HomeMy WebLinkAbout1964 PELICAN PL - Building Permits CITY OF COSTA MESA
r� rw`W BUILDING DIVISION
441!!!!'I. 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa. .us
— . FOR INSPECTIONS CALL: (714)754-5626
4Ofro.mm ie
PERMIT NUMBER: M07-00522
•
PERMIT TYPE MECH STATUS: ISSUED
DATE ISSUED: 11/02/2007
• ISSUED BY: BJK
JOB ADDRESS: 1964 PELICAN PL CM Suite/Unit:
Vicinity: GARAGE
SQ. FT: 0
SCOPE OF WORK: CHANGE-OUT OF A FAU IN THE GARAGE OF AN EXISTING SFD. INSTALL FAU < 100K BTU. NO OTHER
WORK AUTHORIZED WITH THIS PERMIT. -
OWNER: CORNELISON,KENNETH R TR • •Address: 1964 PELICAN PL Unit:
PHONE: City/State/Zip: COSTA MESA,CA
APPLICANT: PARSONS,GORDON Address: 2282 ORCHARD DR -Unit:
PHONE: 949-456-0064 City/State/zZip: NEWPORT BEACH, CA ,
CONTRACTOR: ABC HEATING AND AIR CONDITIONING License No. 810481
Address: 2282 ORCHARD DRUnit: PHONE: 949-456-0064
City/State: NEWPORT BEACH,CA ZipCode: 92660 CELL:
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MECHANICAL PERMIT FEE SUMMARY
MECH ITEM FEE: $38.30 4.410
PLAN CHECK FEE: $0.00
INVESTIGATION FEE: $0.00
REINSPECTION FEE: $0.00• . .
•
•
TOTAL FEES: $38.30 •
•
3
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
CODE INSPECPON TYPE DATE INTITIAL$ CODES INSPECTION TYPE } DATE �INIRIAL
1616 Fixed System Final Fire Prevention 206 Final Mechanical 3-08
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 DECLARATION: Owner ID verified by driver's. ,e. ❑Yes ❑No
I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires:
❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed):
compensation, as provided for by section 3700 of the Labor Code, for the
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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 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. My workers' compensation Insurance carrier and policy ❑ I hereby certify that no excavation five(5)or more feet in depth into which a
number are: / person is required to descend,will be made in connection with work authorized
by this permit,and that no building structure.scaffolding,falsework,cr demolition
Cartier: n /.e r!� n'-s7 or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
(This swim need moli oe/mnpeted d the perme is valued al me hundred xuars(5100)or less.) 2 Art 2 $et 341 Title B,California Administrative Code).
Policy Number: /LF 7 5--) e1 -
0 As owner-builder, I will not employ anyone to do work which would
❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless
issued. I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division.
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 forthwith comply with these provisions. Applicant's Signature Date
7 Division of Industrial Safety Permit Number:
Applicant's Signature Date HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes 0 No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. 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
LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons,or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is in full force and effect. / a registration form for acutely hazardous materials? 0 Yes ❑No
Lic.# Cr/ Class# ab — t a (Section 25533 of the California Health and Safely Code, with some
,/ exceptions, requires registration with the Costa Mesa Fire Department by
/��/-e //- Z—G7 each business which at any one time has on hand a quantity of acutely
Contractors Signature Date 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
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? 0 Yes 0 No
,- (Section 25534 of the California Health and Safety Code provides that the
Lender's Address: 4,'Costa Mesa Fire Department may require the preparation, certification and
r. I' filing with the Fire Department of an RMPP by businesses which are required
• to register acutely hazardous materials with the Fire Department.
Signature Date '
4. If an RMPP is presently required. has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: - V •. - .. Health and Safety Code been fully complied with? ❑Yes ❑No
I hereby affirm that under penalty of perjurythat I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE.LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? ❑Yes 0 No
issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Govemment Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits).
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 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes 0 No
applicant for a permit subjects the applicant to a civil penalty of not more than (If'yes",the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec.7044,Business and Professions Code:The Contractors subject of this application. have all of the disclosures prescribed by California
License Law does not apply to an owner of properly who builds or improves Health and Safety Code Section 42303 been made? ❑Yes ❑No
thereon,and who does such work himself or herself or through his or her own 8. (If"yes'',attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for
sale. If. however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build pr improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH
city ordinances regarding Hazardous Materials and Emissions.
LICENSED CONTRACTORS to construct the project(Sec.7044,Business and
Professions Code: The contractors License Law does not apply to an owner of Signature Dale
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:.I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
❑ am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: 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.
Signature of Legal Owner(s) Date
Signature Dale ( //7- z .•
3057<8(3I07)
And/or Authorized Applicant Date
' CITY OF COSTA MESA
4 ► BUILDING DIVISION
°:fl r �, DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
�• i� • PERMIT M
• �`� 17P06-00646
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.cFtuMBING PERMIT 7 77 FAIR DRIVE,COSTA MESA,CA 92626
EXTE
Job Address: 1964 PELICAN PL
NSION08/10/
Status: D
Suite No �� Applied: 02006
Issu : 086/10/!11/2006
Vicinity: :?,7ED
Parcel Nunmber: _13947216 PER r • •
EXPIRES (/a9*.
Applicant: PAULEY, SHANNON ISSUED BY: �;
Address: 17390 MT CLIFFWOOD __ "--- - - -
_.-- --1 v-9Phone!'714,241-1414 `_--�
FOUNTIAN VALLEY;CA-'2 v rZip:'-92708 -- - - "
)://2/22"--;- • ) / l/ -A �,
Owner CORNELISON, KENNETH R TR', 41 - S
"4 s ' , :- \
Address 1964.PELIC\AN PL - J - - - - -
/,(/U / �j i.-Phone:-7-14-754-1688, \���. �• �/\ \
/� �� ' <STA MESA;CA .- Zip: 92626-4732 \/ \\
Contactor: COASTjROOTER PLUMBING HTG AND AC N.;\.:\,\<",/ ` N\\
\��vA
\ '7
Jc'lAddress: 17390'MTCCIFFWOOD
{ / /�� Phone:`7',714-241-1414 • \\ \\ % V. \
), ) FOUNTAIN VALLEY t Zip: 92708 �� �
/79/ - License =529127o co -
V I nY
� �r
u.'' -', ' '9' SCOPE OF PERMIT 4 • t
WATER HEATERCHANGE OUT,NO CHANGE IN LOCATION. _ \'"
l ri lir k' i'---' - •j'- - �t
�' U i' FEE SUMMARY \ \;
` • j/ ` / AMT QTY - _- -- - AMT _ QTY=- - ,- AMT !QTY
u
.ISSUE FEE ' 1 i) / $23.50 j ,'17F'7/L'aundry"Tub/Washer'' ''$000' t0 ',P �•v I\Sump Pump $000 ;1\0
Backflow irrigation: ' $0.00 0 . Landscape Irrigation :_2 2_mob... -0 ` 'Swimming Pool • $0.00 ' '0-
Backflow Preventeh, } i $0.00 'on- --=`P-Trap --- - - - ---$0:00 ---0 - f Trap Primer /' . - $0.00 ' 0'
Bathtub" - • `; ,', I $0.00 0\ Pressure Regulator $0.00 -b" ' Urinal • -/ $0.00 0
Clarifier System t,.,,, $0.00 0 - P�rocess.Piping(per 10 ft) $0:0 /Or - Vacuum Brkr Bkflow(1-4) - ' $0.00 "0
Connect(Ice,Soda etc) $0.00 0 c iec
Reptors v - --_-;$0.016-/,Oy 'AI Vacuum Brkr Bkf_Iow(5+) •- 4$0 00 P 0
Dental Units ` (�; - $0.00 0 _-"-"Septic Tank- $0:00 0 ' Wash Basin 7 ' ' `$0:00 r�j 0
Dishwasher" $0.00 0 , - _ Sewer Cap'for Demo•'-- -$0,00 6.0• .- - r Wash Basin Set L 2 , $0.00 / 0
Drain0 Floor ,\�, $0.00 0 ' Sewer Connect $0.00.' 0 , Waste and Vent System,_ `$0.00' 0
Dr'ain'Rainwater \ \ J. $0.00 02 Sewer Private Line <$0:00'_ 0 '--Water Closet(Toilet) --x$0.00,' 0
Drain;Roof, \\ � VA$0.00 0 Shower `;$0:00''0 Water Heater!vent /1---!: -,$12.30 1
Drinking Fountain\ \•\\ $0.00 Oi Sink,bar $0.00 0 Water Piping.(Inst or Rep.)i $0.00/ 0
Expansion Tank \$0.00 0 Sink commercial, i`:=4S r$000 0$0.00 0 Water Re-pipe/ ( ; - $0.00 0
Gas Earthquake Valve \$0 00 Of Sink Floort -' Water Service • ., / .46.06 0
Gas(1-4 outlets) ti. $000\ 0i Sink kitchen , 16:00::•• 0 • Water Softener /$0.00 0
Gas(Over,4:outlets)< t $000%, of Sink service/mop $000 , ^0 OTHER/ ' $0.00
Gas Repipe c \ ' $0.60•\\0)4.7t-r141,5pa(private) " „ - $0.00 i' 0 4`re''VIOL'ATION ' r / "$0.00
Gas Service
\ ��� /$0.00��gJ Spa(public). c' 0,,,,,,' $0.00 0 �P.LAN CHECK / % $0.00
Interceptors(Grease,Oil)7/$0.0O- '6 �c, ni ,� „i„,-
REINSPE TION 7 $0.00 0
Interceptors(Sand Auto) <$0.00 - o • = . % /- •
\/9 �' \�� �, o -- o` - 'TOTAL CALCULATED,FEES: $35.80
-N\ c� /nom - ,-" ‘,�'7 2 //9/
\��\ �
- , :COMMENTS?SPECIAL CONDITIONS \.7(,,27/V
r - �
_..-_-, : ;\\t ;- .-. -- -,/-/.-
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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)754-5826
2446-46(6/00)
de
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
OKI 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' p natiop Insuran _carrier and policy number are: ^�
+Carder. `^ &74 (-JI✓(^, Policy Number: 0/? �CWQ70(71
:(This es Carrier_.:
ne no be completed it t permit is valued at one hundred dollars($100)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 C:: ••yy: and agree that if I should b:-• . subject to the workers'compensation provisions of Sec' n 3700 of the Labor Code,I shall forthwith
comply with these pro ':�/ '_- / ,/�
Applicant Signature: _� / Dal-: _ - /( T T V{(/
-
WARNING:FAILURE TO SE. .• •'ORKERS'COMPENSATION•• ERAGE IS U (W FUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND OOLLARE($1%,000),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed r o a 9(commencing with Section 7000)of Division 3 of the Business an ole orya Code,and my license is in full
force and effect.Llc.'a..--1 Mass# l C(^- (��, /
_Contractor's Signature: -��A _ Die - (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: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not Intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or Improvement Is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). •
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires:
Verification of Ownership by(type of document,I.e.-properly 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? 0 Yes ❑No
(Section 25505 of the Celifomia 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 or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yeo ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes I�No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which Is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
e�Signature Of Legal Owner(i / (1 Date 11/
/ -_.- —�. . _ Cil•/_
•OCAuthorize• -ppli•:nL_ _ ___e - - 1.______Date --�
CODE f INSPECTION TYPE DATE INTRIALS ;ODE` INSPECTION TYPE EMI 2(0ALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical p Q
1266 Pool Spa Final 208 Final Plumbing 1-AS-bO BN
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
• it- Page lof1
WEIDENKELLER, MARY JANE
From: Dgc2272@aol.com
Sent: Tuesday, November 27, 2007 10:17 AM
To: WEIDENKELLER, MARY JANE
Cc: KRCornelison@yahoo.com
Subject: Request Extension for Permit#P06-00646
To: Mr. Ed Petros
From: Ken & Dada Cornelison
1964 Pelican Place
Costa Mesa, CA 92626
(714) 754-1688
Dear Mr. Petros:
We would like to request an extension for Permit#P06-00646--a water heater installation. We did not realize
this permit had expired until we had a permit pulled for a heating system issued on November 2, 2007. The
plumber who installed our heater told us that it was not signed off when he pulled the permit to do the heater.
He also told us at that time we needed more work done on the water heater to bring it up to current codes.
We are in the process of hiring someone to do the work at this point. We would like an extension so that we
can get the water heater up to code and have it signed off, possibly at the same time we'h'ave the hew
heater signed off. Would it be possible to get an extension until the end of January so that we can get the work
completed?
We are dealing, also, with insurance companies regarding a non-related issue—our cabin at Lake Arrowhead
was bumed down to a total loss in the Grass Fire on October 22nd. Trying to get everything done that is
required by the insurance company, meet with them, etc. is one reason we need to have extra time to deal with
the water heater repairs.
Thank you for your consideration of our situation.
Ken & Darla Cornelison
i
•
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11/27/2007
PROJECT ADDRESS: 1964 PELICAN PL UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 05 /0bt
OWNER'S NAME: CORNELISON, KENNETH R
ADDRESS: CORNELISONDARLA C PERMIT NO; B 057066 PLAN CHECK NO: N GOVT; N SUPP: N
1964 PELICAN PL •
COSTA MESA CA 92626 CONSTRUCTION TYPE: 5—N PERMIT TYPE: STR PURPOSE: ALT
( 714 ) 754-1188
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : I/O SHAKE, APPLY "CEMWOOD" ( ICBM( 4312 ) SQ FT: 5, 000
ADDRESS: UNIT:
CLAIM VALUE: 5, 000 . 00 CALC—VALUE: 5, 000 . 00 GROUP OCC: R-3 /M-1
1 PERMITTEE: HOMESTAR ROOFING ( 714 ) 538-1878
ADDRESS: 1539 ORANGEGROVE B COMMENTS: SMOKE DETECTOR(S) REQUIRED IN HOME. C��Ar11lc 1'1Cp
ORANGE CA 92665 ****************************** ********************m•xc�F�F**�F�E�t7Wi fi E*QE/4� R
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS REQUIRED
7000)of Division 3 of the Business and Professions Code.and my license is in fun force and effect. SETBACKS
CITY LIC.: 044971 STATE uc.:516205 C.'S : C-39
_' Dale: i/ MAIN BUILDING ACCESSORY BUILDING
it.. -9v4 Signature: FRNT: FT IN REAR; FT IN FRNT: FT IN REAR; FT IN
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I•. -a certificate of consent to self-insure or a certificate of Workers' LEFT; FT IN RGHT: FT IN LEFT; FT IN RGHT: FT IN
Compensation Insurance,or a certijie¢copy thereof(Section 380'pL .. 8L9/01 /92
POLICY NO.: InC.1 1 3 1 /—00 T
COMPANY' GOLDEN EAGLE PARKING REO• PROV: PARCEL ; 13947216 ZNE: REF NO;
❑ Ce ified copy is hereby furnished. (2{ Certified copy i wi h 1• y Building Division. PLANNING NOTES;
�0�/ — *****************************************************3(**************1E**********
Date: Applicant D E V E' L O P M E N T S E R V I C E ST R E U I R E ME Ni S
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: ' section need not be completed if the permit is for one hundred(5100)pr less). Q
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. ZONING APPROVED BY DATE:
Dale: Signature:
NOTICE:If.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : — .... DATE; is
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. r
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y: 4j 4,.......
` ` •, DATE• 46i/Z-7.
which this permit is issued(Section 3097.Civ.C). *********************** n ** 3t***** ** **** ************** **
LENDER: *********************************************** *******************************
ADDRESS: LEGALI7..ATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES/ GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 72 . 00 , 5 0:
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed SM I P/NONr RES •
'pursuant to the provisions of the Contractors'Slate License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN '1
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by r '
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE - =" /
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
I. as owner of the property or my employees with wages as their sore compensation, will do the work, and the TOTALS----> 72 , 50 0 . 00 —r 0, 00 72 . 50 72 . 50 ,00
❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State 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 v ^^
his or her own employees.provided that such improvements are not intended or offered for sale.If.however the building or REVENUE DIVISION TOTALS--> COLLEC/I'ED • 72. 50 OVER/SHORT' 00• f
improvement oie soldfs within one year o1 completion,the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SNIP/TOT GRAD NGPLAN—CHECK
for the purpose of sate).
72 . 00 . 50 )
as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business I ./• r
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon L
and who contracts for such projects with a contractor(s)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 N D I V I D U A: L- FEE BREAKDOWN
❑ I am exempt under Section: B.8 P.C.
for this reason: TYPE QTY D E S C R I P T I O''N UNIT COST 'TOTAL COST
/ •
Date: Owner: SFR 5000 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 4.`, 5, 000 , 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505.25533,and END OF FEES '
25534 and that I or any future building occupant wilUwill not(circle one)need to comply with said state codes and the requirements for a •
permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from '
these provisions. •
`'
Date: Applicant: _
I hereby certify that I have read this application and state that the boy int mation is correct.I agree to comply with all city and county I:t 001 1J_:t'- 't Q
ordinances and slate laws relating to building construction and her aud„"nzWdy representatives of this city to enter upon the above-mentioned DATE: C•r.'2 ,'•_ �Tir;5;').• .
property fpr .--s2on purposes.
7q2— ,, `
Dail?:��' Zo (2— Signature. 1kL[J _
Driver's License or Social Security x:
1641.46 White—Building:Green—Code EnforcemenC Canary—Applicant:Pink—Revenue;Goldenrod—Assessor
40
CONSTRUCTION AND PLANNING POL .s SPA
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole .52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Unargrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. 57. APPROVAL TO COVERGUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O 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
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 O Gas O Oil
25. Roof Sheathing ]��. �'fN 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 PREY. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOODs_ CERTIFICATE ISSUED /�/ Itl
-
33. Final Electric Note ( Ali //i1.
34. Final Heating & Air Conditioning )24:411 /Q'l�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. Backf low Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations �/
47. FINAL STRUCTURE & BUILDING '1 23`12 6,44_ e, ,,L! B�_ ',de_48. FINAL PLANNING • O` '�"�
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co .1,61 27-92 �� /,_ __ e
51. CERTIFICATE OF OCCUPANCY [�"''"C-6401 - U
No. Date
J. Vn'MCA% \Y• LAM I
JOB ADDRESS 1964 Pelican Place BUILDING PERMIT NO. 24425
f GENERAL CONTRACTOR owner/builder DESCRIPTION OF WORK att patio cover
AP No. LOT }6-0 TRACT 5289 FIRE ZONE VALUE $ 400.00
I? FACTIONS Signature Date GROUP J TYPE V ZONE Ri
5= SUBCONTRACTOR PERMITS ISSUED
Gas I Date I Number I Signature
Water Plumbing
Rough Plumbing
Prop. Swr. Line 0 House Con.10
Sprinkling System
Miscellaneous
Rough Heating and Air Conditioning
Temporary Service or Pole
Underground 0 Power 0
Rough Wiring Heating and Vent.
Trenches 0 Forms 0 Steel Reinf. 0
Floor System
Bond Beam 0 Steel Reinforce 0
Sheathing
Frame and Flashing
Lathing — In 0 Out 0
Plaster, Brown Coat
Str ^tural, Final Electric
Ii :g, Vent., Refrig. and A.C., Final
Plumbing, Final and Gas Test 0
Electric, Final � �
Building, Final 4A 9—tc- A
24425e CITY OF COSTA MESA
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O.BOX 51T COSTA MESA,CALIFORNIA J U L 19 1965
For Applicant to Fill In Completely APPLICATIONTT1FpO(RRPPERMIT
TYPE///O��IR PRINT/// F� Dg-�f ly
BUILDING i96 ,/4 / rot/ A) f e r$eeDfl
BUILDING 3 147` ,/
RECEIPT NO. PERMIT NO.
COSTA MESA, CALIFORNIA r-
• /,�/� RECEI EY DAT R/(`/�', �7D T/ IRS //D//''
OWNER LSl1Y (/!II [/1� / C ( (? f
MAIL //�� / BUILDING f tr�
ADDRESS /q)IP SZ ��// (�t7 pi /(t C e ADDRHSB / p �� C^�(C IRE �–
//� /////J/p /�/� TEL.Silt— ZONE TYP GRO P
CITY l D f l'�•-�-�i-�..+g NO. 7 3B / ,,�.�r -
APPROVED // �S �/J /
AR' -TECT TEL. BY _/f✓JvEj GP�AT' (O,�j
OI '.INEER NO.
ZONING y ' pr� /
ADDRESS /� _7 I I NO.OF I OF NEW/Y` - ..V
/j, 1/
PLANS BUILDING V /N/'N
CONTRACTOR Own et--- LA.i t4-
LEGAL / f o
ADDRESS DESCRIPTION �U 1 J1() 9
A.P.NO. .r'1iY --"-----'
CITY
NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
STATE TEL. SO"TO SIDE @ REAR P.L
LIC.NO. NO.
EAVES
SIZE I NO.OP BLDGS. / ALLOWED (U.B.C.REQUIREMENT)
OF LOT NOW ON LOT
USE OF �//'I / YARDS APPROVED YARDS APPROVED
EXISTING BLDG. JC of dente MAIN BUILDING ACCESSORY BUILDING
JJ •` (FROM C/LSTRE )
SETBACKLINE PROM M /FRONT PT.
CENTER OF STREET REAR YARD L -/.
SIDE YARD LEFT I RIGHT y R.SIDE FT. . F .
DESCRIPTION OF WORK L.SIDE Ci tk'J4 Fr.
N. V'''. ALTERATION ADDITION REAR
UFT. FT.
—
DISTANCE BET. BET.MAIN @
REPAIR MOVING DEMOLISH MAIN BLDGS. ACCESS.BLDGS.
* DATE
SUILDIN° [77/ry(� ROOMS D STORIES / C.U.P.# APPROVED
SIZE {7 /
EXTERIOR WALL A�/ APPROVED APPROVED _ I
COVERING /K DlT C. COVERING!/ / i/ BY .1 a'LA. /.
USW B ILDIN AND WORK TO BE PERFORME•- I
, t� r, ,
N
`/7 SQ.FT.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND 0 COM. PURPOSE OP ESTABLISHING A PERMIT FEE ONLY. O
PLY WITH ALL CITY ORDINA AND STAT LATINO VALUATION S 2 h
BUILDING CONSTRUCTION. PERMIT FEE $ 4:--1SIGNATURE OF O
PERMITTEE 'A 74:7 4ens•1 z
/ $ b O EC 0
AUTHORIZED AGENT TOTAL FEE $
3
VW1VGn, rnivn, UUS V. DATE: vc'. C
JOB ADDRESS 1964 Pelican Pl. BUILDING PERMIT NO. 23349 -
. GENERAL CONTRACTOR Owner—Builder VALUE $ 100.00 Slab• Only .
AP No. LOT 60 TRACT 5289 FIRE ZONE 3 DESCRIPTION OF WORK for Future Patic
IICTIONS Signature DATE GROUP .1 TYPE III ZONE R1 Att.
St.. PERMITS ISSUED
Gas SUBCONTRACTOR DATE I NUMBER
Water
Rough Corn. Refrig. Air Cond. .❑
Rough Heating
Rough Plumbing
Miscellaneous
Prop. Swr. Line-❑ House Con. -❑ St. Swr. 0 _
Sprinkling System
Construction Pole
Underground .❑ Power ,❑ _
Rou h Wiring
Trenches 0 Forms B' Steel Reinf. 0 _ ,ea see
Floor System
Bond Beam ❑ Steel Reinforce 0
Sheathing
Frame and Flashing
Lathing— In.❑ Out 0
P' •er, brown coat
1 g. 10 Air Con. 0 Final
Heating, Final _
Plumbing Fixtures, Final
Final Gas Test _
Electric Fixtures, Final
0.
23349 FEE RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT DEC 22 1964
P.O.BOX 317 COSTA MESA,CALIFORNIA ((����TTFIIN(A�FNCEn��DEPMT.
For Applicant to Fill In Completely APPLICAI Z P RCP&MIY--ESA
TYPE 0 PRINT BUILDING
BUILDING / (�[/ For Office Use Only
ADDRESS 19 I (� (PI:
RECEIPT NO, GGJJ��-JJJJ Pfjiyl 044c)
COSTA MESA, CALIFORNIA
--- - - /� th 0 RECHI D BY �D/AJE RHCY/VED DA ISSUED
OWNER lT/Iy rr1/9I� '�f �i Z/Fv I� Z�(�y
BUILDING J9 , / 'E/ c i ?1
MAIL /q i/ / ADDRESS 7 �J �l 1�
MAIL 8 ( % T P' ` ran fr/aCGS , /
/� TEL.j�F.S-/ ZONE Z PE I/ / / GROUP
CITY ( /7fmesa NO. "'?0/ APPROVED rrP"rrr
46
DATE �)ZZ/�
AR' -'TELT -ZEL. BY
y
Of I INEER NO.
ZONING 44 1“-/
ADDRESS
ZONE NO.OF USE OF NEW
�(p� / PLANS 49...---BUILDING -..0
CONTRACTOR
CONTRACTOR ( l,(f/'J e/L-- Lc Wei-- 6-9-87
Wei--
0 DESCR I „,4 6 f/ i K I sa(J /
ADDRESS
DESCRIPTIO„ ,4 I
CITY - - A.P.NO. t --
NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
STATE `—.-- TEL. 30"TO SIDE B REAR P.L.
LIC.NO. NQ.
EAVES
SIZE I NO.OF BLOGS. 2 ALLOWED (U.B.C.REQUIREMENT)
OF LOT NOW ON LOT
USE OF a
YARDS
IN BUILDING YARDS RAPPROVED
BUILDING
EXISTING BLDG. MAIN BUILDING ACCESSORY BUILDING
- <FROM C/LSTREET))
SETBACK LINE FROM z*7 . �j-
CENTEROFSTREET REAR YARD FRONT LCA^ 1•-j.�)YYY111-,,,...Y���_ ��,
SIDE YARD I LEFT �- I RIGHT -rr— R.SIDE SFT. LO 4�•FT.
DESCRIPTION OF WORK L.SIDE cZ. - 6-.3..--0.----x0 r • Fr.
KT.N• \ ALTERATION _ ADDITION REAR 2- T. FT.
DISTANCE BET. BET.MAIN&
REPAIR MOVING _DEMOLISH MAIN BLOCS. ACCESS.BLDG9.
BUILDING / �/ NO OP VAR.}{ DATE
SIZE 'V Y 2c/ ROOMS O ST,O,RIES/ / C.Ui.�OP.S APPROVE-DT//A . 77
EXTERIOR WALL/1,7C/Z/ I COVERING (�L/ BYP(f/ . � • DATE //Jar/o
COVERING
USE OF BUILDING AND WORK TO BE PERFORMED 0-7'I/
SLAB mil Z/ AzI Le2/3 cintr-'s — ,
N
SO.FT. B
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE S
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM-I
PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O
PLY WITH ALL CITY ORDIN ES AND STAT REGULATING
BUILDING CONSTRUCTIO /J. VALUATION OD •
r ry
SIGNATURE OF �/� �r PERMIT FEE $ O
PERMITTEE J/ // m
$ 0 O PLAN CHECK $ a
AUTHORIZED AGENT u
TOTAL FEE $
Lot 60• . 21874 FEE RECEIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT w1 9 1 1961. •
P.O.BOX 317 COSTA MESA.CALIFORNIA [;II''(FIINANCEEn jjDppEPMMT..��pp
For Applicant to Fill In Completely d1PLICaATIdF1SKlSf(•• MATT
TYPE OR PRINT BUILDING
For Office Use Only
BUILDING
ADDRESS 1994. PO lean Placa RECEIPT NO. PERMIT NO.
COSTA MESA. CALIFORNIA 9 1 P74
R[C[IytD EY DATE5-3,...g[ APR 1 4E 964
OWNER Pemba Subdividers, Inc. /!/��/
BUILDING
ADDRESS 2850 Mesa Verde Drive ADDRESS
FIRE 1/
CITY Costa Mesa No'5490395 ZONE TYPE GROUPIS
�Y�
__ APPROVED 0
OF /NEER E. G. Kaltenbach 1,1;7.5478046 BY DATE
ADDRESS 1833 E. 17th St. , Santa Ana ZONING
ZONE I HOOF I USE OF NEW bingl Yam.
Owner c R_1 PLANB2 BUILDING w/ att gar,
CONTRACTOR v 4 ISL`�,
LEGAL TT.... Go
ADDRESS DESCRIPTION l,vt OV, Trart 5289
A.P.NO. none
CITY
p p NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
STATE N 187318 TELO. SO'TO SIDE a REAR P.L.
EAVES
SIZE 70x100 I NO.OF BLDGS. 0 ALLOWED (U.B.C.REQUIREMENT)
OF LOT NOW ON LOT
YARDS APPROVED YARDS APPROVED
USE OF MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG.
(FROM C/L STREET/
SETBACK LINE FROM 501 28' FRONT SID FT. FT.
CENTER OP STREET REAR YARD
SIDE YARD LEFT 5 I RIGHT 5 R.SIDE 5-FT. FT.
DESCRIPTION OF WORK L.SIDE S---.12T.
Fr.
N1 X ALTERATION ADDITION REAR O Q FT. FT.
DISTANCE BET. BET.MAIN&
REPAIR MOVING DEMOLISH MAIN BLDGS. ACCESS.BLDGS.
Q VAR.# DATE
BUSIZE IDING 2��e47"(8'77'1 NO.OF IRO MS `� O ES 2 C.U.P. \ APPROVED Z (��/
EXTERIOR WALL-p�jAn ) ROOF APPROV y 1 /Hj DATE 7 r✓O ]'
COVERING &StUCC COVERING Shingle BY Y" IILW
USE OF BUILDING AND WORK TO BE PERFORMED
in:le famil ivith attached :ara:e. ti/_
House 2, 030 sq.ft. ,, , 6
Garage 451 sq.ft. Plan 54-A 02 o3Q.FF. _
t.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE z
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION /G— q
BUILDING CONSTRUCTION, h J N
SIGNATURE OF PERMIT FEE
PERMITTEW 1•07.471 I/ /t/✓'�
) /6/_ - •_
S
AUTHORIZED AGE nu.
TOTAL FEE $ /U 3-54