Is exempt Nerefram and the besls for the allegeA e:emptlon. Any Woletian ol Soction 7031.5 by any epplicant lor e pem+' subjecu the epplicant to e Uvll penalry of not more Ihen Ilve hunCretl tlollers ($500).): ❑ I, es owner ol ihe properry, or my employees wlih weges as iheir sole compensatlon, WILL DO THE WOpK, antl the structure is not Intende0 or oflerad tor sale (Sec. 7044, Business antl Professions Code: The Contractors Licenso Law tices not appy to an owner of property who Dulltls or improves Iheraon, antl who does such work himsetl or hersetl or I�rough his or her own employees. Drovitletl thet such ImD�a�emems ere not imended or aHereO for ule. If, however, the bulltling or ImD�ovement is soltl within one year oi completion, the owner-builtler will have the burtlen of proving that he or she did not build or im0�a'e tor purpose of sale.j. ❑ I, es owner ot Ihe properry, am E%CLUSIVELV CONTAACTNG WfTH LICENSEO CON7RAC70R5 to construct the project (Sec. 7044, Business anA Professions Cotle: The contrectors Llcense Law does not appty to en owner ot propeny who builds or improves thereon, end who conirects lor such project wit� a comrecior(s) license Oursuent to the Contrectors License Lews.). ❑ I em ezempt under sec. Business entl Pmfessions Cotle for this reeson: Signawre: Date: Owner ID vodiied by tldver's Iicense. ❑ Vos ❑ No Dnver's Licensa No. Venlicatlon at Ownership by (rype at document I.a. - property tea blll or tleetl): Expires: DIVISION OF INDUSTRIAL SAFE7V PERMIT CERTIFICATON: ❑ I hereby certity thei no excavetion flve (5) or more leet in depth into which e persan is requiretl to descend, will De mede In connectlon wllh work authonzed by this pertniL end that no bullding sWcture, scafloltling, lalsework, or demolltion or dismantling Ihereot, wlll be more than thirry-six (38) faet high. (Chep. 32, Gry 2, Ar12, Sec. 34/, Title 8, Califomia Atlministretive Cotle). ❑ As owner-builder, I will nol employ enyone to do work which would require a permil Irom the Divislon of Indusiriel Sefery, es noted ebovo, unless such person has e pertnil to do such work tmm the division. Signature: Date: Division ol Indusirial Selery Permlt Number: CER7IFlGATE OF COMPLJANCE AND AllTHORIZATON OF ENTTiY: I certity untler penalty ol perjury that I have reatl this application end state t�at Ihe information given is correct. I agree to comply wlth all state lews entl ciry ortlinances relating to 6uilding constmction, and euthodze rapresentatives ol the Clty ol Costa Mesa to enter upon the above-deunbed property for Inspeclion puryoses. I egree not to occupy or ailow occupflnty ol any building authorized by this pertnit until tinal inspection. CODE �. �x5vernoNTrre 1616 Fi:etl System Flnal Fire Prevenllon 1288 Paol Spe Finel 200 Finel Re-Root 201 FIneI Block/Releining Well 202 Finel Fectory Fire Place 203 Flnel Sign 204 Finel Demolltlon QdjE INTffULS �j INSPELTIONTYPE 206 Final Mechanical 208 Final Plumbing 210 Finel Electrical 212 Finel Fire Prevention 220 Flnal Planning Apprwel 222 Finel Slte 250 Finel Bullding/OccuOency � Peg II�ELS � Costa Mesa 1� ..� �.�.Y.� �� P.�� CITY OF COSTA MESA INSPECTION REQUEST SUMMARY Addresa Permit Twe Sub Twe DescriuNon 1.��-�1 Lf �.l ) o�rn, �fp �iD-�--�� :� � �— �� . .4 � 1 1 � r• - � -- rM ' �� vi ili � _ 16. 17. AOP��ant to flll In all soaces excev� ��ase wlthin heavY Doraer Iines ana si9n all aooroD��ate aeclaratlons. CITY OF COSTA MESA CONSTRUCTION PERMIT PEFj�v11T NO. � � TRACT NO. LOT NO. UN�NO. •) i � / � � _ Project Address _..[�.L—�� Applicant's Mailing Ad�r_�ss ' �' Y �/ � Owner's Name ' � Phon�C.� Address Arch/Eng." Licensa No. Address / � Contracmr's Nam Phone . Address (mailingl _ Ciry license No. � LICENSED CONTRA TOR OECLARATION I hereby'affirm [hat 1 am Ilcensetl untler provlslons of Chartor 9(commencing with section 7000) of Division 3 ot lhn Business antl Professlons Cotle, antl my license is in � II jpr�qaptl et/ect^ 1 � l` (� � !I A/n Ja License C�sc q b�a � ^� ice/�s% o ' I oate��/� a t _ j �F1'.L67� � �� WORKERS' COMPENSATION DECLARATION • I hereby aftirm that I hdv¢ a certifica[e ot consenl lo selt-insura or a certlilcate �, Workers' Compensation �In1surance, or a certl{fi-e�a copy thereof (Section '00� Lab. C�}, '.`- /� I 1/� IComPanY ^�l j1S . oliq No. �...70E��-7-{�-uJ �ertitietl �oPY �5 Flletlbwith�[hehci[Y Oi %`'ISiqn. �q-� ' Date APPlicant � ��I:/�-.�-/,�// � /��/ ./� EXEM N FROM WORKERS' COMPENSATION DECLARATION (This section neetl not be completetl if'tne permit Is for one nuntlrea (5100) or less)-. I certlty tha[ in th< p¢r�ormance ot the wark lo� wnlch t�is perm�t Is Issuetl, I snall not employ any Oe�son in any manner so as to become subject to the workers' Compensation Lawz of Califomia. � Date Signature `N0T1[E: If, after makin9 this tleclaratlon, you shoultl become subject to tha Workers' Compenution provlsions o/ tbe l.abor Cotlo, you must torthwlth comO�Y w�[h such p�oviSions or IhiS pe�mlt Shall be �tleemetl ravok¢tl. CONSTRUCTION LENDING AGENCY_ � ' 1 hereby atfl�m Ma[ [here i5 a ConSVUCUOn IGntling dg¢nGy IOr the p¢rfOrmanCC 01 the work for which this permit I5 IiSmd (Seclion 3097 tiv. C.) � L.entler's Name Lentler's Atltlress OWNER BUIIDEN DECLARATION I hereby aftirm that I am oxompt trom tho Contractols Ucenso Law tor the tnuewina reason ISection 7031.5 Buslness antl Protesslonal Cotlo: AnY cilY or to nie a ision 3 ot tne ! ref�om antl the I7.5 by any ap alty oi not more I, as owner ol ipensatlon, will � or tlollars Of [n8[ OO/SnC Iz oxamp[ Any vlolalion ot Sectlon tha appllcant to a Civll with wag05 as tnoir sole i nOt IntunOetl ar olferetl Cotle: The Contractor's ty wM10 bullUs OI ITO�OWS ir tnrouoh his or her own sale. If, �owoveq t�e bulitling or improvOmen[ is sow wrtmn ona year or com- pletlon, the own¢r�will have lhn bu�tlon of provin9 he/sho tlltl not builtl or im� �rovo 1o�tha pu�pose ot Sale). I, as owne� ot tha prOPerty, am ex<lusively ContraCling with Iicensetl con- t�aclors fo tonstruGl the projecl (Seclion ]044, Business antl AO�e55ion5 Cotle: The ConVactor's License l.aw does n0� apply to dn Owner o( property wbo builtls or Imo�oves thereon, antl who contracts for such orojects with a<on- tractor(sl license Oursuant�fo the Contractor's License Law�. I am awaro [bat proof o( tM1eir Worker'S Compen5alion InSuran<a ShOultl be prOvltletl to ?1e. ❑ I$m exempi untler Section B. & P. C. tor tnis reason � �ate ' Owner _ � I hereby certify .that I have reatl [niz Ifl/OlR1dIlOO IS CO!lCCL I dOf2C LO COTO antl state law5 relati� SCOIdIIVCS Of H115 �CI insoection o ses � Signature Driverz' License or 55 IF OB65-46,rev.10/84 ntl state lhai tho above y antl county orainancas h¢reby authoriz¢ r¢pra- �enlionetl O��opert,y, f/or Date .�1: / c ��TT CC TYPE OFCONSTRUCTION �LINEW IJ AOD LJ ACTERATION L�YREPAIR ❑ CONVERSION � DEMOLISH ❑ OTHER p�p *, DESCRIPTION OF WORK/USE OF BLDG. � � S Main Buildi E TVFEOFPERMIT GRADING FOUNDATION STRUCTVRAL T FrOnt ❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL 8 Rear - ❑ OTHER A PROJECT DESCRIPTION SQ. FT. ' OCCVPANCV C Right K �CONSTRUCTION TVPE VALUATION S S Left ZONE GRADINGCU.YDS. ACRES _ PIng.ReL�h : Remarks: ' Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains � 3as Service Outlets interceptors ' <itchen Sink� Lavatories � �—Trap Roof�Orains . . . Reinspection Fee $15 Duct - Under Ground Duct - Siructural Duct - Ventilating Exhaust System ❑ MWtiple ❑ Firepl/FacL BIL IC80 # Heating System & Ducting . ❑aioo,000aTuOiao,00asr Rein ct' F � , � spe ion ee White - Bullding; Canary - Appllcant; Plnk - Accountin9; Goltlenrotl - Assessor $15 Showers 1 Service Sink - ' Sewer Cap $ewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater ' - Water Service AUIO-WeSA Launtlry Trays Issue Fae Hood or Type I ❑ Canopy Type II ❑ Refrigeration System ' 00.100,OOOBTU ❑100,000 System Repair/Alteration Fire Dampers Registers Isue Fee g 3 $ 3 n u Automatic Washer -' Construction Pole Sub. Cooking Unit 3401 5/2 /,�,. : �. Zone Accessory Building: � Parking Req./Provided ELECTRICAL � �Transformer ❑� 15-50 KW , � 50+ KW Meter ❑up to 100 amps � Meter ❑over 100 amps Dryers LJGas LlElectric Fan F.A.U. Fixtures Device Boxes ' Outlets Switches Garbage Disposal Generator �0�5 KW �5-15 KW Suh Panel' � MororsOai HP Oih-8 Inc.Solar �9-15 HP �16-15+ Microwave Pole Light Range � ; Standing Sections Trash Compattor FEE$ Z O N I N G R E Q M T S Reinspection Foe $15 Issue Foe $ 3 � DEVELOPMENTSERVICESREQUIREMENTS: � Zoning APP�oVed By Data Buildin8 Approved By Date Appliption laued By � Dat Z2� SUMMAHV OF FEES ' � , BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT — PLUMBING $ �.(LQ— ��UANCE $ PLAN CHECK 25% 3 ENERGV P.C. $ � ELECTRICAL $ GRADING $ PLAN CHECK 50% $ � MICROFILM $ � — MECHANICAL $ TOTAL FEE $ ,�Q �1 PLAN CHECK 25% $ , CpNSTRUCTION ANDPLANNING - POOL �A , ApPROVALS Permit# Date Inspecior APPROVALS . Permit# Date Insprctnr 1. 7emporary Electrical Service or Pole 52. Pool & Equipment Location 2. $oil Pipe�Undrgrnd. 53. Steel Reinforcement �3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding . 5. Steel Rei�torceme�t 56. Rough Ptumbing & Pressure Test 6. �lectrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings , � 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK i t. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 72. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System�Final 16. Rougfi Electric Wiring 67. Fencing & Access Approvat 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T 8ar Ceiling 69. POOL/SPA SYSTEMS FINAL 79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test , 72. Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank �Gas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structurai) & Monocoat 75. Dry Chemical 27, ftameandFlashing 76. DryStandpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. PlBster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 5�2.��$- GEF%G�/i G�O 34. Final Heating & Air Conditioning 35. Final Gas Pipe�Test 36. HOod or Canopy 37. Final Factory Fireplace 38. Final Plumbing (c,3 �s G,�(� 39. Water Service-Final � 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer , 43. Backflow Irrigation 44, Landscape Irripation 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 57. CERTIFICATE OF OCCUPANCY No. Oate �OT 6 - TRACT 3625 1�� COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX ffi17 COBTA MEBA. CALIFORNIA For Applitanf fo Fill In Completely TYPE OR PRINT BUILDING qooREss 22� MINNESOTA AVENUE COSTA MESA. CALIFORNIA owkER KENKOL CONSTRUCTION CO. ADOREss �555 P�A�ENTIA AVENUE ��.�, NEWPORT BEACH Naw�[ 6-32� ARCHITEGT TEL. CONTRACTOR K•W• Ko�� po�aess ��J55 PLACENTIA AVENUE c�n, NEwPORT BEACH STATE 6t�95 TEL. MI -3zz7 LIG. NO. NO. SIZE /,. _. ,.... I xo. ov e�oce. FIRE ZONE �Haw� r�!e r�r /T� R p � �� U�� J �.' �U% 5-13-(en ��j�„�c� �t-- �- APPLICATION', FOR: PERMIT �� •��i �•. . _ :,.,,,,.i..•. BUILDING For Office Use Only NECEIPT NO. I� P.lRMIT: NO� COSTA MESA. CALIFORNIA USE OF . YARDS EXISTING BLDG. APPROVED BETBACK LINB FROM ICeNTCR LINC CENTeR OP 6TREeT O� REAR YARD 2 � FRONT t t SIDE YARD LEFT � RIGXT � R.61DE DESCRIPTION OF WORK SIZE�ING � / � � O FJCTERIOR WALG.T� COVERING J U E OF BUI1,pING � �INGLE-YAMI� 3 I II DEMOLISH I APF'ROVED BY 10. OF tOOMS STORIES � ROOF WOOD SHINGL�ES ZONING NO.OF SE OP NEW PNNB BUILDING i� 1 HERHBY ACKNOWLQ��H THAT 1 HAVE q6AD TNIB APPYWTION 'mC AMOUNT BXOWN UNOEfl VALUATION IB POP THE ♦ND BTATE TXAT ABOVE I6 CORNECT AN� GRE6 TO CON- pUHP08E OP HBTABLI9HIN0 A eeftMlT FEE ONLY. PLY WITH AL 1 RDINANC¢8 NO BTAT¢ RBGUTATIN6 BUIta1No c 8 oN. VALUA710N �j �— 91GNATURE OF " :'ERMIT FEE $ i PERMI7TE ' /� �� a $ f �/� PLAN CHECK $ AUTHORIZED AGENT Lr.i 0 TOTAL FEE LL