HomeMy WebLinkAbout1693 SAMAR DR - Building Permits airs CITY OF COSTA MESA
,y ,I BUILDING DIVISION •
ERMIT NUMBER
DEVELOPMENT SERVICES DEPARTMENT
kV *�; PERMIT
B99-01661
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 1693 SAMAR DR Status: ISSUED
Suite: Applied: 10/13/1999
Vicinity: Issued: 10/13/1999
Parcel Number: 13927302 Zoning: R1 R1
Applicant: HOLLIS, DENNIS ISSUED BY: Or
Address: 949 N.CATARACT AV. `�
UNIT G Phone: 909-394-5584
SAN DIMAS Zip: 91773
Owner: COOLEY, DAVID M
Address 1693 SAMAR DR
Phone:
COSTA MESA,CA Zip: 92626
Contractor: HANSTEG SYSTEMS INC.
Address: 949 N.CATARACT AV.
UNIT G Phone: 909-394-5584
SAN DIMAS
Zip: 91773 License: 207609
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF SHAKE INSTALL 1/2"PLYWOOD,30 LBS FELT AND 30 YEAR COMP.SHINGLES.
FEE SUMMARY
•
Plan Check: $0.00 Calc Valuation: $5,000.00
Permit: $111.25 Claim Valuation: $5,000.00
SMIP Res: $0.50
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $111.75
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:
-EX Pit lael)
X21
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
f
1
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
O 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.
y workers'compensation Insurance carrier and policy number are:
Carrier: • Policy Number:
(This section need not 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 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' I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with these pro�v�nn�s.� Q
Applicant Signature: nt/'�✓r'4� L• Date: 7 ///3797
WARNING:FAILURE TO SECURE WORKERS COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),IN ADDITION TO THE CY1ST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST.AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.a 7 O7 (n OClass# C —39
Contractor's Signature: )'lo-el' Date: / U ""/ 7 /72
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. ❑Yes ❑No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet In depth into which a person Is required to descend, will be made in connection with work authorized by this
permit.and that no building structure,scaffolding,falsework,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 ❑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).
._-___ ... . __... __....... .fu_.
......... ._. ... ...... ........ .......... .......... ..... ......_ _..-,_.___. _._._.
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.
_ .__ ._ . .__ ...o
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application°permit for such construction or modification
from the South Coast Air Duality Management District or from any other air pollution control district or agency? U Yes 0 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 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.
/Ct Signature O Le ner(s) Date
d Y7.0, , ) ) /a //7/9 y
And/Or Authorized Applicant Date
CODE I INSPECTION TYPE PAIS 1NTRIALs CODE I INSPECTION TYPE. QATh INTITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final ;'�p/_// (��.�L 208 Final Plumbing
200 Final Re-Roof 3JZ i` (Arm- \ 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
PROJECT ADDRESS: UNIT:
1693 SAMAR DR CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 064469
OWNER'S NAME: COOLEY, DAVID M
ADDRESS: COOLEY, CINDY D PERMIT NO: B 064469 PLAN CHECK NO: 04016-93 S GOVT: N SUPP : N
1693 SAMAR DR
COSTA MESA,CA 92626 CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: ADD
ARCH/ENGINEER: 979-8291 REG.NO.:
ADDRESS: UNIT; JOB DESCRIPTION : 252SF ALUMINUM PATIO ENCLOSURE ICB0#3421 SQ FT: 252
PERMITTEE: CLAIM VALUE; 6, 000 . 00 CALC-VALUE: 9, 324 . 00 GROUP OCC : R-3 /
ADDRESS: SUN VUE BUILDERS ( 800 ) 654-2806
646 E NORTHRIDGE COMMENTS: X
GLENDORA CA 91740 ***+cot*******ar*aE*ar********i6*+t*ar*Sar*ar+c-aE*9E******Tr**Brie*+L***+ ***** -N-*+ek6 -N-*********+H
LICENSED CONTRACTOR DECLARATION; I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z O N Z N G R E Q U I R E M E N T S
70001 of Division 3 of the Business and Professions Code.and my license is in full farce and effect.
CITY LIC.: STATE LIC.: LASS:
S E T B A C K S
0 6 3 522295 B •
Dale:___[A signature: _ �' MAIN BUILDING ACCESSORY BUILDING
WORKERS'CO PE SATION DECLARATION: I hereby affirm that I hav a certificate of consent to self-insur ra
At/
of Workers' FRNT: FT IN REAR: 15 FT IN FRNT: FT IN REAR; FT IN
Compensation Insurance.or a certified copy thereof(Section 3800, Lab.C). LEFT: 12 FT IN RGHT: 5 FT IN LEFT: FT IN RGHT: FT IN
POLICY NO.: 1084192-92 EXP.DATE: 08/01 /94
COMPANY: STATE PARKING REQ: PROV; PARCEL; 13927302 ZNE; R1 REF NO:
❑ Certifieticopyisryerebywr shed. [ Certified wi the ddmgDivisi°o PLANNING NOTES> ADD 252 SQ, FT, ALUMINUM PATIO ENCLOSURE TO THE REAR OF
'Q ',/,�111I�e7,�4� /�L��/�ly- -�.r > EXISTING SINGLE-FAMILY RESIDENCE,
7 Date: n 0.4 Applicant: ********************************************************************jD*********
EXEMPTION F DM ORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit r one hundred(5100)or less). DEVELOPMENT SERVICES R E Q U I R E M E N.e: S
I certify that in the performance of the work for which this permit is issued.I shall not employ any person i ny manner so as to become
subject to the Workers'Compensation Laws of California.
ZONING APPROVED BY Q/L91� DATE: 1_0 �� Y
Date: Signature:
NOTICE:If.after making this declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY Y
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. DATE: 'i
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for �`, Q
which this permit is issued(Section 3097,Civ.C). APPLICATION ISSUED BY: ` DATE.: �d l
**PLIC********SUED************************ * ***********************$$** *** **
LENDER: *******************************************************************1************aoDREss: LEGALIZATION:N F E E S ,L` M M A R Y STRUCTURAL SEGMENT: Y
OWNER BUILDER DECLARATION; I hereby affirm that 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 I T 1 i 7 , 0 t 1
repair any structure,prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed . 93
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business - SMIP/NON-RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN 76 . 05 t ,
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 4
I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 1 1 7 . 9 3 0 . 0 0 , 7,6'- 0 5 19 3 . 9 8 19 3 . 9 8
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through • 00
his or her own employees.provided that such improvements are not intended or offered for sate.If, however the building or • kg
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED : 193 . 98 OVER/SHORT: 00
. for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044.Business 117 . 00 ' . 93 76 . 05
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).l am aware **,*,K,*,*,*„N„K,**,N,*,**,**,****************U'k*,1/h*,1F*1E*****UDE*�"c*SUE******U*****S*SS*****SSUD
that proof of their Worker's Compensation insurance should be provided to me.
❑ I am exempt under Section: B. 8 P.C. INDIVIDUAL F,'•E E BREAKDOWN
tar this reason: TYPE QTY DESCRIPTION ter- Y UNIT COST TOTAL COST
Date. Owner:
I do hereby certify that I am aware of and understand the requirements of CaliforniaHealth and Safety Code Sections 25505,25533.and
SFR 252 RES—PATIO COVER-ENCLOSED—PATIO 37 , 00 9, 324 , 00
2e534 andrthat uc any orfuturembuilding occupant ht irlDl not nle one)need Dis toicomply with saidstate ion codes tic the are
for a j END OF,• FEES \
permit for conI m mbuildlion from the Air Duality Management District. construction applications are exempt from E
these provisions. / ' J
Date: Applicant: / \
re
I hereby certify that I have read this application and stale that the Arm-information is correct.I agree to comply with all city and county
ordinances and sr Ie law relating to building construction and hereby Drize representatives of this city to enter upon the above-mentioned .-
property for ins Ilion imposes, z/'
7 �s 0100148920-00142922 TOT 3.93.98
Dale: /� Signature: �L \ f DATE; i ' 15:47
l g lv:i5/93 TIME:
Driver's License or Social Security a: •T''
(1641.46 White—Building:Green-Code Enforcement.Canary—Applicant:Pink—Revenue:Goldenrod—Assessor
,
CONSTRUCTION AND PLANNING POOL 'A - -
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole - 52. Pool & Equipment Location
r,. 2. Soil Pipe-Undrgrnd. • - 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5: Steel Reinforcement . • 56. Rough Plumbing & Pressure Test
6.- Electrical LIFER Grnd. 57. {APPROVAL TO COVER-GUNITE
7, Footings - 58. Electrical Conduit-Undrgrnd.
•
8. Foundation59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. - 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System I 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 ❑Gas 0 Oil
-
23. Gas Pipe-Rough & Test 72. Underground Flush
24, Roof Framing 73. Undergrnd.Storage Tank 0 Gas ❑Oil
25. Roof Sheathing • 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 PREV. FINAL
30. Drywall Nailing t HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat . 79. FINAL INSPECTION I
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:AN�y' ,q06 n; A 5 c_ 7y/.(I]
34. Final Heating& Air Conditioning - s� - !ll-- -1'
35. Final Gas Pipe-Test 4
36. Hood or Canopy
37. Final Factory Fireplace •
38. Final Plumbing ~
'-
39. Water Service-Final
40. Gas Service-Final .
41. Solar Domestic-Final
42. Backflow Preventer i ^�^
43. Backflow Irrigation '
44. Landscape Irrigation System •
45, Sound Attenuation .
I( (/V ..
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING friff0
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
—
PROJECT ADDRESS: UNIT:
OWNER'S NAME: 1693 SAMAR DR CITY OF CO TA MESA — BUILDING PERMIT PERM NO: E 064470
COOLEY, DAVID M —
ADDRESS: COOLEY CINDY D PERMIT NO: E 064470 LAN CHECK NO: N GOVT: N SUPP : N
1693 SAMAR DR
COSTA MESA,CA 92626 CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE: ADD
979-8291
ARCH/ENGINEER: REG.NO.:
ADDRESS: UNIT: JOB DESCRIPTION : 252SF ALUMINUM PATIO ENCLOSURE ICBSQ
O#3421 FT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /
PERMITTEE: SUN VUE BUILDERS ( 800 ) 654-2806
ADDRESS: 646 E NORTHRIDGE COMMENTS : RE: #B64469
GLENDORA CA 91740 +r**+r*ac-*aF+t+F+e*ac******+rk1k6***************N-*kFvr-**+r+6+F -+k****x-*********+rkFkF*+r****err*x** -ic
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z 0 N I N G R E Q U I R E M E N T S
70001 of Division 3 of the Business and Prolessions Code,and my license is in full force and effect. SETBACKS
CITY LIG.: 0 6 93 STATE LIC.: 52229 k." CLASS:
Dam:_ — Signature-
ywdNr MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell-incur r a certi mate of Workers' FRNT: i FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Compensation Insurance.or a certified copy thereof(Section 3800,Lab.C). LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN
POLICr NO.: 1084192-92 EXP.DATE: 0 8/0 1 /9 4
away: STATE / _PARKING REQ• PROV; PARCEL : 13927302 INE: REF NO:
j Certified copy is ereby furnished. Ek Certified copy is Cl' with the city Saadi .Divi li . PLANNING NOTES>
>
Date: Q Applicant: •t' I� tiAE, **********************************"*********************************************
EXEMPTION F OM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is .ion: ndred($100)ar less). DEVELOPMENT S' 'EE!R V I C E S REQUIREMENTS
I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any r er so as to become
subject to the Workers'Compensation Laws of California. ZONING APPROVED BY . '
DATE:
Date: Signature: •
NOTICE:If,alter making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : • DATE:
Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. L. . I
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: r DATE: LC) 1 4 `�—Y
which this permit is issued 3097,Civ.C( iF iF*1F*iF*M.*i1.iE**it. 3f.*******ih iF*if+E iF 3E iE iF
LENDER: *******************************************************************************
ADDRESS: LEGALIZATION; N F E E SUMMARY STRUCTURAL SEGMENT:N
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 5 . 25
repair any structure.prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 5 1:1% SMIP/NON—RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500). ISSUE FEE 1 5 . 0 0
I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sate(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS----> 5 . 25 15 , 00 0 . 00 20. 25 20 . 25 . 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/hersell 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 wit have the burden of proving he/she did not build or improve REVENUE DIVISION TOTAL S--> COLLECTED; 20 . 25 OVER/SHORT: . 00
for the purpose ot sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 20 . 25
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to the Contraclors'State License Law).l am aware ,N,*,**,*,*,xK,**,***,***,*,*,******,*****,******,*** x,**,* ****,*******,****N*********************
that proof of their Worker's Compensation insurance should be provided to me. IND I V IDUAL F E E $ R EAKDOWN
❑ I am exempt under Section: B.&P.C.
tor nis naso": TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: Owner' ELE 1 FIXTURES, LIGHTING 1 ST 20 EA. . 75 • . 75
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505.25533.and ELE 5 RECEP T/OUTLET 1 S T 2 0 EA. . 75 3 7 5
25534 and that I or any future building occupant will/will not(circle one)need to comply with said stale codes and the requirements for a
permit for construction or modification from the Air Quality Management District,Residential construction applications are exempt from ELE 1 RECEPT/SWITCH END 10 STF 20 20S EA. . 75 . 75
these provisions.
Dale: Applicant:
I hereby certify that I have read this application and state that thr t trye information is correct.I agree to comply with all city and county
ordinances and state laws relating to building construction and he•r authorize representatives of this city to enter upon the above-,entioned
property for span purposes. ! 01 00148919-00148919 TOT 20.25
Date: (b)I( /fv3 Signature: I i - a. ..
DATE: 10/15/93 TIflE: 15:46
•—/B Driver's License or Social Security+: £ /
1641.46 Whue—Building:Green—Code Enlorcemenr,Canary—Applicant:Pink—Revenue:Goldenrod—Assessor
CONSTRUCTION AND PLANNING POt SPA
APPROVALS Permitr _ 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-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 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 9 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 OGas ❑Oil
•
23. Gas PiPe-Rough & Test t 72. Underground Flush
24. Roof Framing - • 73. Undergrnd.Storage Tank O Gas O Oil
25. Roof Sheathing - 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. FOOD CERTIFICATE ISSUED
33. Final Electric /3 alNotes:
-34. Final Heating& Air Conditioning
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. Backflow Preventer
43. Backflow Irrigation
4
44. Landscape Irrigation System..
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING - -
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
$1295 k EE RECEIVED
•
COSTA MESA BUILDING-SAFETY DEPARTMENT JAN 211960 iv
P.O.BOX 317 COSTA MESA. CALIFORNIA FINANCE DEPT.
• CITY OF COSTA MESA
FOR APPLICANT TO FILL IN COMPLETELY APPLICATION FOR PERMIT
• TYPE OR PRINT BUILDING
:. BUILDING
ADDRESS 1693 Samar Drive FOR MESA. CALIFORNIA FOR OFFICE USE ONLY
OWNER Kenkol Development Co . , Inc I RECEIPT NO. law"MITf1,0.
MAIL 1555 Placentia RECEIVEQ BY DATE RECEIVED( TIIOATTE ISSUED
ADDRESS _ •6"1}_ / '-o� �_V 4 �AN 2 7 74Cn
CITY Newport Beach TEL
6-3227 ABUILDING
DDRESS
• ARCHITECT LIC. I
. OR ENGINEER NO. COSTA MESA. CALIFORNIA
ADDRESS •
Zii 1T�1
ZOO FIRE NE TYPE .V GROUP �1T 4 Jur
CONTRACTOR K.W, Koll CTNTo. 61195 APPROVED
BY DATE
• 15$ Placentia
' ADDRESS Newport Beach. Califf( U ZONING•
�]f�
LEGAL LOT ZONE NO.OF USE OF NEW/C�a ,�
j DESCRIPTION I NO. 10 I BLOCK I ib"TRACT rat ' I PLANS �I'BUILDING .-v_/ /� L
APPROVED, �� J1 ( (/��DATE I�u�/ / -�6LJ/0
SIZE 77 'X100' irreg I NO.OF SLOGS. 0 YARDS ` / EVES // �/
OF LOT NOW ON LOT REQUIRED ALLOWED
USE OF none (CENTER LINE ST.) _
EXISTING BLDG. FRONT I`) OFT. IN.
SETBACK LINE FROM 501 23 '
CENTER OF STREET REAR YARD R.SIDE '. FT. IN.
I5 ' 5'' I 5
; SIDE YARD LEFT RIGHT J L.SIDE 0 FT. IN.
DESCRIPTION OF WORK
REAR 3 FT. IN.
' NEW I X II ALTERATION I II ADDITION I
REPAIR I II MOVING I II DEMOLISH I
. SIZE
BUILDING 1800 $ ,f'RROOMS OST,QRIES 1
EXTERIOVERINORG WpJ`m uCCO ICROVEF RING
OOShakes
C
. USE OF BUILDING AND WORK TO BE PERFORMED
Single-Family Residence
and Attached Garage
•
I HEREBY ACKNO. . . E THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE T THE BOVE IS CORRECT AND AGREE TO COM-
PLY WITH A CITY OR•INANCES O STATE WS REGULATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
L BUILDING C•NST- CTI• . I VALUATION
SIGNATURE •F \ PERMIT FEE $ 1. •
PERMITTEE _ I• • A ..�. $ //' .3 J' o�
----'`� S PLAN CHECK $ // ---
AUTHORIZED AGENT TOTAL FEE S ST•i