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HomeMy WebLinkAbout1767 PITCAIRN DR - Building Permits • afg tetO CITY OF COSTA MESA � BUILDING DIVISION PERMIT NUMBER f r •••�hir ' DEVELOPMENT SERVICES DEPARTMENT • PERMIT M00-00112 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 1767 PITCAIRN DR Status: ISSUED Suite No Applied: 03/20/2000 Issued: 03120(2000 Vicinity: Parcel Number 13934126 l /l', ISSUED BY: Applicant: WILLARD D. MEARS Address: 01835 WHITTIER AVE Phone: 949-650-5916 COSTA MESA CA Zip: 92627 Owner: JUSKA, LEONARD ANTHONY TR • Address: 400 HOBRON LN#3206 Phone: HONOLULU,HI Zip: 96815 Contractor: WILLARD D. MEARS Address: 01835 WHITTIER AVE Phone:• COSTA MESA CA Zip: 92627 9 ' License: 278460 Arch/Eng : Address: Phone: Zip: License: SCOPE OF PERMIT REPALCE FAU. FEE SUMMARY Quantity - Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $14.80 1 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0 Inst/Rep. Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000dm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 • • NOTICE: The work.authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 • , 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. ❑ 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 are: Carrier: Policy Number: (This section need not be completed it the permit is valued at one hundred dollars($100)or less.) I certify that In the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' 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 ions. AILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBIECi AN EMPLO RTO PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(8100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION Le BOR CODE.INTEREST,AND ATTORNEY'S FEES. LICEN - • • - • _ DECLARATION: I h- • irm a : 'cense• under provision of Chapter 9(commencing with Section 7000)of Division ass and Professions Code,and my license is in full force and effect.Lic.b 4O Class a C^to Contractor's Signature: Date: 3/7.0/®A CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the properly,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business•and Professions Code:The Contractors License Law does not apply to an owner of 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 orie;yei of cbmpl�i�the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). o I, as owner of the property,aaEXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code: The contractors Licenseaw(does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursu`antdo the Contractors.Clcense Laws.). *48 ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: - "),!7,„„. Date: Owner ID verified by driver's license. ❑Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e..property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,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,Califomia Administrative Code). O 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 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3..-...... i.11..the. . -r.... future ngoccu. .....t.op. MP nage en d._. o___ .r ..tel__ - mater s)?... 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 0 No 5 Does or will the applicant or present or future buildingoccupantrequire for the work which is the subject of this application appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). - --_e .-.----.._..............................................._... 6 Will any part of the facility to be constructed under This permit be within 1000 feet from the outer boundaries of a school? ❑Ves0 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 Calitomia 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 end 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. Signature Of Legal Owner(s) Date / . r _ 3/w o0 ••_'Terized Applicant MU; INSPECTION TYPE ` -9AIE INTRUL$ COoE1 INSPECTION TYPE 1616 Fixed System Final Fire Prevention 206 Final Mechanical 6-1a-07 6) AU 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 2646-46 • /‘, - 9 CITY OF COSTA MESA 4 BUILDING DIVISION > •.,.•. , DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4r Zia ..� Yv PERMIT / S `/ B04-00528 (714)754-5273 • Fax(714)754-4656 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 1767 PITCAIRN DR Status: ISSUED Suite: Applied: 03/12/2004 Vicinity: Issued: 03/12/2004 Parcel Number: 13934126 Zoning: R1 R1 A1 Applicant: MOBERLY, TODD ISSUED BY: \A A Address: 15201 PIPELINE LN#A V Phone: (714)936-5908 HUNTINGTON BEACH,CA Zip: 92649 Owner: JUSKA, LEONARD ANTHONY TR Address 400 HOBRON LN#3206 Phone: HONOLULU, HI Zip: 96815 Contractor: CONSUMER SERVICES Address: 15201 PIPELINE LN#A Phone: (714)936-5908 HUNTINGTON BEACH,CA Zip: 92649 License: 676090 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT REROOF;T/O SHAKES, FILL IN SPACE SHTG.,&INSTALL APPROX.33 SQR'S OF 50 YR.TIMBERLINE COMP.SHINGLES. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $8,164.00 Permit: $167.25 Claim Valuation: $8,164.00 SMIP Res: $0.82 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $168.07 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 244648(8100) DECLARATIONS I WORKERS'COMPENSATION DECLARATION: }�hebby affirm under penalty of perjury one of the following declarations: r t , v r/ 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. 4 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 wTqr—kers'��'compensationqqqInsurance carrier and policy number are: f / c/)�7 'E Carrier: .e Policy Number: f lJ S Ni.(This sect n nee or be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this pe • it is issued,I shall not employ any person in any manner so as to become s bject to the workers' compensation laws of Calif nia, e th- I s.•uld ., o su ' 'the workers'compensationpe�ns of Section 700 oft Labor Code,I shall forthwith comply with these pr ' .Applicant Signature: ,i/ l Date: . WARNING:FAILURE TO SECURE WORKERS'tr ' NSATION COVERA IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMI PENALT S AND CIV RNES UP TO ONE HUNDRED THOUSAND DOLLARE(S100,000),IN ADDITION TO THE COST OF COMPS SATION,DAMAGES AS PROVIDED FOR IN SECTION 3706OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under pro '.ions of Chapter+(commencing with Section 7000)of Division 3 cf thb Busi 'ss-.d Profession Code,and my license Is in full force and effect.Lie.II 4 ii / ./ i `Class it Y Contractor's Signature: in ifi���� Date Car CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,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.). O I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No 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,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). O As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the 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 apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes 0 No (Section 65850.2 of the California Govemment 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 end 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 CO 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 a to e lam�:f,"- d ci. rdinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the 410,aboys-d6 bed . :die 7r'..,'sf,- 'e.. . . cupy or allow occupancy of any building authorized by this permit until final inspection. �ya. ot/% ,/ - An. •r •uthorized Applicant Date CODE I INSPECTION TYPE PAIL INITIALS CODE f INSPECTION TYPt PSIS MAU • 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof '3 _live/ lG ca✓/ 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 • ' 4 coact Tia iideteaf D ) ✓4 DECLARATION OF AUTHORIZATION I; �. ,. FOR AGENTS OF CONTRACTOR TO APPLY FOR PERMITS 1. 1, �Valti tz- MentS I , declare that I hereby authorize the following person(s) to obtain permits on be /C;dr// f%& SIGNATURE y+ WO 1�7 r{`7/ f C L J) tdd yYt.OtpAef ltd 7r ` 1 RI�ROOI66 OR SOCE'L//-IIT/ 3LIO - :IG, TURE PRINT NAME DRIVER'S LICENSE OR SOCIAL SECURITY II SIGNATURE PRINT NAME DRIVER'S LICENSE OR SOCIAL SECURITY# 2. I will also file a Worker's Compensation Insurance Certificate, issued by my insurance agent,covering all persons employed by myself, my company or corporation prior to the issuance of any permits in accordance with Section 3800 of the State of California Labor Code. 3. I understand that my signature below acts as a continuous authorization until a written document cancelling such authorization of any or all of the persons listed above is received by the Building Division. Any additions or modifications will require a new form. 4. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or personal injury to myself or any other parties as a result of work authorized by the permits from the City of Costa Mesa. 5. I have read and understand the above statements as they pertain to the issuance of permits by the City of Costa Mesa and the California State Contractor's License Board. 6. I declare under the penaltynof perjury that the foregoing is true and correct. Executed this 5" day of 511 fin' , I -, at Orange Ciunty,California. 1(s A _ )AT // /+ �R SIC�+ TORE '1°1\4ttTs.c• CILIA .Sc,&M V ink (L Meth fS1 COMPANY NAME Sawi-n I NAME(PRINTED OR TYP D) 62f)( FfrdtttLA °A" WJ VLc t yireS41" COMPANY TITLE 141),K-4\ 1�if1 COMPANYADDRESSSTATE r CALIFORNIA.ICONTRACTOR'S NUMBER 14 ' n- 657,2-'- 3i C - 2- G31IPIGAE1G COMPANY PHONE NUMBER AN ACKNOWLEDGEMENT BY A NOTARY PUBLIC OF CONTRACTOR'S SIGNATURE IS REQUIRED. ATTACH COPY /OF STATE/ ' CONTRACTOR'S LICENSE. 1868-46 (PEV.9I98) -' f IJ 7 (- "f, -L4 SC `l: \1c,\r.tli,l 1LDcc:'tc '`' NOTICE TO ALL CONTRACTORS The Costa Mesa Building Division has instituted a policy whereby contractors can designate others to sign for permits on their behalf. This procedure necessitates filing a Statement of Authorization with the Building Division. This statement will remain on file until a written document cancelling such authorization is received. Additions or modifications require a new form. If you wish to authorize a person(s) to obtain permits on your behalf, the form on the reverse must be completed and returned to this office. An acknowledgement by a Notary Public must be signed by the State Licensed Contractor, RME or RMO of your company or corporation. A signed copy of the pocket license must accompany the statement of authorization or be on file at the City Building Division. Your authorized agent(s) will be required to list a driver's license or social security number on the permit(s) application and have it verified by the person issuing the permit(s). This procedure has been instituted for your convenience and our mutual protection: no permits will be issued to any person who is not included on your filed notice of authorization. • 1131-46 (REV.9/98) CITY OF COSTA MESA BUILDING DIVISION Y • ..�. DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER �. j !viacaffiru PERMIT If11_ppdff (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 1767 PITCAIRN DR Status: ISSUED Suite No Applied: 08/13/2001 Issued: 08/13/2001 Vicinity: IN THE GARAGE Parcel Number: 13934126 ISSUED BY: Applicant: WILLARD D. MEARS Address: 1835 WHITTIER AVE. , Phone: (949)650-5916 COSTA MESA, CA Zip: 92627 Owner JUSKA, LEONARD ANTHONY TR Address: 400 HOBRON LN#3206 - . Phone: HONOLULU, HI Zip: 96815 Contractor: WILLARD D. MEARS Address: 1835 WHITTIER AVE Phone: (949)650-5916 • COSTA MESA,CA Zip: 92627 • . License:278460 SCOPE OF PERMIT REPLACE EXISTING FAU • FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $14.80 1 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0" ---- , Ventillation System $0.00 0' Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0 Inst/Rep. Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct $0.00. , 0 " Over 50 hp/Over 1,750:BTU $0.00 0 Appliance $0.00 0 ' Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp . $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $38.30 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) 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. ❑ 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 are: Carries .: Policy Number. (This section need not be Lbompleted i/the permit is valued at one hundred dollars($100)or less.) -(-]—Icertify 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 al ornia,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 pr Isi ss.--�y� o 'Applicant Signature: `� �G.[Q Pry�t[' r Date: - tl f/3/// WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL'PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOU.ARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm thattarn licensegjunder provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business nd Professions Code,and my license is in full force and effect.t ic.# Th iC.7 60 Class k- 20 Cootractors'Signature:-- c-"/Ste w/ DDtel y / 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 end 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.-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? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Flre Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 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 apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (If ryes",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 e (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. Signature Of Legal Owner(s) / Date L/t37m And/Or Authorized Applicant_-- -- (Date CODE 1. INSPECTIONTYPE 26IE INTrnALq CODE( INSPECIIONTYPE 267E IHT!➢Ala 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Root 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 • OWNER IC COY, JAMES E.• DATE AUG 2 9 1963 JOB ADDRESS 1767 Pitcairn Drive BUILDING PERMIT NO. 201179 . GENERAL CONTRACTOR owner VALUE $ 11 AP No. 139-3141-26 LOT TRACT FIRE ZONE DESCRIPTION OF WORK patio cover c., IN""ECTIONS Signature DATE GROUP I TYPE V ZONE R1 � SUBCONTRACTOR PERMITS ISSUED Gaa DATE NUMBER Water a Rough Com. Refrig. ❑ Air Cond. 0 Rough Heating Rough Plumbing Miscellaneous Prop. Swr. Line 0 House Con. El St. Swr. 0 Sprinkling System Construction Pole Underground 0 Power ❑ Rough Wiring Trenches [y— Forms 0 Steel Reinf. ❑ /a/ Floor System Bond Beam 0 Steel Reinforce 0 Sheathing Frame and Flashing /// Lathing — In.❑ Out 0 Plaster, brown coat / 'rig. 0 Air Con. 0 Final f Sating, Final Plumbing Fixtures, Final Final Gas Test Electric Fixtures, Final Building, Final CeM 9'-Z¢- (1 OCCUPANCY • Form DU4-5M-3-63-5-B P 20479 20479 CESTA MESA BUILDING-SAFETY DEPARTMENT FEE 9R E C E I V E D P.O.BOX 317 COSTA MESA.CALIFORNIA For Applicant to Fill In Completely APIP�ILII1�(T OI,I�j}�IQ{I$ PERMIT BUILDING (�7 /7 TYPE OR PRINT FINS 1� ADDRESS I / 1 PI TCA 1 R^1 DF�. CITIF4�F�flPdIWIIS/nlr RECEIPT NO. M T COSTA MESA, CALIFORNIA � L� Th R pJgr`Re7E0 A-E 19EyE= OWNERJA nne s E E . M t Coy " �'J( /G/Y A///5P ( MAILP� �T ADDRESS amt /I ADDRESS 176 PI TC AiRW De$ CryC/�1-� �/ rr1// FIRE OsTm MC.S/s NO.P�W6 ZONE GROUP AF TECT ...-----. TEL 59oy APPROVE DATE ••••-70I 1INEER'^ NQ. ZONING ADDRESS ZONy2 _.1 I NO.OF 9 I USE OF NEW }}�� 1/V!(l/• PLANE O/\- OUILDING�. p / _ CONTRACTOR OW10eR Rui LD a!i Y_ _ SAM e�G LEGAL Lor . D O 7aZ D O a • ADDRESS SA M DESCRIPTION 22 ,�//-f/ ��Lf/.,� CITY A.P.NO. 839-- 3 ! ' - �+ NOTE: NO EAVE OVERHANG SHALL BE LESS THAN STATE TEL. „--.---. 90-TO SIDE @ REAR P.L. LIC.NO. NO. EAVES SIZE I NO.OF BLOBS. ALLOWED • (U.B.C.REQUIREMENT) OF LOT NOW ON LOT YARDS APPROVED YARDS APPROVED USE OFpp Res MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG. (-.J . (FROM C/L/ST. T)�I. n. �/t ,(/ • SETBACK LINE FROM FRONT / j.- „wt.,. K/V✓J CENTER OF STREET REAR YARD 'IT- SIDE YARD LEFT I RIGHT R.SIDE /d FT. PT. DESCRIPTION OF WORK L.SIDE /O FT.1"-- Fr. N. • V ALTERATION ADDITION L� REAR /0 FT. Fr. DISTANCE BET. BET.MAIN @ MAIN SLOGS. ACCESS.BLOCS. REPAIR MOVING DEMOLISH BUILDING r �/ ^^A� NO.OR VAR.# DATE SIZE (� !� G'LL-/ ROOMS STORIES C.U.P.* APPROVED EXTERIOR WALL I ROOF APPROYE� 8-ac -r3 COVERING COVERING BY ` • DATE USE OF BUILDING AND WORK TO BE PERFORMED �_�Z' PATIO Coven ONLY R SO.FT. O 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 AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. O PLY WITH ALL CITY ORDINANCES AN TT LAWS REGULATING VALUATION 4 0� BUILDING CONSTRU ION. �1, R SIGNATURE '", '///j)- (/�J PERMIT FEE 5 0 PERMITTEE �F/ C `-" Q/(� m S a(J X G AUTHORIZED AGENT / ..--- b. STOTAL FEE $ [� .. 15033 FEE RECEIVED JUL 31 1961 COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT. P. O. BOX SI7 COSTA MESA. CALIFORNIA CITY OF COSTA MESA For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING BUILDING ti ADDRESS /']6 I /7// C �Ry P/(- COSTA MESA. CALIFORNIA For Office Use Only RECEIPT NO. P� YNO� OWNER Pacesetter Jt. Venture I I ..1 '�'t.�: Drive 1653 Minorca RHCEIBY DA RECEIVED DATE I SUH ADDRESS K '-- b -6�I '7 -31-6 I TEL. Ki BUILDING IT CY Costa Mesa NO. 9-0395 ADDRESS ARI ;CT TEL. COSTA MESA. CALIFORNIA OR (NEER NO. E ADDRESS ZIRZONE TYPE ,V J GROUPS;V JJ oV'V .- � CONTRACTOR Mesa Verde Builders Inc. APPROVED BY DATE ADDRESS 1653 Minorca Drive ZONING ZON --r_ CITYCOeta Mesa - E /� P ."y,4t... !w 1��r I PLANBNO.OL I USE OF NEW S BUILDING 4/ /.1 STATE TrEio. 181269 TEL Ki 9-0395NO. LEGAL Zen,'- /Q6 ?/�/qoo b DESCRIPTION SIZE //7500 St.Fq• I NO. OP BLDBina0 ---_ OF LOT IVV U NOW ON LOT A.P.NO. USE OF YARDS EVES EXISTING BLDG. _ APPROVED ALLOWED SETBACK LINE FROM50 (CENTER40.03 (CENTER .)ER LINE BT __� CENTER OP STREET REAR YARD FRONT So FT. IN. SIDE YARD I LEFT 5 I RIGHT 5 R.SIDE Sr—FT. — IN. DESCRIPTION OF WORK L.SIDE J FT. IN. NE. Ix II ALTERATION I II ADDITION I REAR lje'if 03 FT. IN. REPAIR I II MOVING I II DEMOLISH I BYPROVED vied DATE 7/4 /` ( t SZLDING 1620 Sq. It ROOMS 6 STORIES 1 VP EXTERIOR WAL1�LSQ (/tUCCO I ROOF Shake // 47C47/ COVERINGUSE OP BUILDING AND WORK TO BE PERFORMED Single family residence and garage % y�y a Standar Plan No. 620-B Attached garage 450 Sq.Ft. I HEREBY AC WLEDGE THAT I HAVE READ IS A PLICATION THE AMOUNT SHOWN UNDER VALUATION IB FOR THE AND STATE A THE BOVE IS OR ECT AN AGR TO COW PURPOSE OP ESTABLISHING A PERMIT FEE ONLY. PLY WITH A L TY INANCE A STATE EDUCATING BUILDING C NS ON. VALUATION p� SIGNATURE P A/� ,,,/// PERMIT FEE $ ?0 es PERMITTEF '-`" I /!/ /)/// $ f L/7 PLAN CHECK $ /9 i 5-7 I AUTHORIZED GENT N, TOTAL FEE $ 5J-/y— F.