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Home My WebLink About1653 SAMAR PL - Building Permits -;?..1 ' Y CITY OF COSTA MESA , ,r BUILDING DIVISION >�/ DEVELOPMENT SERVICES DEPARTMENT ) PERMIT NUMBER 4q PERMIT �I�I D • "�o�' �2-00520 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 1653 SAMAR PL Status: ISSUED Suite No Applied: 08/13/2002 Issued: 08/13/2002 Vicinity: Parcel Nunmber: 13928127 ISSUED BY: - • Applicant: RUSSELL, JEFFREY Address: 1653 SAMAR PL Phone: 714-751-5672 COSTA MESA,CA Zip: 92626 . Owner: RUSSELL, JEFFREY , Address 1653 SAMAR PL , Phone: COSTA MESA,CA Zip: 92626 Contractor: OWNER-BUILDER • . Address: Phone: Zip: License: 0 Arch / Eng: Address: Ph• one: • Zip: License: . SCOPE OF PERMIT PLUMBING TO INCLUDE: 1 BATHTUB, 1 SEWER PRIVATE LINE, 1 SHOWER, 1 WASTE&VENT . SYSTEM, 1 WATER CLOSET,AND 1 WATER PIPING.REF.: 902-00976 • FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation •- $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $9.80 1 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00. 0 Vacuum Brkr Bkflow(1-4) .$0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors _ $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo . $0.00 0 Wash Basin Set $0.00 0 Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $9.80 1 Drain, Rainwater $0.00 0 Sewer Private Line $24.65 1 Water Closet(Toilet) $9.80 1 Drain,Roof $0.00 0 Shower • $9.80 1 Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Ins(or Rep.) $9.80 1 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink,Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $0.00 0 Sink, kitchen $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 , TOTAL CALCULATED FEES: $97.15 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related( regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended r ndoned 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) 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. O 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: Cartier: Policy Number: (Thisct/on need not be completed It the permit is valued at one hundred dollars($100)or less.) I certify that in the performance of the w rk 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 lifomia,and a r that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these prove 1, 1 ' o Applicant Signature: _/�,r( Nw�l�"� Date: - I ��dZ� WARNING:FAILURE TO SECURE W ERS' PENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER 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 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.Lie.# Class# Contractors Signature: Date: 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: 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 sub' cts the applicant to a civil penalty of not more than five hundred dollars($500).): LE 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 e Law does not apply to an owner of properly who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuan to the sLicense Laws.). •: ❑ I am exempt unc. • Business and Professions Code for this reason: Signature: iris! Date: k - 11, - Q L Owner ID verified by driver li 'nse. \ 1t Yes 0 No Drivers License No. Expires: 's /T i CIS Verification of Ownership by(type of docum=' i.e.-property tax bill or deed): t DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: 9 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: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes 0 N (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 II an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ppermit for such construction or modification from the South Coast Air Duality Management District or from any other air pollution control district or agency? Yes LJ No (Section 65850.2 of the Califomia 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 stetg�aws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-describ operty for inspectio p rposes.I agree not to occupy or allow occupancy of any building authorized by t is perms until final inspection. iD -tura 01 Legal Owner(s) Date And/Or Authorized Applicant Date YODE I INSPECTION TYPE PATE INTTTIAL$ CODES INSPECTION TYPE PE INTRgLg 1616 Fixed System Final Fire Prevention 206 Final Mechanical � 1266 Pool Spa Final 206 Final Plumbing a -2 CI -c,f CW 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 CITY OF COSTA MESA r- ,. : BUILDING DIVISION F • :.1,1.1 ''.1, , I DEVELOPMENT SERVICES DEPARTMENT I 0� PERMIT NUMBER !i PERMIT k ) e 602-00976 %`^won w+44. / (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 1653 SAMAR PL Status: ISSUED Suite: Applied: 06/28/2002 Vicinity: Issued: 08/13/2002 Parcel Number: 13928127 Zoning: R1 R1 Applicant: RUSSELL, JEFFREY ISSUED BY: Address: 1653 SAMAR PL Phone: 714-751-5672 COSTA MESA,CA Zip: 92626 Owner: RUSSELL, JEFFREY Address 1653 SAMAR PL Phone: COSTA MESA,CA Zip: 92626 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 0 Arch': RIVER, COLLEEN - Eng: Address: 2904 ANDROS ST Address: Phone: 714-979-3904 Phone: COSTA MESA,CA Zip: 92626 License: C23579 License: SCOPE OF PERMIT CONSTRUCT 489 SF ADDITION TO AN EXISTING SINGLE-STORY SFD.WORK TO INCLUDE EXPANSION OF EXISTING ROOMS:DEN,BATHROOM,REAR BEDROOM AND MASTER BEDROOM;A NEW MASTER BATHROOM WILL BE ADDED.A 169 SF PORCH AT THE FRONT AND A 26 SF ENTRY COVER WILL BE ADDED AT THE REAR OF THE DWELLING.ALSO INCLUDES FRAMING NEW ROOF OVER EXISTING ROOF AND REPLACING SOME OF THE EXISTING WINDOWS. FEE SUMMARY Plan Check: $450.29 Calc Valuation: $56,952.90 Permit: $692.75 Claim Valuation: $0.00 SMIP Res: $5.70 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $1,148.74 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 20-0 Rear 25-0 Left 5-0 Right 5-4 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 4 Required: 4 Proposed: 0 NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related, regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or aban 'ni d for a period of 180 days. f` 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 In WORKERS'COMPENSATION DECLARATION: I hereby of rrn unde:.r,enalty 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 ction need not be completed if the permit is valued et 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,an ree that if I should become subject to the workers'compensation provisions of Section 300 of th Labor Code,I shall forthwith compply with these isions. Appy SSi nater eW —R -Rt Demote:: ' WARNING:FAILURE TO SECUR O COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL P TIES D OWL 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 DE,I EREST,AND ATTORNEY'S 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.4 Class 4 Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that hear she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subj is the applicant to a civil penalty of not more than five hundred dollars($500).): V 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 contr tors 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 put ua to e Contractors License Laws.). ❑ I am exam.t• r s Business and Professions Code for this reason: Slgnatu : - ate: - IS"OL Ow� Owner ID verified•• .''vers license. '1 Yes 0 No tDrlvers�License�Jo. Eapir�es: ��/L L OS Verification of Ownership by(type of d• men,'.e.-property tax bill or deed):ll DIVISION OF INDUSTRIAL SAFETY 'ERMIT 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? ❑Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LI 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 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 I s and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described prope for inspection u es.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. CIn n igri r Legal Owner(s) 1"Dater[- x ads And/Or Authorized Applicant Date CODE II 1ISPECTIONTYPE QAIE 1NRTlAL$ LODE! INSPECTION MC RATE gam$ 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 Y� 204 Final Demolition 250 Final Building/Occupancy Z,' '1 jOS t . I ® 1 CITY OF COSTA MESA ggqggg BUILDING DIVISION F •-11-""7" , a) DEVELOPMENT SERVICES DEPARTMENT 1 p PERMIT NUMBER 4. done PERMIT �\�o l IV// M02-00363 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT , ' Job Address: 1653 SAMAR PL Status: ISSUED Suite No Applied: 08/13/2002 Issued: 08/13/2002 Vicinity: Parcel Number: 13928127 ISSUED BY: Applicant: RUSSELL, JEFFREY Address: 1653 SAMAR PL Phone: 714-751-5672 COSTA MESA,CA Zip: 92626 Owner: RUSSELL, JEFFREY Address: 1653 SAMAR PL Phone: - COSTA MESA,CA Zip: 92626 Contractor: OWNER-BUILDER Address: Phone: Zip: License:0 SCOPE OF PERMIT MECHANICAL TO INCLUDE: 1 INST FAU>100 K BTU, 1 GAS PIPING AND 1 VENT FAN/SINGLE DUCT.REF.: B02-00976 FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $0.00 0 - -- Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $18.20 1 - 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 $6.15 1 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 - • 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct $7.25 1 - - Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 • Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 ' 15 to 30 hp $0.00 0 Air Handlers< 10000cfm $0.00 • 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee - Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $55.10 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes.and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 _ 2446-46(WOO) 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: Carder: Policy Number: (This section need not be completed it 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 Ca' rnla,and ogrehat if I should become subject to the workers'compensation provisions of Section 37 0 of the Labor Code,I shall forthwith comply with these provisi n . ' `y Applicant Signature: ".J` . `"'`n�-- Date: V ( z1cr2. WARNING:FAILURE TO SECURE WORK RS' ENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE TIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND COLLARE(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm 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.Lk.a Class U Contractors Signature: Date: 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: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Cale:My 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 subje 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,end 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 properly who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant t• Contractors License Laws.). ❑ I am exam• • de v: Business and Professions Code for this reason: Signature: 4 La ( Date: a"...- ' J 02-- Owner ID verified• •IFvers license. A: Yes 0 No Drivers License No. Expires: z(1274 C Verification of Ownership by(type of docum:nt, .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)feel high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa 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 Califomia Health and Safety Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aRermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes L-I No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Arr 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 wit state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-desc b'•property fortion purposes.I agree not to occupy or allow occupancy of any building authorized`b-y this permit until final inspection. Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date coos t INSPECTIONTYPE MTh INTIALS CODED INSPECTION TYPE ^ ME 1616 Fixed System Final Fire Prevention 206 Final Mechanical .Q-223-oD 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 • `oytp 44. CITY OF COSTA MESA -'�^o CALIFORNIA 92628-1200 P.O.BOX 1200 ).v,s..:.. .AT mi 'iO',. JSa DEVELOPMENT SERVICES DEPARTMENT H4y9 �ofPOan 0 9. MINOR MODIFICATION Reference No.: Status: APPROVED Applied Date: 10-16-2002 Approved Date: 10/16/2002 Denied Date: • MINOR MODIFICATION NO.: MM-02-33 Project Address: 1653 SAMAR PL • Suite: Parcel Number: 13928127 Project Applicant: RUSSELL, JEFFREY PROPOSED MINOR MODIFICATION: FOR A 16'6" FRONT SETBACK(20' REQUIRED) FOR AN ADDITION TO AN EXISTING SFD. PROPERTY IS LOCATED ON A CUL DE SAC AND • ADDITION IS NLOCATED WHERE THE PROPERTY LINE CURVES IN CLOSER TO THE RESIDENCE. SEE B02-00976. REQUIRED FINDINGS:Y The improvement will not be materially detrimental to the health, safety and general welfare of persons residing or working within the immediate vicinity of the project or to property and improvements within the neighborhood. • Y The improvement is compatible and enhances the architecture and design of the existing and anticipated development in the vicinity. This includes the site planning, land coverage, landscaping, appearance, scale of structures, open space and any other applicable features relative to a compatible and attractive development. PROJECT PLANNER: BOUWE_W • NOTES: 77 FAIR DRIVE Building Division (714)754-5273 • Code Enforcement (714)754-5623 • Planning Division (714)754-5245 FAX(714)754-4856 • TDD(714)754-5244 CITY OF COSTA MESA /kitmss-. �, P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628-1200 t' t: 'V ' DEVELOPMENT SERVICES DEPARTMENT BUILDING DIVISION NOTICE OF PERMIT EXPIRATION February 11, 2005 Jeffrey & Joan Russell 1653 Samar PI Costa Mesa, CA 92626-3627 PERMIT NUMBER (S): B02-01070, B02-00976, E02-00758, M02-00363, P02-00520 FOR: Demolition & Addition PROJECT ADDRESS: 1653 Samar PI., Costa Mesa This is to advise you that the above permit is about to expire. Per Ed Petros, Chief of Inspections, you have 10 days in which to complete the job and have an approved final inspection. If you do not complete work and have an approved final inspection, your permits will expire on February 28, 2005. Additional fees will be required to finalize expired permits. If you have any questions, please contact the Building Division at 714-754-5273, between 8:00 a.m. and 4:30 p.m., and a staff member will assist you. We appreciate your working with us to resolve this matter. Sincer- y, (i fir'/ Ma • Jane Weidenkeller Office Specialist II Building Division(714)754-5273 • Code Enforcement(714)754-5623 • Planning Division(714)754-5245 FAX(714)754-4856 • TDD(714)754-5244 • vmrw.ci.costa-mesa.ca.us .. ., _ .,....n` ,. trotOF COSTA ma I P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92028-1200 • -1 DEVELOPMENT SERVICES DEPARTMENT il BUILDING DIVISION EXTENSION NOTIFICATION 1 \' November 24, 2004 :- :?Tcf . 7 c-• Jeffrey & Joan Russell (-'- 1653 Samar PI S'2.1.ti p,- rs ;r; ':Si IH t.l!G.G,-. o+ �• I Y} Costa Mesa, CA 92626 : - " PERMIT NUMBER (5): 802-01070, B02-00976, E02-00758, M02-00363, P02-00520 FOR: Addition PROJECT ADDRESS: 1653 Samar PI., Costa Mesa This is to advise you upon payment of 'A the original permit fees the above permits will be extended by 60 days per Ed Petros, Chief of Inspections. The job must be completed, inspected and receive final approval by this date or your permits will expire. Additional fees .al k- . ,; f., final; roa pc!-mil- If may; ...._ . .........__ 'fir'. r`'..... If you have any questions, please contact the Building Division at 714-754-5273, between 8:00 a.m. and 4:30 p.m., and a staff member will he happy to assist you. We appreciate your working with us to resolve this matter. Sincerely, L._.._,-1�y0tr it, I�� ill' 1 Mar�Jane Weidenkeller Office Specialist II _ r.- 1,271. . rr:,% i _ . - :a!i' : �' /. !` L ? . _ . >I_C.1t i;-1,q? i i ., .719 2 � �(� Pw � '• Rnildinn fLr.icinn 17141).14.5973 • rnrlc Pninrr✓mcni(7141 7c.1-..Ari . Planninn flidcinn(7141 754_5J45 JEFFREY AND JOAN RUSSELL 1653 Samar Place Costa Mesa, CA 92626 (714) 751-5672 November 10, 2004 Mr. Ed Petros Chief of Inspection CITY OF COSTA MESA 77 Fair Drive Costa Mesa, CA 92628 Re: ZP„e tsB02s01:070,-802-00976,—E02-00758;M02-00363;102=00520 .� Demolition, Addition and Remodel 1653 Samar Place, Costa Mesa, CA Dear Mr. Petros: We are in receipt of Mary Jane Weidenkeller's letter regarding the above permits. Please be advised that we are requesting a thirty (30) day extension for our final inspection. During the time of this remodel, my husband, Jeffrey, was having severe physical difficulties with his cervical spine, tingling and numbness in his limbs and actually, falling due to the pinched nerves in his legs. He endured it until the doctors finally said that's it: surgery. His surgery didn't go as planned, he had tremendous complications, not the least of which was a severe staff infection acquired while in surgery. They didn't discover that particular problem until he had been in the hospital for about a month, and didn't know if he was going to survive. They had to completely re-open his surgical site to remove the massive amount of infection, placed him on antibiotics via an intravenous pic line, and he was on the mega doses of antibiotics for at least two months after that. Needless to say, he has struggled for a very long time just to function and is only now beginning to feel human again, although his spine will never be what it was. Because of this, we request the extension of time for our final walk-through and thank you in advance for your understanding and cooperation in working with us on this issue. As I'm sure you are aware, our house has I • been inspected completely and we only await final. Jeff would like an opportunity to put in some light bulbs in the ceiling and close up some receptacles, so we will have a successful walk-through. We will await a response from you regarding this letter. Can someone let us know if the extension will be granted by November 16? We want to avoid any penalties, especially since the additional medical expenses incurred from Jeff s complications (even with insurance) were quite high and we hope to avoid further financial debt. Very truly yours,ou QQvL /C&44tL.L Joan Russell IN . CITY OF COSTA MESA BUILDING DIVISION i f •____ DEVELOPMENT SERVICES DEPARTMENT A0 PERMIT UMBER 0 p� PERMIT �` E -00758 se (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1653 SAMAR PL Status: ISSUED Suite No Applied: 08/13/2002 Vicinity: Issued: 08/13/2002 Parcel Nunmber: 13928127 Applicant: RUSSELL, JEFFREY ISSUED BY: Address: 1653 SAMAR PL Phone: 714-751-5672 . COSTA MESA,CA Zip: 92626 • Owner RUSSELL, JEFFREY Address 1653 SAMAR PL Phone: • COSTA MESA,CA Zip: 92626 Contractor: OWNER-BUILDER Address: Phone: • Zip: License: 0 SCOPE OF PERMIT ELECTRICAL TO INCLUDE: 15 OUTLETS AND 6 SWITCHES. REF.: B02-00976 . FEE SUMMARY Quantity . Quantity ISSUE FEE $23.50 - Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res.a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0 Lighting Fixts $0.00 0 up to 50 kva/kw $0.00 0 Recept Outlets $16.50 15 up to 100 kva/kw $0.00 0 Switches $6.60 6 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 0 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 •0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1 hp $0.00 0 • Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 . 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $46.60 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 / 244648(6/00) DECLARATIONS ., WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This action need not be completed if the permit is valued at one hundred dollars($100)or less.) pf 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 a that it I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pr Ions. Q l Applicant Signature: 4_ Date: 6 - 17— �— WARNING:FAILURE TO SECURE RKE ENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML RNES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN AoDMON 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 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.# Class it Contractor's Signature: Date: 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: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subj s 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 Con ctors License Laws.). ❑ I am exe ,• nder sec. gliblib Business and Professions Code for this reason: Signature: _ _L JIB � Expires: S//77 OS Verification of Ownership by(type of docume 1.:.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CE•TIFICATION: ❑ 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,Op 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 hes e permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application 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 0 No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health end 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 certifyunder penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Ma r lc and Fmissi, Signature: cella..V 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 co ly with all stat s and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described pro for inspection u oses.I agree not to occupy or allow occupancy of any building authorized by this rmit until fin inspection. T. / 0 2 n (u�0 Legal Owner(s) Da111eee And/Or Authorized Applicant Date CODE t INSPECTION TYPE PEE INTI'RALS CODE f INSPECTION TYPE DAIS (MAW 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 5- 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 p f CITY OF COSTA MESA 4 BUILDING DIVISION Y • ,,,r ,1 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER M t .,._..7. I PERMIT N' � B02-01070 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 1653 SAMAR PL • Status: ISSUED Suite: Applied: 07/15/2002 Vicinity: - Issued: 07/15/2002 Parcel Number 13928127 Zoning: R1 R1 Applicant: RUSSELL, JEFFREY ISSUED SY: __ E2F_ Address: 1653 SAMAR PL Phone: 714-751-5672 COSTA MESA,CA Zip: 92626 • _ Owner: RUSSELL, JEFFREY ' Address - 1653 SAMAR PL Phone: _ . , COSTA MESA,CA Zip: 92626 Contractor: - , Address: . Phone: Zip: ' , License: Arch : - Eng: , Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT _, ' MISC.DEMOLITION FOR FUTURE ADDITION AND REMODEL. INTERIOR DEMOLITION AND REMOVAL OF METAL PATIO AWNING AND CONCRETE SLAB AND PLANTER BOX IN FRONT OF STRUCTURE. STRUCTURE TO REMAIN WEATHER RESISTANT. REF:B02-00976. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $Soo.od Permit: $23.50 Claim Valuation: $500.00 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: _ $0.00 • Total: $24.00 . - ' 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 4 NOTES: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 • 2446-46(6/00) DECLARATIONS ( ) Fl . 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 3Z®of the Labor Code,for the performance of the work for which this permit is issued. My workers'comps psatin/p Insurance rrier and policy number are: - ' 6 Carrier: C y;I/_�-�,�',� Policy Number: Of a (This section need not be completed if this valued at one hundred dollars($100)or less.) . ertify that in the p:'o 'ance of the work • which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' mpensation laws.f Cali.mia,and agre: : if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these prevision . Applicant Signature: _•_I ..a. _ - 0 Date: '7 — I .] O1----- WARNING:FAILURE TO SECURE W 41 RS'or.: ' NSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND OVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(swam),IN.'•TION TO THE MCT OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DEC •-ATION: I hereby affirm that 1 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.# Class# Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subje 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.). O 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 pursu nt to the Contractor ikense Laws.). ❑ I am exempt un r sec. 8(us71ness and Professions Code for this reason: Signature: 1, _ . .✓r k 1 Y Date: -1 / 5 —.0 Owner ID verified by ri is lice e. : -es ❑No Driver's License No. Expires: Verification of Ownershi (type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). O As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Duality Management District or from any other air pollution control district or agency? 0 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). k ❑Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 6 Yes El No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Duality 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 ❑No (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 end city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE CATe Oo COMPUANCE with a AND AUTHOR aws TION certifytounder penalty tr ocf perjury that I have readrethis applicationesfthands that the information toergivenn is correct. I agree to corn 1 with all state laws and i ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described pro rty 'nspection purposes.I a ee not to occupy o allow occupancy of any building authorizeddbby this pe>1 until final'nl spection. • Sign tura e I O er(s) Date An Authorized Applicant Date copE# INSPECTION TYPE DAJI INTITIALS CODE# INSPECTION TYPE QM errnuiS 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 ''1�Yr_ 222 Final Site 204 Final Demolition 2' 250 Final Building/Occupancy 'N OWNER WHITE, P. J. DATE 2-2t5-b7 rJOB ADDRESS 1653 Samar Place BUILDING PERMIT NO. 26739 ,S GENERAL CONTRACTOR Kool Metal DESCRIPTION OF WORK Add Patio roof t An No. 139-2$l-23 LOT TRACT FIRE ZONE VALUE $ 300.00 ECTIONSSignature Date GROUP J TYPE ZONE R-1 Sou PERMITS ISSUED Gas SUBCONTRACTOR I Date � Number Signature C Water Plumbing Rough Plumbing _ Prop. Swr. Line 0 House Con. 0 Sprinkling System Miscellaneous _ Rough Heating and Air Conditioning _ Temporary Service or Pole Underground 0 Power C _ Rough Wiring Heating and Vent. Trenches O Forms i7 Steel Reinf. ❑ Floor System Bond Beam 0 Steel Reinforce 0 _ Sheathing _ Frame and Flashing Lathing— In ❑ Out O _ Plaster, Brown Coat ural, Final Electric I_ .ng, Vent., Refrig. and A.C., Final Plumbing, Final and Gas Test 0 Electric, Final Building, Final ad -27-67 n 4. i I* PAID - .c.. Y . . 2137414. FEB 2b-ul�NSA001029 z .- *3.00 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 - - For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING Bu1LDINa{{ y�`I For Office Use Only ADDRESS 1L53 SN ` IAC. RL • RECEIPT NO. �ryN�739 ^�C/OS^T�`A MESA, CALIFORNIA DATE n j1/� //7 ^/�llJa(/�/�§IJI'JCVY 1 v V . Wk I I L.. R[CIIViD BY /7 - -e/ �`�TE�A!) B2� D OWNER /hG.Y/` / L y/'/� MAIL I / SI SQM AIL �. ADDRESS /d 53 p irn-Q/d� .(11�U ADDRESS^� l0 .cl T ern, \NEIN 11Gbh TEL. NO. ZONE TYPElir GROUP 4/ ARCHITECT TEL BYPROVED /��ffaAT `l z G�? OR ENGINEER NO. / E` O ZONING ADDRESS =Qu�{ NO.or /� USE OF NEW / # - / V / I PLANS 1 I BUILDING / �� CONTRACTOR ^OO L r�E//-fers C.. ,yr/�1 ��JJ '�// }��[/��Q/ /� ADDRESS � 2 70 6E-AC-in ,, r-(V nI LEGALLIRION '. /0, v 4/g/ J/T/ os U y CITY 1.--0/0 s L-TAC-V1 A.P.NO. /0/ - al/ - V' 7 '1 p.�/ NOTE: NO[AVE OVERHANG SHALL BE LESS THAN STATE �I l I p I NO. 80-TO SIDE a REAR P.L LIC.NO. l EAVES SIZE I NO.OF BLDG'. ALLOWED (U.B.C.REQUIREMENT) OF LOT I NOW ON LOT YARDS APPROVED YARDS APPROVED USE OF YST S MAIN BUILDING ACCESSORY BU ILDING EXISTING BLDG. F (FROM C/L STREET) SETBACK LINE FROM FRONT FT. hl]TFT. CENTER OF STREET REAR YARD SIDE YARD I LEFT I RIGHT R.SIDE PT. a(' FT. DESCRIPTION OF WORK L.SIDE FT. aO/FT. 111 • NEW ALTERATION ADDITION REAR PT. FT. DISTANCE BET. BET.MAIN B REPAIR MOVING �QHMQLISn MAIN SLOGS. ACCESS.BLOCS. BUILDING ( f NO.OF VAR.S DATE SIZE �Q 16 ROOMS STORIES C.U.P.#' APPROVED EXTERIOR WALL ROOF ALL) APPROVED /� ) �J �J Q / �/ COVERING COVERING ALoM BY l/GG� DATE ,!%Jl0 '�i / USE OF BUILDING AND WORK TO BE PERFORMED P. T I°'x )b' RI T to an 2ec Qe t.- 1SQ.PT. 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE j AND ST AND STATE THAT THE ABOVE IS T AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT PEE ONLY. ,F?y6 PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION / BUILDING CONSTRUCTION.r / t (} PERMIT FEE $ •C:775 PI Pfi MATTES OF T G 11 1 Q o `' � f Jo PLAN CHECK S -- I" AUTHORIZED AGENT , /��Y_V�p-- Q J{y. TOTAL FEE S 65 U U . 'CT ;?EC NED "' 10935 COSTA MESA BUILDING-SAFETY DEPARTMENT FINANCE DEPT. P.O.BOX 317 COSTA MESA. CALIFORNIA - CITY OF COSTA MESA FOR APPLICANT TO FILL IN COMPLETELY APPLICATION FOR PERMIT. TYPE OR PRINT BUILDING BUILDING ADDRESS 1653 Samar Place • COSTA MESA, CALIFORNIA FOR OFFICE USE ONLY _ RECEIPT NO. �f.�dl��_,ERM( N`O ` OWNER Glenverde Homes, Inc. I MAIL Box 65 RECEI D BY I DAT REC/Fi IVSD NOVTE ISSUED ADDRESS - ././9115 112, 3 1959 CITY Balboa Island,Cali£. TNo0r3-4220 BUILDING _ ADDRESS ARCHITECT LIC. COSTA MESA. CALIFORNIA OR ENGINEER NO. ADDRESS FIRE / Lv Y ZONE TYPE V GROUP ry }�I�� STATE APPROVED • CONTRACTOR 1"lnCCO Corps LIC.No. 98808 BY DATE ADDRESS BOX 65, Balboa Island,Calif. sland,Calif. ZONING 7r1 [/ �" el LEGAL LOT 104 (TRACT34V7ZOry/ 7 NO.OF PLAN51�IUBSUELODFINNGEW [ Jr.-- DESCRIPTION ( DESCRIP ION I NO. BLOCKJ- A.P.NO. APPROVED (id,,Z_ DATE I `0 SIZE 7n00 I NNOOW.OOFNBLLDOGTS.O YARDS / OF LOT 1RED A USE OF • (CENTER LINE ST.) 2.-y. EXISTING BLDG. FRONT J t FT. IN. SETBACK LINE FROM CENTER OF STREET O _ REAR YARD 31 R.SIDE /C FT. IN. •SIDE YARD (LEFT 5 ( RIGHT 15 L.SIDE `7 FT. • IN. DESCRIPTION OF WORK �, REAR -2-1 /FT. IN. NEW I XI ALTERATION I II ADDITION REPAIR I I MOVING I p V DEMOLISH I S ZIE DING 1504/1.30 ROOMS 8 STORIES 1 EXTERIOR W TALL-COO I COVERING rock COVERING teti USE OF BUILDING AND WORK TO BE PERFORMED ) 7/�� residence !i(/ ,/(t I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. BUILDING CONSTRUCTION.iO� ni�n HOMES, INC. VALUATION SIGNAT RE OF - LENvERWE HOMES, NPERMIT FEE SL36 PER / - $,(�./�J�� PLAN CHECK S`7�a AU ‘1"*".. .rte ,v i�'/ TOTAL FEE $l,}