HomeMy WebLinkAbout1700 SAMAR DR - Building Permits • p CITY OF COSTA MESA
:. ►, BUILDING DIVISION
FI.J ..�1 r:. DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
flPERMIT
•
fid'° B04- 486
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 1700 SAMAR DR Status: ISSUED
Suite: Applied: 08/23/2004
Vicinity: ROOF Issued: 08/23/2004
Parcel Number: 13927131 Zoning: R1 R1
ISSUED BY:
Applicant: DAMON MONTGOMERY
Address: 1001 APPLING AV
Phone: 714-577-0457
PLACENTIA,CA Zip: 92870
Owner: HOLMES, JEFFREY G
Address 1700 SAMAR DR •
Phone:
COSTA MESA,CA Zip: 92626
Contractor DAMON ROOFING INC
Address: 1001 APPLING AV
Phone: 714-577-0457
PLACENTIA,CA
Zip: 92870 License: 420695
Arch : - Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
TEAR OFF EXISTING ROOF. INSTALL 30#FELT,30 YEAR TIMBERLINE COMPOSITION SHINGLES,REPAIR/REPLACE SHEATHING AS
NEEDED.30 SQUARES INCLUDES ATTACHED GARAGE.
FEE SUMMARY
Plan Check: $0.00 i Calc Valuation: $8,500.00
Permit: $167.25 Claim Valuation: $8,500.00
SMIP Res: $0.85
SMIP Com: $0.00 ,
Other: $0.00
• Inspection: $0.00 -
Total: $168.10
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
•
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: - • ff s.
❑ 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
Fr rk for which this permit is Issued.
,• I'have and will maintain workers'compensation irance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued.
r_ My.workers' mpensation Insuranc ardor an policy number are: .. ['
Carder: � . � (f ti PolicyyN ainb°er: 7 I�/ ) Co�— 2C>O�/
(Thls.sectlon 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'
compensatlo w forma,and agree that If I sho d become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
m p ese.provislo ''1/�j/J r 2—3 — o V
Applicant Signeturey; -• / _ i df/ krt.
WARM 'FAILUREbTOSECURE WORKERS'COMPENS ION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPIOYER:TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOUARE($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 I: 'by.Nirrn4he ,am,licensed under provision of Chapter 9(commencing with Section 7000)of Division Nt t eLBusiness and Professions Code,and my license is in full
J QyppiCJeffecL^,Lic q Y Z V Co• S Class N s C— 3 c
:Contractors Signature "'C>.�� A7-6n ! .r* S —2 5—a ye
—
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 Ucense Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Cade)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).):
O 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 ❑No
(Section 25505 of the California Health and Safety Code requires,with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
' 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No
5— Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes Ul No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No
(if yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have at of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 9 Yes ❑No
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
. Si � 2-ate 3
-� , o r'
.. And/Gr Authtr rized"Applicant ., . 7-311,767.
__._
CODE f INSPEC110N TYPE - PATE 1NTT ALS g00€t INSPECTION TYPE DEE INTmAIA
1816 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final �L 208 Final Plumbing
200 Final Re-Roof '-3k-014 210 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
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
•
CITY 0 COSTA MESA CONSTRUCTION PERMIT PE�MIf NO.-o4 TRACT NO. LOT NO. UNIT NO.
2636 II /20/6L 54e60 • 11
. Groject Address /7o° 554" A2 R. COSTA Iv1SSA /lV,
Applicant's Mailing Address
/7 to SA rs't AR b TYPE OF CONSTRUCTION LI NEW L ADD LI ALTERATION LI REPAIR j _ f
PAIR rC/C 3 N 97q-7T3 El CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# Zone
Owner's Name y/� es Phone aDESCRIPTION OF WORK/USE OF ' DG.
Address /7o O SAm A/; D/2• Cos T/1 PV),Ef Pt i _ - s� • S Main Building: Accessory Building:
a.Arch/Eng. License No. _ TYPE OF PERMIT N GRADING II FOUNDATION m STRUCTURAL E Front o
Address ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear N
Contractor's Name Phone ❑ OTHER A I
///��� PROJECT DESCRIPTION SQ. FT)C 3 40 OCCUPANC ' K Right G
Address(mailing) 1L 30�-D S Left
L CONSTRUCTION TYPE VALUATION$)e- R
City License No. ZONE GRADING CU.YDS. ACRES
LICENSED CONTRACTOR DECLCRATIONPing. Ref.# Parking Req./Provided E
O
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: • Mwith section 7000) of Division 3 of theBusiness and Professions Code, and • T
my license is in full force and effect.
License Class License No. S
Date Signature U �� PLUMBING FEES
WORKERS' COMPENSATION DECLA ATION Bar Sink Showers
1 hereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES
f Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink
BOO, Lab. C.) Automatic Washer Transformer ❑ 5015-50 KWW
rot Cy No. Company Backflow Irrigation Sewer Cap Construction Pole Sub.
❑ 5105-+K
certifietl copy is hereby furnished. •
- Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps
Date Applicant -
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers / Solar Collectors Dishwasher Meter Dover 100 amps
(This section need not be completed if the permit is for one hundred ($100) or
less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel
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 Drinking Fountains t Solar •
Tank - Fan Motors❑0.1 HP ❑114-8
Date s�ompy 05ation Laws a CalifomsB_-ic--'/1�/
Date // ZOO/ r Signature `n, you s�'F [�nc{�+i-v-� Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar ❑9-15 HP ❑16-15+
'NOTIC If,after making this declaration, you shout beco a subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal
comply with such provisions or this permit shall be deemed revoked. ' Fixtures Microwave
CONSTRUCTION LENDING AGENCY. '
• Gas Service Outlets Water Closet Device Boxes
1 hereby affirm that there is a construction lending agency for the performance Pole Light
of the work for which this permit is issued (Section 3097 Civ. C.) I —
nterceptors Water Heater Outlets
Lender's Name Range
Lender's Address Kitchen Si r Water Service Switches Sign
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories \ 1` Illi/ Auto-Wash
following reason (Section 7031.5 Business and Professional Code: Any city or Garbage Disposal ;Standing Sections
countywhich requires a permit to construct,alter,im rove,demolish or repair )
\
undry Trays
any sructure, prior to its issuance, also requires the applicant for such permit - P-TrapGenerator ❑0-5 KW ❑5-15 KW Trash Compactor
-to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains
•the Contractor's License Law (Chapter 9 (commencing with Section 7000) of r
Division 3 of the Business and Professions Code) or that he/she is exempt
•berefrom and the basis for the alleged exemption. Any violation of Section • -
31.5 by any applicant for•a permit subjects the applicant to a civil _ •
salty of not more than five hundred dollars($500). 3
J Las owner of the property or myemployeeswith wages as their sole Reinspection Fee $15 Issue Fee $
compensation, will do the work,and the structure is not intended or offered - Reinspection Fee I $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's ' MECHANICAL FEES
License Law does not apply to an owner of a property who builds or improves - 1
thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I ❑
sale. If, however, the building or improvement is sold within one year of com- Canopy Type II ❑ Zoning Approved By Date
pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under GroundBuilding Approved By Date
prove for the purpose of sale). / p
El I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By J ,/� 4Date 31.
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑o-100,000 BTU ❑100,000 BTU SU l)RV OF FEES
builds or improves thereon, and who contracts for such projects with a con-
tractors) 1lcense pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple❑ System Repair/Alteration BUILDING PERMIT $ ct.c�0 SMTP $ , St
proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT
` Date / Q1t� owner `i�7�1i� �T ._� Heating
0 I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers_gma PLUMBING $ ISSUANCE $
,�/\ , System& Ducting Registers PLAN CHECK 25% $
ENERGY P.C. $
I hereby certify that I have read this application and stat- that the above 00-100,000 BTU 0100.000 BTL GRADING $
Information is correct. I agree to comply with all city and county ordinances ELECTRICAL $
and state laws relating to building construction, and hereby authorize repre- PLAN CHECK 50% $ MICROFILM $
•
sentatives of this city to enter upon the above-mentioned p opert for
inspection ion p -� �. /2_00,5- MECHANICAL $ TOTAL FEE $ b`-l•St
Signature
-- Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
`'MF 0865-46,rev. 10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod -Assessor .
f
CONSTRUCTION AND PLANNING - POOI PA .
Date Inspector - Date Inspector
••APPROVALS - Permit# . APPROVALS ' Permit#
'\. Temporary Electrical service or Pole .. • -• 52. Pool & Equipthent q pment 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'Conduif-Undrgrnd. . _
- 8' FoundaIion59. Gas Pipe, O Undrgrnd., Test •
_9. Water Pipe-Undrgrnd. . 60. Backwash Lines, P-Trap, 0 Undrgrnd. •
' 10. Structural Floor System . ' 61. APPROVAL TO DECK -
11. Property Sewer Line & House Connectign - 62, Backwash & Receptor-Final
- 12. Sewer Cap 63. Heater & Vent-Final -
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing - - 65.. Electrical-Final.
215. Rough Electrical-Conduit - - 66. Solar System-Final. - .
16.) Rough Electric Wiring - 67. Fencing & Access Approval
17.' Rough Wiring Sign • • 68. APPROVED FOR PLASTERING
• 18.E Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning - FIRE DEPT. REQUIREMENT .
- - 20. Rough Factory Fireplace APPROVALS- .Permit#
21. Ducts, in Structure 70.',,Underground Hydro
22. Ducts, Ventilating - '71. Product Piping 0 Gas 0 Oil ,
"23. Gas Pipe-Rough &Test • 72.`,Underground Flush
24. Roof Framing 73. 'dndergrnd.Storage Tank 0 Gas 0 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 HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat • 79. FINAL INSPECTION .
32.E Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
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 Prevedter
43. Backflow Irrigation •
44. Landscape Irrigation System '
45. Sound Attenuation • .
46. Handicap Regulations , _ I '
47. FINAL STRUCTURE & BUILDING - -
48. Special Requirements Completed .
49. Electric Releaseto Edison' - - -
•50. Gas Release to Southern California Gas Co • -
51. CERTIFICATE OF OCCUPANCY - - _ - •
No. - Date
11299 EE RECEIVED
•
COSTA MESA BUILDING-SAFETY DEPARTMENT JAN 211960 4 U
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 1700 Samar Drive
ADDRESS
COSTA MESA, CALIFORNIA FOR OFFICE USE ONLY
Kenkol Development Co. , Inc . I RECEIPT NO. ItiP x+q.
OWNER I- J
MAIL 1555 Placentia RECEIIyED BY DATE RECEIVED p, 8$UED
ADDRESS A- ' I /J/"411 IE' .1 1960
MI
CITY Newport Beach TEL. 6-3227 BSG
UI EISN
ARCHITECT LIC.
OR ENGINEER NO. COSTA MESA, CALIFORNIA
FIRE
(((���
ADDRESS .- - ZONE TYPE •�// GROUP ft
K:W. Koll STATE 61195 APPROVED
CONTRACTOR LIC.NO. BY DATE
1555 rlacentia
ADDRESS Newport Beach ZONING ,�/
LEGAL LOT]4 3529 ZONE NO.OF USE OF NEW J -�
DESCRIPTION I NO. I BLOCK I TRACT l I PLANS 2/i/ BUILDING2P. 1 ..
A.P.NO. APPROVED(/
L /r . DATE (/9-/4-0
SIZE 63 .64x95-:56 irregl NO.OF BLDGS.0 YARDS ( EVES
OF LOT NOW ON LOT REQUIRED ALLOWED
USE OF none (CENTER LINE ST.)
EXISTING BLDG. FRONT eV) FT. IN.
SETBACK LINE FROM '
CENTER OF STREET 50 REAR YARD 24 R.SIDE .3 FT. IN.
515'
SIDE YARD I LEFT IRIGHT L.SIDE l- FT. IN.
DESCRIPTION OF WORK REAR ---21/FT. IN. \
NEW I XII ALTERATION I II ADDITION I
REPAIR I II MOVING I II DEMOLISH I
BUILDING 1800 sf NO.OF 7 1
SIZE ROOMS STORIES
EXTERIOR WA
SItuCCo I ROOF Wogging le
COVERING COVERING `
USE OF BUI NG 0= aK n. P*as1 ?nce
and Attached Garage
I HERESY CKNO DGE THAI HAVE READ HIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATEA TMA TH ABOV Ti CORRECT A DT AGREE TO COM-
PLY WITH ALL TY RDINA C S AND STATE WS REGULATING. PURPOSE OF ESTABLISHING A PERMIT FEE ONLY.
BUILDING CON U ION. VALUATION Pi
SIGNATURE OF '^ A PERMIT FEE $ 0S j'
PERMITTEE o J`� VVYI A-�—
�`
V v $ / /93,5-- PLAN CHECK $ /9..--
AUTHORIZED AGENT TOTAL FEE $ /