HomeMy WebLinkAbout1821 PITCAIRN DR - Building PermitsADORS6OFBIRLDWO: 1821 PITCAIRN DR
ONNEWSHIUNEWINOYRh FOURNIER, BARBARA' A TR
ADDRESs:1821 PITCAIRN DR
COSTA MESA,CA 92626
WL. MMIING ADDRESS.
ARCIRMT OR ENGINEER:
ABCtL OR ENG.'S ADDRESS:
OMT: CITY OF COSTA MESA - BUILDING PERMIT
PERMIT NO: M 086358 PLAN CHECK NO: N
CONSTRUCTION TYPE: V -N PERMIT TYPE: MEC
M RIO, JOB DESCRIPTION
UNIT:
CLAIM VALUE:
WNIR.LCTORSNa 'X 6 H AIR SYSTEMS (909)736-1999
CONIRACTOnuluu1G 4057 TEMESCAL
ADDREss: NORCO CA uc.No: 684853
91766 MT.
LICENSED CONTRACTORS DECLARATION: I hereby affirm under peraly of Mquq that I sin limos e l under prmisons of Chapter S
(aommmn , with Section 7000) of Whine 3 of the Busur. aid Profession. Code, aid my lice. is in lull facer and aVad.
UUC).No.:0691431 utclAss:C-20 LIC.NO.: 684$;53 EXP: 03/98
ER BUILDER DECLARATION: 1 hetmby dhmh under penaly d perjuryIMf 1 em ezempr Item the COmractm limine law la Va
ow.g reason (Section 7031.5 Busirat end Pnlassons Cab: Any city or county which r ml a petmh to mnebitd. Mer. ima0va,
deeh, repair y aruwa ewan
cra. Idl0 as hce, also remuirsa IM applicant for la such permaaa
it to file a signed ment had M a and
`mdpr an
d licensed pursuant to the provisions of theConlracnma License Lew (Chapin om
9(omencin with Sedicn 7000) of d Diyeion 3 IM
Business and Profession$ Cade) or that he m she is exempt therefrom end the basis for the alleged exemption. Any violation of Section
7031.5 by any applicant for a permh wbjmde the applicant to a evil penahy d no more than five hundred "Im;5500;).
❑ I, as owner of the progeny or my employe s, wllh wages as their sols mmpenemion, will do tits work, and the nnAnure is not intended
or Mered for cab (Section 7044, Dueness and Prolmsom Cab: The Contractor• Liceroe law does not appy to an owner d properly
wW Wider a knpoyae thereon. and who dace such work himseh or hereel or through he a her own empoyeas, pno diclad that amh
ima sna are nor intetded or offered for rale. V, however, the Wildbg a orlm yemerel is cob within aha yam of paim. the
owner -0 Rcfsr will hove the When of Iso dry, he or she did not build or bnprvw la the xxpme of sale).
❑ 1, as owner of the Izo ert, sin exrlyatraly ooramip weh gcar sed ccneactaa a ccnebud the project (Sadie 7044, Buakress and
Professions Cale: The C naorora Licenas Law data not appy a an owner of property who bdW or ve roves thereon and who
cowacts ler smin prajade with, er emireda(e) Icamed Wnuad to IM Cantrmas Limine Lew).
❑ 1 am a smpl under Se don: B. d P.C., ler Chat ream:
Dina: Ow7w
I de hraby mrlgy Val I am aware of and understand! One requirements of Cmlama fleapit and Safety Caller Sa tons 25505.55533. and
5553x. and that I or any Mum Wilding opwpyn will I At not (circle ane) need no canply with said nae codas and IM napukenrhergs ler
a parmhlamatrucliona mndifmli0nhantM Alai Y-W.-weerant Octroi. Residential oonmroon. appicaMroan ezempl front Vasa
provisona.
Ome: Applicant:
WORKER'S COMPENSATION OMLARATION: I hereby affmm undr prrehy d perjury are of the hNbwihp dadered.:
❑ I haus and sail mebsan amnAcmer of consent to sMimae ler wakri co eprtsmim, as Ixoyoed for by Sso im 37M of IM Labor
Cods, la the Wamanes of she work for wNch that permit it; esued.
I haw end W malnan ova W esanpenemon marma,e, m remuuad by Section 3700 of Vre labor Code, b the padamenoe of IM
work for whits this permit at iumd, My workers' compemale. baunnce carrier and polity number are:
carder:CALIF COMP EXPIRES
Policy Number: r, 07/27/98
(This mon. need not be mo plalad d the saryk is ler one hundred dollars 151001 or baa)
❑ mnty iMl in the pedormenee d the wok la which this pamnil is issued, shall M empty any person In any manner w as to
oma aublect b the workers' eompeeamion laws d Calilomie, end spree that V ehwld become oubjep to the xoekera'
m peeas�M7n prwiaion• d Section 3700 d the Lahr Coda, I sh�egll I�ajNywyil/h oompy dvlg�Nnee pnwisione.
Dins: d-' Applimru:� y!_
1 a'em p: F ffma he ••con worksn' osepaaedon roan nape /a unlerNl, mat mWl •tbJsct an wrtployw fo aIMrW paafgas anC
ne• rpt he ow htndred neo: y M.
(SfogawA N oWltlpn d ata cwt al rnnpertsatbrs denrps u pwvyM ror In
Von 3]06 of VI• Labor Cerate, Infonet sari mohnn '• Isere
CONSTRUCTION LENDING AGENCY: I Mnby eamh under panaM of perryry ihe1 there is a axmmaion lending apma, W den
mdmance of the work la which the peneh is sued (Section 3W7. Car. C).
LENDER'S NAME:
LENDER'S ADDRESS:
I certify that I Mw reed Ne epplioame end nate that the abos idammion at coned. l prem to comply vmh M city end mdy mfiancas
and care awe reaig to Iwid'vhg mwWim and hereby adhabe repreaenauym d this city to aper upon IM properly
for impedon purposes.
BILL SAMMONS
Date: 1,2-3L
(5151,towp) White -Buil ig 4 Smmy: Orsmn ile; Csnary-Appicem; Pink -Re rmc (1oMedod-Nmeaor
: CHANGE OUT FURNACE
CALC—VALUE:
q - m cog I
PERM NO: M 086358
GOVT: N SUPP: N
PURPOSE: OTH
SQ FT:
GROUP OCC: R-3 /
COMMENTS: X
*iE*4*rt**dE**fE it iE iE***k4dE iE iE*iE iE iEk**if dE*iE***iE iEk*1E 1E 1t 1E iE 1E iE 1E it*k**iE 1E iE**1E BE 1E iE 1E dE 1E*dE it lElEiE BE 1Ek1E iE 1k 1E
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
LEFT: FT IN
RGHT:
FT IN
LEFT:
FT IN
RGHT: FT IN
PARKING REQ:
PROV:
PARCEL:
13938336
ZNE:
REF NO:
PLANNING NOTES>
>
lk irk dE 1E 1E 1E iE4**♦E*1E 1E 1E±F1E♦E
♦E iE ♦E ♦E iE 1F 1E iE 1E 1E*k1E 1E dE**irk**♦f irk lE iE iE irk irk irk*1f 1E**1E
iE lEkkiE♦E iE 1E*1E
SE iE iF lE if lF dE dF dE dE dE iE lE irk iE lE irk
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
BUILDING APPROVED BY
APPLICATION ISSUED BY:
1F irk iF*1F iE dE lE dE iE 1E iE SE**4kiE iE*irk It
LEGALIZATION:N
F E E S U M M A R Y
BLDG PMT PLUMBING ELECTRIC MECHANIC
PERMIT 13.25
253
PLAN
ISSUE FEE 22.00
BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK
TOTALS ---- > 13.25 22,00 0.00
DATE:
DATE:
STRUCTURAL SEGMENT:N
FIRE SMIP/RES GRADING
SMIP/NON-RES
TOTAL PAID DUE
35.25 35.25 .00
REVENUE DIVISION TOTALS--> COLLECTED: � 35.25 OVER/SHORT:00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN -CHECK
35.25
*irk****141E 1EiE iE 1Ek 1E*it BtiE i4*k1E iE lE iE iE*iE it dE lE iE iE*iE 1E iE 1EBE iF lE irk irk lE irk It*%iF irk iE 1E*kirk*iE iE iF if iF iE iE 1E iF 1E iE*irk irk*irk It iE iE 1E 1E 1E 1E
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
MEC 1 INST FORC-AIR/GRAV FURN <= 100 K BTU 13,25 13.25
END OF FEES
71
12-3i-1997/_ii:35 6'11,35.:5
PERMIT -.9863E-6
� r - s
CONSTRUCTION AND PLANNING-_
APPROVALS Permit 4h Date
Inspector
P�& SPA
APPROVALS Permit#
Date
Inspector
1. Temporary Electrical Service or Pole
52. Pool & Equipment Location
2; Soil Pipe-Undrgrnd. - ��
53. Steel Reinforcement
�3? Electrical Condui(-U.tility-UntYrgrnd.
54. Forms
;4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding
.,,ZSheel Reinforce6ent
56. Rough Plumbing & Pressure Test
6;•-glectrical LIFER Grnd.
57. APPROVAL TO COVER-GUNITE
4 27 'Footings _
58. Electrical Conduit-Undrgrnd.
8: Foundation -
59. Gas Pipe, ❑ Uncfr�rnd., Test
9. Water Pipe-Undrgrnd. -
60. Backwash Lines,? -Trap, 0 Undrgrnd.
�0. Structural Floor System
61. APPROVAL TO DECK
'11 -Property Sewer UnC& 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-CcZduit -•
66. Solar System- F`t W
16. Rough Electric Wiritllj -
67. Fencing & Access .Approval
17. Rough Wiring Sign
-
68. APPROVED FOR PLASTERING
18. Rough ElectricaltT Bar Ceiling
69. POOUSPA SYSTEMS FINAL
19. Rough Hgating&.Ajr Condiging
_
FIRE:DEPT-REQUIREMENT
APPROVkS, -' Permit # '
u, r
20.-;Roi)'h Rattot�+ Fir401ace = 0� t
C. x -
t 7:*
�.
7 7 �� <
21. Ducts, in;Btrubtuie j S
^..:
70.. Underground Hydro
22. Ducts, Ventil3tinjis: :�
"7 rr,
C
t' tie <
x
71• Prod u�ti,'Piping-.0 as 70i1
23. Gas Pipe -Rough &`Test _ _, ['tom
n.
- -
72. Underground Flush
24.' Roof Framing
73. Undergrnd. SttS e Tan ❑ Gas ❑ Oil
25. Roof. Sheathing
74. Overhead Hydro- .:
26. T•Ba; Ceiling(Structural) & "coat
>;
'
75. Dry Che. -typical '� , �u
^
27. Frarlie agZd Flashings = -� ^
_
' �
'�
76. Dr �'x V
y Stai pipe-,
. 28. Lathing $ Siding w 7-p-+
�.
77. FIXEO-SYSTCWINAL
PON
29. Insulation
73. FIRE ?REV. FINAL
•;�'
30. Drywall -Nailing r --
i
S aiHEALTH DEPT. REQUIREMENT
31. Plaster Brown,Coatt "
79. FINALINSPECTION =t
32.-Electricai:Power Meter -Final
>*
;,.
80: FOOD CERTIF_1CATE ISSUED _
33'FinalElectrie, c -
{
Ngtes: i„ s _
34. -final Heating `& Air, Conditioning' :e,
-
. _ .rrl- r -
35.•FinalGasPipe-Testy = r
°-
tit -,"s;'-
�....
•: 36. -Hood or Canopy
37.'FinarFactory Fireplace'
38. Finali Plumbing - _
,
?�
• +:% • _ r. "�
39. Water Service -Final" - �
"" >
�t
-
T
m
� 40. Gas Service -Final •. ;:
;
41. Solar Domestic -Final
42. Backflow Presenter{
43. Backflow Irrigation<
44.t.Landsca4 Irrigation System • _ -
r
J
„ _ j_ . � -
45..Sound Atteribatiom
.46. 'Handicap RegUlations
:47. FINAL STRUCTURE & BUILDING
T r-
J,
48.:fINALPLANNING
r i
99. Electric Release to Edison
-
7
50. Gas Release to Southern California Gas Cn
,
tf L
• Y.
51. CERTIFICATE OF OCCUPANCY
No. Date
--.
M CITY OF COSTA MESA
a �9
BI/ILDIN6 DIVISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT PERMIT NUMBER .
M99-00042
(714) 754-5273 Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626
MECHANICAL PERMIT
Job Address: 1821 PITCAIRN DR Status: ISSUED
Suite No Applied: 02/09/1999
Issued: 02/09/1999
Vicinity:
Parcel Nunmber: 13938336
Applicant: BELL, RALPH
Address: 11801 MAC ST
Phone: 714-534-2593
GARDEN GROVE Zip: 92841
Owner: FOURNIER, BARBARA A TR
Address: 1821 PITCAIRN DR
Phone:
COSTA MESA,CA Zip: 92626
Contractor: CRYSTAL AIR
Address: 11801 MAC ST
GARDEN GROVE
Arch/Eng:
Address:
Phone:
Zip:
License:
Phone:
Zip:
License:
714-534-2593
92841
¢55030
SCOPE OF PERMIT
ADD A/C UNIT (3.5 HP).
FEE SUMMARY
Quantity
Quantity
ISSUE FEE
$22.00
Repair/Alt Absorbtion Unit
$0.00
0
Inst FAU <100 k BTU
$0.00
Repair/ Alt Refrigeration Unit
$0.00
0
Inst FAU >100 k BTU
$0.00
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 / 100k 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 Dud
$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
$24.25
1
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
$46.25
COMMENTS / SPECIAL CONDITIONS
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
DECLARATiOMS
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 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.
❑ 1 have and will maintain workers' compensation insurance, as required by section 3700 of the Labor Cade, for the performance of the work for which this permit is issued.
My workers' compensation Insurance carrier and policy number are:
Cartier: Policy Number:
(This section need not be completed if the permit is valued at one hundred dollars ($100) or less.)
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 forthwith
comply with these Moons.
Applicant Signature: \, g Date: ��
WARNING: FAILURE TO SECURE WORKEgSCOMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE ($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 underprovisions 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. Lic. P CD3 6 Class a
Contractors Signature: ` L/ / Data:
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).
Lenders Name: Lender's Address:
Signature: Dale:
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).):
❑ 1, as owner of the property, or rely 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.).
❑ 1, 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.).
❑ 1 am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires:
Verification of Ownership by (type of document, Le. - 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 W III 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
metedel? ❑ 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 fila a registration toren 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 Doee 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, hes Section 25534 of the Celifomla 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 �plicalion apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes U 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 Ali Oualily Management District or other air pollution control district or agency Is reQwired for the work which is the subject of this
application, have all of the disclosures prescribed by Celifomla 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:
CERTIFlCATE 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 ell 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.
Signah7l(fj1 Legal Owner(s)
And/ t " n I ed Applicant Date '7
CQDF—L INSPECTION TYPE 2Ag IK®ALS CODE INSPECTION TYPE IR q9 IIIIIDE65
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 200 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
2"6646
5TR Mlc
CITY OF COSTA MESA
BUILDING DIVISION
F DEVELOPMENT SERVICES DEPARTMENT
PERMIT
(714)754-5273 • Fax(714)754-4856
Job Address
Suite No
Vicinity.
Parcel Nunmber
Applicant.
Address.
Owner:
Address
ELECTRICAL PERMIT
1821 PITCAIRN DR
13938336
BELL, RALPH
11801 MAC ST
GARDEN GROVE
FOURNIER, BARBARA ATR
1821 PITCAIRN DR -
COSTA MESA,CA
Contractor: - CRYSTAL AIR
Address: 11801 MAC ST
GARDEN GROVE
Phone: 714-534-2593
Zip: 92841
Phone:
Zip: 92626
Phone: 714-534-2593
Zip: 92841
License: 655030
SCOPE OF PERMIT
REFERENCE: M99-00042.
ELECTRICAL IS: MOTOR FOR NEW A/C UNIT.
Quantity
ISSUE FEE
$22.00
Temp service test
$0.00
Res. a/c package
$0.00
New Res (1-2 units)
$0.00
New Res (3+units)
$0.00
Pool / Spa
$0.00
Lighting Fixts
$0.00
Recept Outlets
$0.00
Switches
$0.00
Non Res Appl
$0.00
Res Appl
$0.00
Service to 200a
$0.00
Service to 1000a
$0.00
Service over 1000a
$0.00
Motors to 1 hp
$0.00
Motors to 10hp
$11.00
Motors to 50hp
$0.00
Motors to 1 00h
$0.00
Motors over 100hp
$0.00
Communication drops
$0.00
Sub panel to 200a
$0.00
Pole Light Pkg
$0.00
Sign Circuits
$0.00
Temp Pwr Pole
$0.00
Intermed Pole
$0.00
PERMIT NUMBER /
E99-00088
77 FAIR DRIVE, COSTA MESA, CA 92626
status: ISSUED
Applied: 02/09/1999
Issued: 02/09/1999
FEE SUMMARY
Quantity
•
Temp -Dist System / Lighting
$0.00
0
Busway /100 ft - -
$0.00
0
Standing Section
$0.00
0
Misc Electrical Equipment
$0.00
0
Transformers up to 1 kva/kw
$0.00
0
................ up to 10 kva/kw
$0.00
0
.................up to 50 kva/kw
$0.00 -
0
................. up to 100 kva/kw
$0.00
0
................:.over 100 kva/kw
$0.00
0
Low Voltage Equipment
$0.00
0
- - Low Volt Wiring System / Ckt
- $0.00
0
Misc. Conduit
$0.00
0
Misc. Conductor
$0.00
0
_
Circus ( gen or ride)
$0.00
0
Circus_(mech ride or lights)
$0.00
0
Christmas Tree Stand
$0.00
0
Fireworks Stand
$0.00
0
Other Electrical Fee
$0.00
Investigation Fee -
$0.00
Plan Check Fee
$0.00
Reinspection Fee
$0.00
TOTAL CALCULATED FEES
$33.00
COMMENTS / SPECIAL CONDITIONS
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
4
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:
Carrier: Policy Number:
(This section need not be completed it Me permit is valued at one hundred dollars ($100) or less.)
—i-cer ify 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 pkCaliffornia, 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 the'gp 1q sions. ^
Applicant Signature : ��(/\t Date: Q
WARNING: FAILURE TO SECURE WORKERSCOMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3106 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licens@d under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Busines\8 and Professions Code, and my license is in full
force and effect. Lic. #—/� IU�ZT-3 Class #
Contractor's Signature: �I /1.F11 lI/ / Date: 2
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER -BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjurythat 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.).
❑ 1 am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑ Yes ❑ 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:
❑ 1 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 feat of compressed gas at standard temperature antl, 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).
................... ........................................................... .......... ................ I ............ ..................................................................................... ......................... I...............................................
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 It 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 aMplication apernit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? LLII Yes O No
(Section 658502 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 El No
....................................................................................................................................................................................................................................................................................
8 (it "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. 1 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 inTectfor purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
eget Owners) Date
And/Or ooze Applicant Date
CODE N. INSPECTION TYPE PATE If®A65 CODE# INSPECTION TYPE ppTE IfDmALS
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
2446-46
OWNER ADAMS2 N. L. DATE 8/12/63
JOB ADDRESS 1821 Pitcairn Dr. BUILDING PERMIT NO. 20400
IDTQPECTIONS
RACT FIRE ZONI
Signature DATE GROUP
VALUE
DESCRIPTION OF WORK COM. P
TYPE III ZONE R1
Gam SUBCONTRACTOR
PERMITS
ISSUED
DATE
NUMBER
Water
Rough Com. Refrig. ❑ Air Cond. ❑
Rough Heating
Rough Plumbing
Miscellaneous
Prop. Swr. Line 0 House Con. ❑ St. Swr. ❑
Sprinkling System
Construction Pole
Underground 0 Power O
Rough Wiring
Trenehes O Forms ❑ Steel Reinf. ❑
Floor System
Bond Beam ❑ Steel Reinforce ❑
Sheathing
Frame and Flashing
Lathing — In ,p Out O
Plaster, brown coat
�O Air Con. C1 Final
Final
Plumbing Fixtures, Final /
Final Gas Test
Electric Fixtures, Final
Building, Final
-
OCCUPANCY
Form SU4--5M-3-63—S-B P ;'ohm
20400
COSTA MESA BUILDING -SAFETY DEPARTMENT
P. O. BOX 917 COSTA MESA, CALIFORNIA
For Applicant to Fill In Completely
TYPE OR PRINT
BUILDING
ADDRESS
COSTA MESA, CALIFORNIA
OWNER AIL/� //yj /`/ �y
M`'Y/l�Y
ARS HITECT
SIZE/
1^ 5
NO.OF BLDOB.
OF LOT "-
/� O r l/ L%
.WONLOT
USE OF
EXISTING SLOG.
SETBACK LINE FROM
PERMIT FEE S
OF WORK
WALL
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONSTRUCTION.
SIGNATURE OF
PERMITTER
AUTHORIZED AGENT
FEE RECEIVED
AUG 2 1964
A4;N DERTPERMIT
CITY OFBOOP WIVIESA
For Office Use Only
RECEIyBD BY DA—CEIf -Z • yTE 1 ' h
FIRE
Y
"GAL
A. P. NO.
NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
SC- TO SIDE a REAR P. L.
EAVES
ALLOWED (U. B. C. REQUIREMENT'.
YARDS APPROVED YARDSAPPROVED
MAIN BUILDING ACCESSORY BUILDING
VAR. #
DATE
60. FT.
N
�
THE AMOUNT SHOWN UNDER VALUATION
PURPOSE OF ESTABLISHING A PERMIT
IB FOR THE
FEE ONLY.
F
O
VALUATION
PERMIT FEE S
m
S
PLAN CHECKo
--
TOTAL FEE $
LS
OWNERDATE 10-23-b2
JOB ADDRESS 1 1 PitC812T1 Dr. BUILDING PERMIT NO. 18058
GENERAL CONTRACTOR Adams St. Co. VALUE $ 2800.00
AP No. 139-383-3 LOT TRACT FIRE ZONE DESCRIPTION OF WOREAdd Ftge.& Hr
INSPECTIONS
Signature
DATE. I GROUP I TYPE V ZONE
SUBCONTRACTOR
ISSUED
G`
DATERMITSNUMBER
Water
Rough Com. Refrig. ❑ Air Cond. ❑
Rough Heating
Rough Plumbing
Miscellaneous
Prop. Swr. Line ❑ House Con. ❑ St. Swr. ❑
Sprinkling System
—
1
onion Pole
Underground ❑ Power ❑
Rou •h ng
,
+
'Crenches ❑Forms ❑ Steel Rejnf. ❑
Floor Systeme
BondBeam ❑ Steel Reinforce ❑
_
f
—
Shea
Sheathing
Frame and Flashing
1 �
—
Lathing — In ❑ Out ❑
Plaster, brown coat
;
1g. ❑ Air Cond. ❑ Final
I pg, Final
Plumbing Fixtures, Final
_
Final Gas Test
Electric Fixtures, Final
Building, Final
OCCUPANCY
rams mie . 5. - I.., . 0--n
18058
COSTA MESA BUILDING -SAFETY DEPARTMENT
P. O. BOX 317 COSTA MESA. CALIFORNIA
For Applicant to Fill In Completely
TYPE OR PR T
COSTA MESA. CALIFORNIA
■ MAIL
III ARC'
SIZE /
OF LOT
0 SETBACK LINE FROM
NO. OF BLOBS.
S DESCRIPTION .OF WORK 1
■ BUILDING
TO BE
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT
THE ABOVE IS CORRECT AND AGREE TO COM-
PLY WITH ALL CITY ORDINANCES AND STATE LAW161MOULATING
BUILDING CONBTRU/FYI/O,�N.
SIGNATURE OF / /�"/!,x-Zo ��—/ A.v ice/ 1-2
■ AUTHORIZED
FEE RECEIVED /
OCT 2 3 I9s2 �, ^
FINANCE DEPT. v
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
COSTA MESA. CALIFORNIA
FIRE
E NO. OFI i U88 OF NBWv�`�' �T\l"
I / PLANS BUILDING U
LEGAL / /y�
DESCRIPTION %
YARDS
APPROVED
(CENTER LINE ST.)
E MOUNT SHOWN UNDER VALUATION 18 FOR THE
PURPOSE OF ESTABLISHING A PERMIT PEE ONLY.
VALUATION µ
,A PERMIT FEE $
(;✓/ PLAN CHECK S D
N� C
TOTAL FEE D
LL
_ 8
COSTA MESA BUILDING -SAFETY DEPARTMENT
P. O. BOX 917 COSTA MESA. CALIFORNIA
For Applicant to Fill In Completely
hJ'
��`�i// TYPE OR PRINT
COSTA MESA. CALIFORNIA
FFF RECEIVED
SEP 191962
FINANCE DEPT.
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only/ 7_V ,1l
�m A71 /�(A'
RECEIPT NO.
OWNER
MAIL A�/ ^ lO�� ^
RKC81VEjBY I DA z IVEDyI QDATEFIBSUEDJ Fj�
CSbI
ADDRESS „ ,L /-t
L/ fY/
AA TEL
���
%07
/
CITY /�'! NO/
pDORE165
ARr--EGT TEL.
COSTA MESA. CALIFORNIA
OR NEE NO.'
I
-n
FIRE
ADDRESS
ZONE TYPE // GROUP ,>////y�/. / I
`L/
APPROVED
CONTRACTOR %
BY DATE
IZP
ZONING
ADDRESS
ZONE
NO. OF
I
USE OF NEW I♦ •ti ��
CITY `
��,
PLANE
BUILDING
STATE TEL. / �6 P "
5
,,L
LEGAL
/-3 7-e y31/
LIC. NO. NO. i L
ION
DESCRIPTION
B LOT D I
OTB
3 8 3— 3G
f /
NOWOON
A. P. NO.
USE OP _
EXI ING BLDG.- -`_
YARDS EVES
APPROVED ALLOWED
SETBACK LINE FROM
IGENT[R LINE BT.) ((''
CENTER OF STREET REAR YARD
FRONT Sd FT. C IN.
SIDE YARD I LEFT
I RIGHT
R. SIDE /0 FT. IN.
DESCRIPTION OF WORK
��
L. SIDE FT. N.
NE' I XII ALTERATION I I ADDITION I
/�
REAR 6 FT. IN.
REPAIR I (MOVING II DEMOLISH I
q
APPROVED DATE / �% 1112 -
BUILDING NO. OF
ZL Z
SIZE ROOM6
EXTERIOR WALL ROOF //t(S��TORIES
-0^�I.J
COVERING U COVERING
USE OF BUILDING AND WORK TO BE PERFOIjMED
D
_ -
3 3
1 HEREBY ACKNOWUEDCP THAT 1 HAVE IS AP LIGATION
AND STATS THAT THE V8 18 CO AG TO OM•
THE AMOUNT SHOWN UNDER VALUATION IB FOR THE
PLY WITH ALL CI O
PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
VALUATION
Q�t
BUILDING COHB O `O
SIGNATU
PERMIT FEE $
PLAN CHECK $ �C I _I
PERMITTE
�/1 �
S p�S/ 3SI2—
'j
AUTHORIZED AGENT �
TOTAL FEE /a� 7�