HomeMy WebLinkAbout108 GEORGETOWN LN - Building Permitsa
CITY OF COSTA MESA
BUILDING DIVISION '
77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714) 754.5626
PERMIT NUMBER: M10-00145
PERMIT TYPE MECH
APN: 41916217
JOB ADDRESS:
Vicinity:
SQ. FT: 0
108 GEORGETOWN LN CM
SCOPE OF WORK: CHANGE OUT FAU. SAME LOCATION
OWNER: MC CORMICK, MICHAEL E JR
PHONE:
APPLICANT: JACOBY, ERIC -
PHONE:
CONTRACTOR: SERVICE CHAMPIONS
Address: 22911 SAVI RANCH PKWYUnit:
City/State: YORBA LINDA, CA. - ZipCode: 92887
MECHANICAL PERMIT FEE SUMMARY
MECH ITEM FEE: -
$38.30
PLAN CHECK FEE:
$0.00
INVESTIGATION FEE:
$0.00
REINSPECTION FEE:
$0.00
TOTAL FEES: $38.30
STATUS: -, ISSUED .
DATE ISSUED: 12/01/2010
ISSUED BY: KJB
Suite/Unit:
;r
Address: 108 GEORGETOWN_ LN Unit:
City/Slate/Zip: COSTA MESA, CA
Address: Unit:
City/State/zZip: - -
License No. ' 799170
.PHONE: -714-777-7777
. , .... CELL:
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
CODE 1.
INSPECTION TYPE DATE INTITIALS
CODE#
INSPECTION TYPE DATE IN PALS
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
WORKERS' COMPENSATION OECLARATIOO
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
erformance 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�@rkers' compensation Insurance carrier and policy
number are: I (3 W
(This section neetl rrol0e mm/p�letetl/�tl (h perm4a valued at�^me�huntlred tlollars (Si 65)
rube,: � l�7 0 C.15 V I C)
❑ I certify that in the performance of the work for which this permit is
issued, I shall not employ any person in any manner so as to become subject
to the workers' compensation laws of California, and agree that if I should
become subject to the workers' compensation provisions of Section 3700 of
the Lar Code, I shall forthwith mply with these provisi ns.
Bqr f5 S1 runure�, t v
WARNING: FAIL TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($700,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force and effect.�—�y ^ ZO
o
d(+oMracys;Sgnature Lf
CONSTRUCTION ENDING ure Y:
❑ I hereby affimt 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:
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 Omer 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:
305746 (3/07)
Owner ID verified by driv ense. ❑ Yes ❑ No
Driver's License No. Expiresr'
Verification of 0vmership 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 ❑ 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? ❑ Yes ❑ No
5. Does or will the applicant or present or future building occupant require for
the work which is the subject of this application a permit for such construction
or modification from the South Coast Air Quality Management District or from
any other air pollution control district or agency? ❑ Yes ❑ No
(Section 65850.2 of the California Government Code requires that the requested
information be furnished on applications for non-residential building permits).
6. Will any part of the facility to be constructed under this permit be within
1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
(If "yes", the facility must meet the requirement of Sections 25534 and 42303
of the California Health and Safety Code).
7. If a permit from the South Coast Air Quality Management District or other
air pollution control district or agency is required for the work which is the
subject of this application, have all of the disclosures prescribed by California
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. (If "yes", attach certificate of compliance from the appropriate air pollution
control officer). ,
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
information given above is correct. I agree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
Signature Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury that I have read this application and state that
the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
the City of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspection.
G� Signature of L I Owners) nal
Date
� edAppliranC
2008 Residential RV
Climate Zones 1 and 3 - 7
Site Address•
"
2008
Euforcwaenr Agency:
Dare:
li
Permit #:
a �0/ v< i U
C057 r /5"5
zh c
Conditioned
Duct insulatio
Equipment T e'
List Minimum Efficiencyt
Floor Area
re uireme A
Thermostat
❑ P!Oaged Unit
0 -Furnace
C1AFUE?O
❑COP_
Over 40 f f due
❑Indoor Coil
13SEER
❑HSPF
Served by system
X2:0 of
�—
added� re 1 n
nc dittoa ace
ack
(/Ir�O�aheadr prefenr, muss be
❑ Condensing Unit
D EER _
D Resistance
pncy6ditio
[f 6 !, 3pa
insmlied)
O Other
Y'
1. Equipment Type; Choose the equipment being installed; if more than one system, use another CF -IR -ALT -HVAC for each system.
2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPF for typical residential systems.
Contractor (Documentation Author's /Responsible Designer's Declaration Statement)
• 1 certify that this Certificate of Compliance documentation is accurate and complete.
• 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this
Certificate of Compliance.
• 1 certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the
requirements of Title 24, Parts I and 6 of the California Code of Regulations.
• The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable
compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit
into licanon.
Name: ( C ov;3
Signature:
Company: - c
S�/L / 4'_ c' /N iv S
Dat
Address: _
zz"14
License:
u
ChylState/Zip: - L/ C '2—,M %
Phone: —7111-
7 j •� 7 7 7
2008 Residential Compliance Forms March 2010
(ENRORCEMENTAGENC)'
CAN,C OMIZE:YiITHLETTERHEAD/SEAL) % I
r
2008 Building Energy Efficiency Standards Residential HVAC Alterations
Climate Zones 1 and 3 through 7
BUSINESS AND PROFESSIONS CODE, SECTION 7110
Willful or deliberate disregard and violation of the building laws, including the California Building Code, and
local permit requirements constitutes a cause for disciplinary action from the Contractors State License Board
working in conjunction with the local building department. This action may consist of fines up to $5,000 per
violation or suspension/revocation of a contractor's license.
'WHEN IS A PERMIT REQUIRED?
A written construction permit shall be obtained from the enforcement agency prior to the erection, construction,
reconstruction, installation, relocation, or alteration of any mechanical system, except as permitted in Appendix
Chapter 1, Section 112.2 of the 2007 California Mechanical Code. Projects requiring permits include, but are not
limited to:
• New HVAC installation
• HVAC Changeout
• Replacement of fumace, coil, FAU, or condenser
• Relocation of an existing HVAC unit
• Adding or replacing more than 4011 ducting in unconditioned space
2008 BUILDING ENERGY EFFICIENCY STANDARDS (Title 24, Part 6) REOUIREMENTS INCLUDE:
1. Heating equipment must have a minimum 78% AFUE (Exception: Wall & floor furnaces; room heaters).
2. Central air conditioners & heat pumps less than 65,000 Btu/hr must have a minimum 13 SEER.
3. Newly installed or replaced ducts must have a minimum insulation value of R-4.2.
4. A setback type thermostat (24 hr clock with four set points) is required for all alterations.
5. New or replacement ducts must meet the mandatory requirements of Section 150(m):
• All joints and openings in the in the HVAC system must be sealed.
• Only UL 181, UL 181A, orUL181B approved tapes or mastic shall be used to seal duct openings.
• Connections of metals ducts and the inner core of flex ducts shall be mechanically fastened. Flex ducts
must be connected using a metal sleeve/coupling.
• Flex ducts that are suspended must be supported every 4ft. max for horizontal runs with no more than 2"
of sag between supports and 6 ft. max for vertical runs.
6. The CF-6R-MECB-04 must be completed and signed by the installing contractor. The Inspector will collect
this form and verify that the model numbers are the same as the installed equipment.
CITY OF COSTA MESA
ost , BUILDING DIVISION
F4 77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 - Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714) 754.5626
PERMIT NUMBER: BX10-00106
PERMIT TYPE B_MISC STATUS: ISSUED
APN: 42001209 DATE ISSUED: 12/03/2010
Zoning: I&R, ISSUED BY: RMD
JOB ADDRESS: 1701 GOLF COURSE DR CM Suite/Unit:
Vicinity: EXISTING MONO POLE Primary Occ: - Const Type :??
SO. FT: 0 _ Valuation: $20,000.00 "
SCOPE OF WORK:
CO -LOCATION FOR "SPRINT". WORK TO INCLUDE THE MODIFICATION OF AN UNMANNED TELECOM FACILITY CONSISTING
OF
(1) EQUIPMENT CABINET, (3) 4' PANEL ANTENNAS TO REPLACE (3) EXISTING ANTENNAS, (3) 2' PEROBOLIC DISHES
AND (1) GPS WITH (1) TRANSFORMER UP TO 10 KVA.
REF# ZA-01-06 FOR ORIGINAL TOWER APPROVAL. COLOCATION DID NOT REQUIRE A MCUP.
OWNER: CITY OF COSTA MESA
City/State: COSTA MESA, CA
Phone:
APPLICANT:
HULETT, JENNIFER
City/State:
Phone:
909-230-4920
CONTRACTOR: E1TR0 RF SERVICE INC
Address:
2320 S ARCHIBALD AVE
City/State:
ONTARIO, CA
Zip Code:
91761.
ARCHITECT:
Phone
ENGINEER:
CHRIS S LEE
Phone
714-389.9229.
FEE SUMMARY
Building Plan Check:
Building Permit:
Electrical Permit:
SMIP Residential
SMIP Commercial
Bldg Std Admin Fund
Address:: P 0 BOX 1200 - Unit
Zip Code: 92628' "
Address: - Unit:
Zip Code:
License No. 895236
Unit:
Phone 909-230-4920 ..Cell:
License No.
License No. C61054
$208.81
$321.25
$35.80
$0.00
$4.20
$1.00
TOTAL FEES $571.06
HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279
Monday thru Friday - 7:00 am thru 7:00 pm. Saturdays -9:00 am thru 6:00 pm. Prohibited all hours - Sundays and the following Federal Holidays:
New Years Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day and Christmas Day
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
CODE A. INSPECTION TYPE DATE IIMMALS CODE$ INSPECTION TYPE DATE INTRIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re -Roof 210 Final Electrical x� 14�ILI
201 Final BIocklRetaining 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/Occupancyx
WORKERS' COMPENSATION DECLARATION:
1 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
(This seCm need rpt he mnp'e�te[d ANe permR a valued at one hundred ddlars (3100) orless)
Pofcy-Number. ���f'f�i���_
❑ 1 certify that in the performance of the work for which this permit is
issued, I shall not employ any person in any manner so as to become subject
to the workers' compensation laws of California, and agree that if I should
become subject to the workers' compensation provisions of Section 3700 of
the Labor Code, I shall f rthwith corn ly with these provisions. T
V
�U rSSlgnature I I C tel -
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force and effect.
�a��.�lltl i f.� � � •
-r3•LttF:R1x�9�..� ..
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, demoligh, 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 a 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 conbacta(s) license pursuant to the Contractors License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
Signature
3057-46(3107)
Date
Owner ID verified by driv. .sense. ❑ 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, a demolition
or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp
2, Art 2, Sec. 341, Title 8, California Administrative Code).
❑ As owner -builder, I will not employ anyone to do work which would
require a permit from the Division of Industrial Safety, as noted above, unless
such person has a permit to do such work from the division.
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 fled with the Costa Mesa Fire
Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at standard temperature and pressure).
2. Does or will the applicant or present or future building occupant need to file
a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Health and Safety Code, with some
exceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one time has on hand a quantity of acutely
hazardous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
temperature and pressure).
3. Does or will the applicant or present or future building occupant need to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the California Health and Safety Code provides that the
Costa Mesa Fire Department may require the preparation, certification and
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 Safely Code been fully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or future building occupant require for
the work which is the subject of this application a permit for such construction
or modification from the South Coast Air Quality Management District or from
any other air pollution control district or agency? ❑ Yes ❑ No
(Section 65850.2 of the California Government Code requires that the requested
information be furnished on applications for non-residential building permits).
6. Will any part of the facility to be constructed under this permit be within
1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
(if 'yes", the facility must meet the requirement of Sections 25534 and 42303
of the California Health and Safety Code).
T If a permit from the South Coast Air Quality Management District or other
air pollution control district or agency is required for the work which is the
subject of this application, have all of the disclosures prescribed by California
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. (If yes", attach certificate of compliance from the appropriate air pollution
control officer). ,
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
information given above is correct. I agree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
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 constmction, 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.
Si nature f L w Date
J112J*
L,Amda umonzee AOPlirant N[_Da
PROJECT ADDRESS: 108 GEORGETOWN LN UNIT:
OWNER'S NAME: MATTERA, DANIEL G
ADDRESS: MATTERA JULIE M
17825 SANTA ANITA
FOUNTAIN VALLEY,CA 92708
ARCM/ENGINEER: REG.NO.:
ADDRESS: UNIT:
PERMITTEE: STOUT ROOFING INC (310)923-6775
ADDRESS: P O BOX 4309
DOWNEY CA 90241
LICENSED CONTRACTOR 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.
CITY LIC..: 0509377 STATE LIC.: 40253 class: C 39 EXP; 10/95
Date: J�� Signature:
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a candidate of Consent to self -insure or a certificate of Workers'
Compensation Insurance. or a certified copy thereof (Section 3800, Lab C
POLICY No.: 5822699 EXP.DATE: 65/19/95
COMPANY: AIG ,,---vv
r:] Certified copy is hereby furnished. EX Certified copy is filed with the city Building Division.
Date: ApplicanI
EXEMPTION FROM W RXERS' COMPENSATION DECLARATION: (This section need not be completed it the permit is for one hundred ($lXC) or less).
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.
Date: Signature:
NOTICE: Ifafter making this declaration, you should become subject to the Workers' Compensation provisions of the Labor
Code. you must forthwith comply with such provisions or this permit shall be deemed revoked.
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 (Section 3097. Civ. C).
LENDER:
ADDRESS:
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason
(Section 7031.5 Business and Professional Code: Any city of 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/she is licensed
pursuant to the provisions of the Contractors' State License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business
and Professions Code) or that he/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 (8510).
I, as owner of the property Or my empployees with wages as their sole compensation, will do the work, and the
❑ structure is not intended or offered for sale (Secllon 7044. Business and Professional Code : The Contractors' State License Law
does not apply to an owner of a progeny who builds or improves thereon, and who does such work himself/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 will have the burden of proving he/she did not build or improve
for the purpose of sale).
I, as owner of the properly, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business
E-1andProfessions Code: The Contractors' Slate License Law does not apply to an owner of property who builds or Improves thereon
and who contracts for such projects with a contractors) license pursuant to the Contractors' State License Law),I am aware
that proof of their Worker's Compensation insurance should be provided to me.
❑ I am exempt under Section: B. S P. C.
tar this reason'.
Date:. _ ___ Owner
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505, 25533, and
25534 and that I or any future building occupant willlwill not (circle one) need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Duality Management District. Residential construction applications are exempt from
these previsions.
Date- Applicant'.
I hereby certify that I have read this application and slate that the above information is correct.) agree to comply with all city and county
ordinances and stale laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned
property for iaspeechoon�urposes.
Dale: O( jr - t+ Signal ure
Dever s License or Social Security a:
1641,46 Whne—Bmlding: Green—Code Enforcement: Canary—Applicant, Pink—Revenue: Goldenrod—Assessor
CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 069511
PERMIT NO: B 069511 PLAN CHECK NO: N GOVT; N SUPP: N
CONSTRUCTION TYPE; V—N PERMIT TYPE; STR PURPOSE; ALT
JOB DESCRIPTION ; T/O RESTH & REROOF W/ & HOT MOP SQ FT: 2,508
CLAIM VALUE; 2,508.00 CALC—VALUE; 2,508,00 GROUP OCC; R-1 /
COMMENTS; REROOF SLOPE SIDE W/COMP FLAT SIDE BUR SMOKE DETE. REQUIRED
*k****a¢aratBEBr*i¢ar�t4��r4P*it�FiEitat��+titifir�rititititiEit�t��r�ir+rititiritiE*�titir�F�F�Erititit�titit*it x�rit�tit�ititittFiE�riF*
Z O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING
---------- --------- ACCESSORY BUILDING---------
FRNT; FT IN REAR:
FT IN FRNT: FT IN REAR: FT IN
�, �ft ft IN Rill
FT IN LEFTt FT IN R(3HTt FT IN
PARKING REQ; PROV;
PARCEL; 41916217 ZNE; AEF NO:
PLANNING NOTES>
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iF 1F it iF ik * iE ie .1(. * iF iF it iE it 1k iE Tt * * Bt ie ae if 1f it Brr if it * ik * iF it 1E iE iE it it it ie if ae iP it it of i! af 9E iF Bf iE
D E V E L O P M E N
T S E R V I C E S R E Q U I R E M E N T S
ZONING APPROVED BY
DATE;
UILL.rD(5It NN't33, t_
DATE: '17
&..yy.�BYY
yip }}(APPROVED
�1f
pATE t
` `.
',7I
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if
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if iE iE if if iFM
LEGALIZATIONtN
F" E L S U M M A R Y 9TMITURAL SECIMENT:Y
BLDG PMT PLUMBING
ELECTRIC MECHANIC FIRE SMIP/AES GRADING
PERMIT 54.00
,50
SMIP/NON-RES
PLAN
ISSUE FEE
BUILDING -DIV-> PERMIT
ISSUE PLAN -CHECK TOTAL PAID DUE
TOTALS ---- > 54,50
0.00 0.00 54,50 54,50 ,00
REVENUE DIVISION TOTALS-->
COLLECTED: 54,50 OVER/SHORT: ,00
BLDG PMT PLUMBING ELECTRIC
MECHANIC FIRE SMIP/TOT GRADING PLAN -CHECK
54.00
.50
iF iE if*1E M 1f***41F 1E 1E if kiEk le iE lF le iE**1k*1k fF iE ilM*iF****it*1E it it lE it ltiE It lE*ik**iE iE atiF*iF if if iE iE at ik*iE it It ier4**ie if iF**
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 2508 REROOF BY VALUE RESIDENTIAL NOZONE 1.00 2,508,00
END OF FEES
01 00170551-00170`52 TICET 54,50
DATE: 10/28/94 TIME: 12:44
CONSTRUCTION AND PLANNING
POOL ?A
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
�.
t3,xEle�trieal Conddit tHility-Undrgrnd6
-
54. Forms
'
t-
ectrical Condiiit-Uhdrgrnd.
55, Electrical Bonding
?5.=Stzel Reinforcement
56. Rough Plumbing & Pressure Test
•„
6. Etectrical UFE8 Grnd.
57. APPROVAL TO COVER-GUNITE
M Z. -Footings . " ^.r
58. Electrical Conduit-Undrgrnd.
'
197l'Foundation ' -
59. Gas Pipe, Q Undrgrnd., Test
-' r
„y
--_
9. Water Pipe-Undrgrnd. -_
60. Backwash Lines, P -Trap. D Undrgrnd.
1-10. Structural Floor System
61. APPROVAL TO DECK
11. Pro6prty Sewer Line,& House Connection
62. Backwash & Receptor -Final
12. Sewer Cap -
63. Heater & Vent -Final
13. Roof Drains_ r
64. Plumbing System - Final
14. Rough Plumbing _
65. Electrical -Final
15. Rough Electrical -Conduit..,
66. Solar System -Final
16. Rough Electric.Wiring y
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
r4. _. . n - . tti a.ry aROVAL5._ Permit20riRough
,. ; ' -
actorrp
; ` , • ; --'
21r`-Dus, in,Stiuctu 1
I:':
:- r -- -- �:-• r r;
70, Updergrrqund Hydro
.. .,
,a,
22. Ducts, Ventilating'. a
,�s '
x,71, Product'Pi'ping :�;Gas ClOil
'. 1
23:.Gas-Pirre'�Rough &'Tess
-
Undergro,ind Flus h.v
-,1�^J2.
v
24,,Rodr Framing �j i _ �, :.F
''
-
••`
X73.';Undergrnd. StorageTank G Gas CI Oil
25. RoiM Sheathing
(Al'
�74:''Overhead Hydro"�+
26.ar Ceiling (Structural) &.flonocoat
75::'Dry Chemical i
27. Frame and Flashing!
iy pipF,
;F4:
°
Lathin ;& Si in ` q ,
_.
r"
77: FIXED SYSTEM.NAL$-
�228.
9. Insulatidp ` ' _' " "
`'' i
I r
78 -FIRE PREV. FINAL1 to
t >,
- Mt`j
Drywall: Alan Mg p;:
_
c I
I_ . '
MEALTH,OEPTlREQUtREMENT
.31. Plaster Brown Cogi>
'
'
-FINAL IN$P.ECTION
179'
, 2r.ElectricaFPov"rJerM;er„Finale'
i '. ,�
•80.,FOODCERTIFIf14CTEISSUE[
33 �Fina1„ Electric! _'' •:
1
,• `
"Notes: '-• `t< ;,
'
, 34..Fina! Heating'& Air Conditionii_,g
35,r,Final Gas Pipe-Tes4; -
j
, ' _n `-
36: Hoot! or, nopY._
LE
�37.-Fina( Facio'ry Firephce
'38. Final PWrnbing .r•,
.
`39. Water Service -Final
r
Gas Service -F naltty �_
(,
,
'','.:.
1,40. 1
;a
,
.., p1
-'41. Solar Domestic -Final_
R .n i
r
•-,-
42. Backflow Preventers
43. Backflow Irrigation cLl
:,44. Landscape Icrigatioo System;..1
r-
o
of
A5.1 Sound Attenuation+ .yr
I
40
4 n* t
r: . +
Re" ula -'
'46.` p; gHandica- tains
,,,
47. FINAL STRUCTHf?E&BUILDING
t�
^48.
-FINAL PLANNING; I W IT,
j
rk t
49.-ElectricAeleaseto Edison •
I
!, t
:_; r,' -i "i "• 1
n t
n - 7
50. to SouAern California Gas Co
;Gas,Relaise
51. CERTIFICATE OF.000UPANCY"
No. Date
JOB ADDRESS 1W Georgetown Lane BUILDING PERMIT NO. L23V?
GENERAL CONTRACTOR same VALUE$ 13,895.00
AP No. LOT 319 TRACT 160 FIRE ZONE DESCRIPTION OF WORK rea W att gar
INSPECTIONS Signature
DAT GROUP 3&J TYPE V ZONE R3
Soil
SUBCONTRACTOR
PERMITS
ISSUED
DATE
NUMBER
Rough Com. Re "g. p Air Cond. O
Rough Heating
Rough Plumbing _
, �/
o —
Miscellaneous
Prop. Swr. Line [] House Con. St. Swr. ❑
`
gc 9'1963
Sprinkling System
Construction Pole
Underground ❑ Power ❑
;LRo
ugh Wiring
Trenches 2� Forms Steel Reinf. ❑
- _
Floor System
Bond Beam ❑ Steel Reinforce ❑
Sheathing e
Aq—
Fromme and lashing
Lathing — In Out
Plaster, brown coat LIS!
Gleams oem.
Refrig. ❑ Air Con, l] Final
o . R.4. s.esed
Hp -ling, Final _
Z
I )ing Fixtures, Final
WIW$ o.a
Fi...0 Gas Test�S ' , / ,
i
Electric Fixtures, Final
y. -
Building, Final
_
41
OCCUPANCY
ItA
22302
COSTA MESA BUILDING -SAFETY DEPARTMENT
P. O. BOX 317 COSTA MESA, CALIFORNIA
For Applicant to Fill In Completely
TYPE OR -PRINT
ILDING
DRESS 108 Georgetown Lane
COSTA MESA, CALIFORNIA
INER.San Vista Building. Co.
ID`RESS 1166 E. J58th Street
v Los Angeles 11, Calif .rTE -AD 3718
HIT CT NEER Raymond Levanas TEL 3701
3432 Via Oporto, Newport Beach
1166 E. 58th. St.
Angeles 11, Calif.
192782 TEL• AD 37187
SETSACA LINE FROM
13' O1
DESCRIPTION OF WORK'
X II 1 II
BUILDING NO. OF Fes•' -/ r 2
SIZE ROOMS STORIES
EXTERIOR ROOF '
COVERING JtllCCO I COVERING Shingle
USE OF BUILDING AND WORK TO BE PERFORMED
Residence
I HEREBY AD LEDGE THAT I HAVE READ THIS APPLICATION
AND BTATE T AT E ABOVE IS CORRECT AND AGREE TO COM-
PLY WITH AUL CIT ORDINANCES AND STATE LAWS REGULATING
BUILDING COWSTRUdMON.
FEE RECEIVED
INaY 19 Iia
FINANCE DEPT.
APPL of Vb QFF6Q,"SA
BUILDING
For Office Use Only
L�
RECEIPT NO.
PERMIT NO.
RECq SY
DATE RECEIVE
DATEISSUE
JUN •1,1964
BUILDING
ADDRESS '
FIRE�T
ZONE TYPE GROUP t�
APPROVED
BY DATE
ZONING
NO. OFUSEOF
PLANS "
ILD
I BULEGAL
_z
DESCRIPTION Tract 5160 - Lot 319
k
A. P. NO.
NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
90' TO SIDES REAR P. L.
EAVES
ALLOWED (U.S.C.REQUIREMENT)
YARDS APPROVED
YARDSAPPROVED
MAIN BUILDING
ACCESSORY BUILDING
(FROM C/rREET)
FRONT C' FT.
FT.
0rT�
R. SIDE FT.
FT
,�
L. SIDE 'L% FT.
FT.
REAR / FT.
FT.
DISTANCE BET.
BET. MAIN B
MAIN SLOGS.
ACCESS. BLDGS.
VAR. $ /` i ''
C. U. P t/
DATE
APPROVED U 6
APPRO PRO
lf�.L�
{{..,, 11..
DATE
II 77 Og
-fa SQ. Fr.
THE AMOUNT SHOWNDER VALUATION 16 FOR THE
PURPOSE OF ESTAB HIND A PERMIT FEE ONLY.
VALUATION
PERMIT FEE 'S
yn Cf
HECK 7 i�
TOTAL FEE
L�